Abordaje respiratorio del paciente con enfermedad neuromuscular en la unidad de cuidado intensivo pediátrica / Respiratory approach to the patient with neuromuscular disease in the pediatric intensive care unit

En algunas ocasiones, los pacientes con enfermedades neuromusculares infantojuveniles, pueden requerir internación en unidades de cuidados intensivos pediátricos. La principal causa de ingreso hospitalario es la insuficiencia respiratoria aguda, desencadenada por atelectasias y neumonías que, en la mayoría de los casos, tienen su inicio en infecciones del tracto respiratorio superior. Independientemente de su forma de presentación, las enfermedades neuromusculares en periodo infantojuvenil, pueden comprometer en grados distintos a los 3 grupos musculares vinculados a la ventilación pulmonar y protección glótica. Es posible dar asistencia a los músculos inspiratorios y espiratorios con soporte ventilatorio no invasivo y asistencia mecánica de la tos respectivamente. Esta estrategia combinada permite el manejo no invasivo de este tipo de pacientes, logrando extubar o decanular a aquellos considerados potencialmente no destetables con las estrategias clásicas utilizadas en unidades de cuidados intensivos en pediatría. El objetivo de esta revisión es sugerir recomendaciones en cuidados respiratorios no invasivos para pacientes con enfermedades neuromusculares ingresados en unidades de paciente crítico pediátrico. Se presentan 2 casos clínicos ilustrativos, en los cuales estas estrategias fueron utilizadas en forma exitosa.

On some occasions, patients with childhood and adolescent neuromuscular diseases may require hospitalization in pediatric intensive care units. The main cause of hospital admission is acute respiratory failure triggered by atelectasis and pneumonia, which, in most cases, start with upper respiratory tract infections. Regardless of their form of presentation, neuromuscular diseases in children and adolescents can damage the 3 muscle groups linked to pulmonary ventilation and glottic protection to different degrees. Inspiratory and expiratory muscles can be assisted with noninvasive ventilatory support and mechanical cough assist, respectively. This combined strategy allows the non-invasive management of this type of patients, managing to extubate or decannulate those considered potentially unweanable with the classic strategies used in pediatric intensive care units. The aim of this review is present noninvasive respiratory care recommendations for patients with neuromuscular diseases admitted to pediatric intensive critical care unit and illustrated with clinical reports of two patients treated with these strategies successfully.

Latin American Consensus for Pediatric Cardiopulmonary Resuscitation 2017: Latin American Pediatric Critical Care Society Pediatric Cardiopulmonary Resuscitation Committee.

OBJECTIVES: To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. DESIGN: Expert consensus recommendations with Delphi methodology. SETTING: Latin American countries. SUBJECTS: Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. INTERVENTIONS: Delphi methodology for expert consensus. MEASUREMENTS AND MAIN RESULTS: The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. CONCLUSIONS: This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

Evaluación de un brote de leishamaniasis tegumentaria americana en una comunidad rural del Estado Bolívar, Venezuela / Evaluation of an outbreak of American tegumentary leishmaniasis in a rural community in the Bolivar State, Venezuela

La presencia de un foco de leishmaniasis tegumentaria americana (LTA) en la localidad de San José de Hacha, al sur del Estado Bolívar en Venezuela, motivó la realización de un estudio epidemiológico utilizando la intradermorreacción (IDR) de Montenegro. De los 184 habitantes de San José de Hacha, se aplicó la IDR a 121 (65,8 porcento). El 33,9 porcento fueron reactores positives (44/121). El mayor porcentaje de positividad se observó en personas del sexo masculino con 39,5 porcento (P<0,05), y en adultos, principalmente en el grupo etáreo de 31 a 40 años (52,4 porcento) (x² = 16,28; g.l. = 6). Según la ocupación, los trabajadores agrícolas resultaron los más reactivos (69,0 porcento). El 65,9 porcento (27/4 1) de las personas IDR positiva presentaron áreas de reacción entre 5 y 9mm. Se identificaron lesiones activas de LTA en 22 habitantes y cicatrices en sólo siete cases. Se sugiere que San José de Hacha constituye un foco de LTA de reciente instalación