Muerte encefálica: criterios diagnósticos clínicos. Pruebas diagnósticas instrumentales / Brain death: diagnostic clinical criteria: diagnostic instrumental tests

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[Acute respiratory infections in pediatric intensive care units. A multicenter prospective study]. / Infecciones respiratorias agudas en unidades de cuidados intensivos pediátricos. Estudio prospectivo multicéntrico.

OBJECTIVE: The purpose of this study was to know the etiology, clinical background, treatment an evolution of severe infectious diseases in children admitted to Pediatric Intensive Care Units (PICUs). PATIENTS AND METHODS: A multicenter prospective study was carried out. Children with respiratory infections admitted to 10 PICUs throughout Spain between May 1994 and April 1995 were included in a long term survey. The nosocomial infections were not included. Student's t and Wilcoxon tests were used for quantitative variables and Chi square with Yates correction and Fisher's test for the qualitative variables. RESULTS: One hundred twenty-two patients with acute respiratory infections were studied. The mean value on Downes score at admittance was 5.2 +/- 2.3. Diagnosis were allocated as follows: 47 bronchopneumonia (38.5%), 40 bronchiolitis (33%), 15 epiglotitis (12%), 14 laryngitis (11.5%) and "others" 6 (5%). Etiologic agents were identified in 69 cases (56.5%), with respiratory syncytial virus being the most frequently isolated agent (35 cases, 51%), followed by Hemophilus influenzae in 13 cases (19%). The mean PICU stay was 5.8 +/- 7.9 days (1-67 days). Of these cases, 112 (92%) recovered completely and 9 (7%) died (8 with bronchopneumonia and 1 with epiglotitis). A significant association could be seen between the increase in mortality and the variables Downes' score and diagnosis of bronchopneumonia. CONCLUSIONS: The most frequent respiratory infections in the PICU were pneumonia and bronchopneumonia. Viral etiology, with a frequency of 54%, was the main cause of respiratory infection. Bacterial etiology represented 46% of the total cases, with Hemophilus influenzae as the most frequent etiologic agent.

[Foreign-body aspiration]. / Aspiración de cuerpos extraños.

Aspiration of foreign bodies is a common accident during childhood. In its diagnosis, both an accurate clinical history and a high degree of suspicion must be taken into account. Without an early diagnosis and its correct treatment, it remains a major cause of morbidity and mortality in children. The objective was to analyze the incidence, diagnosis and therapy of foreign bodies in the airways in pediatric patients. We have conducted a retrospective study of sixty-four patients admitted to our Pediatric Intensive Care Unit during the last eight years with a suspected diagnosis of a foreign body in the airways. Accordingly, we have evaluated the clinical and epidemiological data, as well as the diagnostic and therapeutic methods used. Half of the patients were under two years of age. Cough was a constant finding in all cases. Most of the cases showed air-trapping in chest X-rays, and in almost all cases a bronchoscopy was needed to remove the foreign body. The aspirated material found was mostly frequently found was a piece of food and it was most commonly placed in the main right bronchus. We underline the importance of prevention to avoid this problem by leaving out of the child's reach dry fruits and other small objects that can be easily introduced into their mouths.