[Treatment of acute poisoning caused by carbamazepine, digoxin, and acetylsalicylic acid, with repeated doses of activated charcoal]. / El tratamiento de las intoxicaciones agudas causadas por carbamazepina, digoxina y ácido acetilsalicílico, mediante la administración de dosis repetidas de carbón activado.

Twelve pediatric patients with acute poisonings caused by carbamazepine, digoxin and acetylsalicylic acid were treated with multiple doses of activated charcoal combined with a saline cathartic (adsorption surface of activated charcoal nearly 950 m2/g). This procedure was effective to shorten the plasmatic levels of the drugs, besides the clinical improvement of the poisoned patients. The average initial and final levels of the drugs were: carbamazepine 21.64 and 0.9 micrograms/ml (lowering 95.81%, p < 0.05), digoxin 5.14 and 1.1 ng/ml (lowering 78.6%, P < 0.05) and acetylsalicylic acid 418.5 and 57.5 micrograms/ml, respectively, (lowering 86.3%, p < 0.05). These results suggest the usefulness of activated charcoal in the clearance of the four overdosed drugs.

[Experience in the use of central venous catheterization via subclavian puncture in a pediatric hospital]. / Experiencia en el uso de la cateterización venosa central por punción subclavia en un hospital pediátrico.

OBJECTIVE: To assess the frequency and type of complications during central venous catheter installation by subclavian puncture, and during its use in children admitted to an ICU. PATIENTS AND METHODS: Patients from one month to 15 years of age, admitted to the Intensive Care Unit of the Hospital de Pediatría Centro Médico Nacional, Siglo XXI, who underwent a percutaneous infraclavicular subclavian puncture for central venous catheter complications were included. Clinical features, diagnosis, complications and indications for the procedure were registered. RESULTS: 92 patients and 102 subclavian punctures were included for analysis. Effectively index was 88.3%. Main diagnosis was infectious diseases in 29.4% and neoplasia in 22.5%. Hemodynamic monitoring was the more frequent indication for the procedure (44%). Of the catheter 45% were successfully installed at first intent. The complication in the installation appear in 11.7%. Was arterial subclavian puncture (6.8%), hematoma (2.9%), without hemodynamic deterioration no any case. The mean time of permanence was 8.8 days. The late complications was present in average 7.3 days, in 18.6% of the cases. Predominance infection in entrance place of catheter. CONCLUSIONS: Installation of venous central catheter by subclavian puncture prove a great utility in our patients, with a few complications and a high effectively. For experimental personal the central venous catheterization by subclavian puncture in pediatric patients to be importance in the first place in critical ill children.

[The treatment of status epilepticus in children]. / Tratamiento del estado epiléptico en niños.

In children the status epilepticus (SE) constitutes a neurological emergency related to a high rate morbi-mortality. The prompt recognition and management are essentially to prevent irreversible neurologic damage. The frequency of SE in emergency rooms and pediatric intensive care units (PICU) is high because of several causes in the group of children less than five years old and particularly in the first year of life. In this paper are analyzed the actual state of drug therapy, general management and prevention of complication to decrease the incidence of severe sequelae in this patients. We suggest a general guide for the pediatrician and intensivist that include monitoring in a PICU for permanent valuation of the patient which result in a better treatment to improve the outcome and survival.

[Prognostic factors in a pediatric intensive care unit]. / Factores pronósticos en una unidad de terapia intensiva pediátrica.

OBJECTIVES: To identify the mortality prognostic factors from a pediatric intensive care unit. STUDY DESIGN: Retrolective cohort study with an analysis of cases and controls (ambidirectional design). PLACE OF STUDY: The intensive care unit at a Pediatric Third Level Hospital. STUDY UNITS: All of the patients admitted into the I.C.U. for a year (August 1989 to August 1990). MAIN MEASUREMENTS: The patients were identified when admitted into I.C.U., while evaluating their clinical course through their charts. Afterwards, they were placed into two groups, those who died while in I.C.U. (n = 49) and those in the control group which constituted the initial cohort survivors (n = 115). The prognostic factors evaluated were age, sex, diagnosis when admitted, organic failure, changes in diagnosis and treatment. MAIN RESULTS: 164 patients were studied, with a slight predominance of the male sex (53%). The patient's age fluctuated between 1 day and 17 years of age, with a mean age of 10 months. The diagnosis established when admitted were predominantly dealing with infectious problems (n = 54, 32%). The most important prognostic factors seen during the bivaried analysis were the peritoneal dialysis (RM = 12.71, IC 95% = 2.41-98.29, P less than 0.01); a Glasgow index less than or equal to 10 points (RM = 7.33, IC 95% = 1.25-47.26, P less than 0.01), respiratory organic failure (RM = 6.32, IC 95% = 2.46-16.8, P less than 0.01) and assisted mechanical ventilation (RM = 5.61, IC 95% = 2.52-12.68, P less than 0.01). CONCLUSIONS: The mortality rate in I.C.U. was 30%. The most important prognostic factors associated to mortality after adjusting for severity were having a cardiovascular ailment, the need to administer blood products, a Glasgow index less than or equal to 10 points, heart and hematologic organic failure and when respiratory mechanical assistance was provided.

[Multiple organ failure syndrome: correlation of mortality and the Modified Criteria for Multiple Organ Failure]. / Síndrome de falla orgánica múltiple: correlación entre la mortalidad y el Criterio Modificado de Falla Orgánica Múltiple.

Seventy-two patients from one month to 15 years of age that according with the Modificated criterion of multiple organ failure (MCMOF) had two or more organ failures were studied. They were divided into two groups: Group I consisted of 55 patients that survived and group II of 17 patients that died. In both groups, the MCMOF was determinated upon admission and discharge, as well as the maximum obtained during the evolution. The comparison of both groups, with respect to the number of organic failures presented and the points of MCMOF showed highly significant differences with p less than 0.001, found in group I: 1.27 +/- 0.96 organ failures and a value of 4.84 +/- 2.92 of the MCMOF and in the group II: 3.84 +/- 1.59 organ failures and 25.68 +/- 7.57 points of the MCMOF respectively. The comparison between the number of organic failures at admission and discharge showed significant differences in both groups, having the tendency to decrease in group I from 1.87 +/- 1.01 to 0.56 +/- 0.60 and in the group II to increase from 3.41 +/- 1.46 to 4.35 +/- 1.45. The same phenomenon was observed for the values of the MCMOF with a qualification of 7.72 +/- 5.36 to 1.87 +/- 1.82 in a group I and from 18.94 +/- 10.31 to 33.38 +/- 8.27 in group II. Spearman correlation coeficient between the number of organic failures and values of the MCMOF showed and r = 0.99 and equivalent p less than 0.001, highly significant.