Paediatric cardiopulmonary resuscitation training program in Latin-America: the RIBEPCI experience.

BACKGROUND: To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. METHODS: A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. Instructors from each country participated in the development of the next group in the following country. Paediatric Basic Life Support (BLS), Paediatric Intermediate (ILS) and Paediatric Advanced (ALS) courses were organized in each country adapted to local characteristics. RESULTS: Five Paediatric Resuscitation groups were created sequentially in Honduras (2), Guatemala, Dominican Republican and Mexico. During 5 years, 6 instructors courses (94 students), 64 Paediatric BLS Courses (1409 students), 29 Paediatrics ILS courses (626 students) and 89 Paediatric ALS courses (1804 students) were given. At the end of the program all five groups are autonomous and organize their own instructor courses. CONCLUSIONS: Training of autonomous Paediatric CPR groups with the collaboration and scientific assessment of an expert group is a good model program to develop Paediatric CPR training in low- and middle income countries. Participation of groups of different countries in the educational activities is an important method to establish a cooperation network.

Validación de un cuestionario para la cuantificación del dolor de espalda en escolares / Validation of a questionnaire for quantification of backache in school children

Objetivo: validar un instrumento de medida fácil, rápido y fiable que permita el acceso a información cuantitativa sobre el dolor de espalda que pueda sufrir la población infantil. Métodos: estudio descriptivo cuantitativo, no experimental, de corte transversal. Participaron 153 escolares (80 niños y 73 niñas) del tercer ciclo de educación primaria y de enseñanza secundaria obligatoria, que contestaron un cuestionario sobre algias de espalda mediante una escala visual analógica. A todos los niños se les tomaron las medidas antropométricas y pesado los utensilios de transporte de material escolar. La fase de validez didáctica y de contenido fue realizada por jueces expertos y la consistencia interna del cuestionario, a de Cronbach, fue elevada (0,809). Resultados: las correlaciones entre los ítems fueron muy significativas (p< 0,001) excepto en un caso (p> 0,05). El índice de la Medida de Adecuación Muestral Kaiser-Meyer-Olkin (p< 0,0001) indicó la posibilidad de realizar un análisis factorial del que pudimos obtener un factor denominado Dolor de Espalda, que explicó el 58,46 por ciento de la varianza total, por lo que resulta un instrumento unidimensional. Conclusiones: el cuestionario creado se muestra como un instrumento válido y fiable para la recogida de información cuantitativa del dolor de espalda en el ámbito del área de educación física relacionada con la salud(AU)

Objective: to validate an easy, rapid and reliable measuring instrument that allows the access to quantitative information about backache that the child population could suffer. Methods: non-experimental, cross-sectional, quantitative and descriptive study in which 153 school children (80 boys and 73 girls) from the third cycle of primary education and secondary education participated. They answered a questionnaire about backache by using a visual analogue scale. All of them were taken their anthropometric measures and their means to carry the school materials. The phase of didactic and contents validation was performed by expert judges whereas the internal consistency of the questionnaire expressed as Cronbach's Alpha was high (0.809). Results: the correlations between the items were very significant (p< 0.001), except in one case (p> 0.05). The rate of the Kaiser-Meyer-Olkin's of Sampling Adequacy Measure (p< 0.0001), indicates the possibility of making a factor analysis from which we can obtain a factor called Backache, explaining 58.46 percent of the total variance, and this instrument finally was one-dimensional. Conclusions: the questionnaire proves to be a valid and reliable instrument for quantitative data collection about backache in the field of health-related physical education area(AU)

Nutritional status and clinical outcome of children on continuous renal replacement therapy: a prospective observational study.

