RESUMO
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
Assuntos
Ventilação não Invasiva , Insuficiência Respiratória , Adulto , Cânula , Criança , Consenso , Humanos , Recém-Nascido , Oxigênio , Piruvatos , Insuficiência Respiratória/terapia , Sociedades CientíficasRESUMO
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
Assuntos
Ponte Cardiopulmonar , Oxigenação por Membrana Extracorpórea , Fator VIIa/uso terapêutico , Insuficiência de Múltiplos Órgãos/etiologia , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/terapia , Transposição dos Grandes Vasos/cirurgia , Disfunção Ventricular Esquerda/etiologia , Injúria Renal Aguda/etiologia , Causas de Morte , Tubos Torácicos , Terapia Combinada , Evolução Fatal , Ventrículos do Coração/patologia , Humanos , Recém-Nascido , Isquemia/patologia , Insuficiência de Múltiplos Órgãos/patologia , Necrose , Uso Off-Label , Complicações Pós-Operatórias/patologia , Hemorragia Pós-Operatória/patologia , Proteínas Recombinantes/uso terapêutico , Transposição dos Grandes Vasos/patologia , Disfunção Ventricular Esquerda/patologiaRESUMO
OBJECTIVE: Our aim was to analyse clinical, diagnostic, therapeutical and evolutionary features in a pediatric population with tuberculous meningitis. PATIENTS AND METHODS: The medical records of thirteen children with this diagnosis admitted to Hospital Infantil Virgen del Rocío from Seville (Spain) between 1984 and 1999 were reviewed. RESULTS: The mean age was 2,35 +/- 2,3 years. The symptoms upon admission were: fever in 11 children, anorexia and vomiting in 8, disturbance of the consciousness in 7. Meningeal signs in 6, all of them older than 20 months, the remaining seven showed irritability and four of these ones hypertense fontanelles. Three patients were in the first stage of the disease, 9 in the second and 1 in the third, according to the Medical Research Council. CSF findings were indicative in all the cases. Five children had bacilloscopy positive and Mycobacterium tuberculosis was isolated in 6 patients, sometimes in CSF others in gastric juice. Mantoux skin test was positive in 11. Radiographic studies demonstrated abnormal chest findings in 8 patients (hiliar adenopathy, 1; miliary pattern, 2; and infiltrates, 5). Pathology cranial computed tomography showed in all the cases and the electroencephalogram was slowed down in the initial phases in 11. Two children died and the neurological complications were the most frequent, appearing in 9 patients. Without consequences cured 4 patients, the rest presented cognitive, visual and motor deficits, sensibility skin disturbance and late seizures. No case has been observed during the last 5 years. CONCLUSIONS: Fast diagnosis tests used for M. tuberculosis identification were useful to begin an antituberculous treatment in a high suspicion of meningeal affectation by this German patient. The early treatment will decrease complications and consequences by this disease. A decrease in the incidence looks to be in spite of the VIH infection increase nowadays.
Assuntos
Tuberculose Meníngea/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Espanha/epidemiologia , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/tratamento farmacológicoRESUMO
OBJECTIVE: To analyze the epidemiological and clinical features of pneumococcal meningitis. PATIENTS AND METHODS: We performed a retrospective study of 53 cases of pneumococcal meningitis that occurred in 47 pediatric patients in our hospital between 1977 and 2000. Four children had recurrent meningitis. In all patients Streptococcus pneumoniae was isolated from cerebrospinal fluid culture. The epidemiological, bacteriological and clinical characteristics were studied. RESULTS: Pneumococcal meningitis represented 6 % of bacterial meningitis in our environment with 2-3 cases registered per year. Seventy-two percent of cases occurred in winter and spring. The age of affected children was between 1 month and 13 years. Sixty-five percent of children older than 2 years had a predisposing disease. Penicillin-resistant strains were detected in 1990 and cefotaxime-resistant strains were isolated in 1994. Seven children (13 %) had severe neurological sequels and two (4 %) died. CONCLUSIONS: Pneumococcal meningitis produces higher morbidity and mortality than other types of bacterial meningitis. The disease usually affects children younger than 2 years and older children with a predisposing disease. In the last few years, the importance of pneumococcal meningitis has increased due to the lower incidence of other types of bacterial meningitis. Because of beta-lactam resistant strains, initial empirical treatment should include vancomycin. The above data suggest the advisability of the generalized use of heptavalent pneumococcal conjugate vaccine in the pediatric population in our environment.