BACKGROUND: No studies on continuous renal replacement therapy (CRRT) have analyzed nutritional status in children. The objective of this study was to assess the association between mortality and nutritional status of children receiving CRRT. METHODS: Prospective observational study to analyze the nutritional status of children receiving CRRT and its association with mortality. The variables recorded were age, weight, sex, diagnosis, albumin, creatinine, urea, uric acid, severity of illness scores, CRRT-related complications, duration of admission to the pediatric intensive care unit, and mortality. RESULTS: The sample comprised 174 critically ill children on CRRT. The median weight of the patients was 10 kg, 35% were under percentile (P) 3, and 56% had a weight/P50 ratio of less than 0.85. Only two patients were above P95. The mean age for patients under P3 was significantly lower than that of the other patients (p = 0.03). The incidence of weight under P3 was greater in younger children (p = 0.007) and in cardiac patients and in those who had previous chronic renal insufficiency (p = 0.047). The mortality analysis did not include patients with pre-existing renal disease. Mortality was 38.9%. Mortality for patients with weight < P3 was greater than that of children with weight > P3 (51% vs 33%; p = 0.037). In the univariate and multivariate logistic regression analyses, the only factor associated with mortality was protein-energy wasting (malnutrition) (OR, 2.11; 95% CI, 1.067-4.173; p = 0.032). CONCLUSIONS: The frequency of protein-energy wasting in children who require CRRT is high, and the frequency of obesity is low. Protein-energy wasting is more frequent in children with previous end-stage renal disease and heart disease. Underweight children present a higher mortality rate than patients with normal body weight.

A paediatric cardiopulmonary resuscitation training project in Honduras.

OBJECTIVES: It is possible that the exportation of North American and European models has hindered the creation of a structured cardiopulmonary resuscitation (CPR) training programme in developing countries. The objective of this paper is to describe the design and present the results of a European paediatric and neonatal CPR training programme adapted to Honduras. MATERIALS AND METHODS: A paediatric CPR training project was set up in Honduras with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The programme was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. RESULTS: During the first phase, 24 Honduran doctors from paediatric intensive care, paediatric emergency and anaesthesiology departments attended the paediatric CPR course and 16 of them the course for preparation as instructors. The Honduran Paediatric and Neonatal CPR Group was formed. In the second phase, workshops were given by Honduran instructors and four of them attended a CPR course in Spain as trainee instructors. In the third phase, a CPR course was given in Honduras by the Honduran instructors, supervised by the Spanish team. In the final phase of independent teaching, eight courses were given, providing 177 students with training in CPR. CONCLUSIONS: The training of independent paediatric CPR groups with the collaboration and scientific assessment of an expert group could be a suitable model on which to base paediatric CPR training in Latin American developing countries.

Cardiac output and blood volume parameters using femoral arterial thermodilution.

BACKGROUND: The pulse-induced continuous cardiac output (PiCCO) system is a less invasive method than pulmonary thermodilution for the measurement of cardiac output and estimating blood volume parameters. The normal values in children have not been defined. The purpose of the present paper was therefore to evaluate cardiac output and parameters of blood volume using femoral arterial thermodilution in critically ill children. METHODS: A prospective study was performed in 17 critically ill children aged between 2 months and 14 years. Two measurements were taken for each determination of cardiac output, global end diastolic volume (GEDVI), intrathoracic blood volume index (ITBI), extravascular lung water index (ELWI), systolic volume index (SVI), stroke volume variation (SVV), cardiac function index (CFI), left ventricular contractility (dp/dt max), and the systemic vascular resistance index (SVRI). RESULTS: One hundred and seventeen measurements were performed. The mean cardiac index (CI) was 3.5 +/- 1.3 L/min per m(2). The GEDVI (399.7 +/- 349.1 mL/m(2)), ITBI (574.5 +/- 212.2 mL/m(2)) and dp/dt max (804.6 +/- 372.1 mmHg/s) were lower than reported in adults, whereas ELWI (18.9 +/- 9.3 mL/m2) and CFI (8 +/- 2.5 L/min) where higher. The GEDVI, SVI, dp/dt max and CI increased with the weight of the patients whereas the ELWI values decreased. CONCLUSIONS: Femoral arterial thermodilution is a suitable technique for the measurement of cardiac output in critically ill children. The intrathoracic and intracardiac volumes are lower than in adults, whereas extrapulmonary water is higher; these values are related to the weight of the patient.