Pharmacological advances in the multimodal management of perioperative analgesia. / Avances farmacológicos en el manejo multimodal de la analgesia perioperatoria.

The concept of multimodal analgesia is currently widespread in our clinical practice. The aim of multimodal analgesia is to reduce the side effects derived from the drugs or techniques used for the control of pain together with greater effectiveness (combination of multiple mechanisms of action) with the maximum efficiency, that is, to combine different pharmacodynamics (synergistic or additive effects) and pharmacokinetics, in the context of a predictable acute pain model, thus allowing a prior strategy such as the model of acute postoperative pain. Pain is a complex physiological phenomenon. Postoperative pain involves multiple pathways including nociceptive, inflammatory, and neuropathic sources. In the transmission of pain therefore, different molecules participate, which means that there are multiple pharmacological targets on which to act, and therefore a wide range of drugs to be used following the physiology of pain.

Tramadol hydrochloride 75 mg/dexketoprofen 25 mg oral fixed-dose combination in moderate-to-severe acute pain: sustained analgesic effect over a 56-h period in the postoperative setting.

Multimodal analgesia constitutes a common strategy in pain management. A tramadol hydrochloride 75 mg/dexketoprofen 25 mg oral fixed combination (TRAM/DKP 75 mg/25 mg) has been recently registered and released in Europe for the treatment of moderate-to-severe acute pain. This paper provides additional analyses on the results of two phase III clinical trials (DEX-TRA-04 and DEX-TRA-05) on postoperative pain to document its sustained effect. The analysis was applied to a modified intention-to-treat population (mITT, n = 933) of patients undergoing active treatment from the first dose, to assess the sustained effect of TRAM/DKP 75 mg/25 mg on pain intensity (PI-VAS 0-100) over 56 h from first drug intake. The superior analgesic effect of TRAM/DKP 75 mg/25 mg over 56 h in terms of difference in PI-VAS (mean [SE]) was shown for DEX-TRA-04 (-11.0 [0.55] over dexketoprofen 25 mg and -9.1 [0.55] over tramadol 100 mg, P ≤ 0.0001) and for DEX-TRA-05 (-10.4 [0.51] over dexketoprofen 25 mg and -8.3 [0.51] over tramadol 100 mg, P ≤ 0.0001). The statistical analysis performed on data coming from both studies confirms the superior sustained analgesia of TRAM/DKP 75 mg/25 mg over tramadol 100 mg and dexketoprofen 25 mg. These results are consistent with the previously published data obtained on the ITT population and strongly support the role of this oral fixed-dose combination in the treatment of moderate-to-severe acute pain.

GEDOS-SECOT consensus on the care process of patients with knee osteoarthritis and arthoplasty. / Consenso GEDOS-SECOT sobre el proceso de atención a pacientes con artrosis de rodilla e indicación de artroplastia.

OBJECTIVE: To develop recommendations on the evaluation and management procedure in patients undergoing total knee replacement based on best evidence and the experience of a panel of experts. METHODS: A multidisciplinary group of 12 experts was selected that defined the scope, users and the document parts. Three systematic reviews were performed in patients undergoing knee replacement: (i)efficacy and safety of fast-tracks; (ii)efficacy and safety of cognitive interventions in patients with catastrophic pain, and (iii) efficacy and safety of acute post-surgical pain management on post-surgical outcomes. A narrative review was conducted on the evaluation and management of pain sensitization, and about the efficacy and safety of pre-surgical physiotherapy. The experts generated the recommendations and explicative text. The level of agreement was evaluated in a multidisciplinary group of 85 experts with the Delphi technique. The level of evidence was established as well for each recommendation. RESULTS: A total of 20 recommendations were produced. An agreement higher than 80% was reached in all of them. We found the highest agreement on the need for a full discharge report, on providing proper information about the process and on following available guidelines. CONCLUSIONS: There is consensus among professionals involved in the management of patients undergoing total knee replacement, in that it is important to protocolize the replacement process, performing a proper, integrated and coordinated patient evaluation and follow-up, paying special attention to the surgical procedure and postoperative period.

Eficacia y complicaciones de las técnicas analgésicas para el tratamiento del dolor agudo postoperatorio moderado a intenso / Efficacy and complications of analgesic techniques for the treatment of moderate to severe postoperative acute pain

Introducción: A pesar de los esfuerzos y la evidencia disponible, el dolor agudo postoperatorio (DAP) moderado a intenso continúa teniendo una prevalencia elevada en nuestro medio. Como parte de una estrategia de analgesia balanceada o multimodal, las técnicas de analgesia regional ofrecen un adecuado control analgésico con menores efectos indeseables (que el uso exclusivo de opioides), aunque no están exentas de complicaciones y no son aplicables a todas las cirugías. El objetivo de este trabajo fue valorar la eficacia de las técnicas analgésicas para el tratamiento del DAP moderado a intenso, la incidencia de complicaciones asociadas a estas técnicas y la relación entre DAP y el antecedente de dolor crónico. Pacientes y métodos: Estudio retrospectivo que incluyó 728 pacientes en los que se indicaron técnicas analgésicas, como analgesia epidural, analgesia perineural continua y analgesia controlada por el paciente (PCA) con morfina intravenosa, para el tratamiento del DAP moderado a intenso entre octubre del 2018 y octubre del 2020. Los pacientes fueron valorados por la Unidad de Dolor Agudo Postoperatorio (UDAP) a las 24 y 48 horas, se registró el dolor con la ENV (Escala Numérica Verbal), la presencia de reacciones adversas y/o complicaciones, empleo de analgesia multimodal y consumo de morfina en equivalentes intravenosos. Los niveles de dolor se clasificaron en leve (ENV: 0-3), moderado (ENV: 4-6) e intenso (ENV mayor o igual a 7). Resultados: Cerca del 60 % de los pacientes presentaron dolor leve a las 24 horas y del 70 % a las 48 horas. Un 71,8 % de los portadores de analgésica continua epidural presentaron dolor leve el primer día y un 83 % al segundo. Las cirugías con niveles más altos de dolor moderado e intenso fueron la cirugía espinal en la que se empleó la PCA de morfina y la artroplastia de rodilla en que se utilizó analgesia a través de bloqueo femoral continuo...(AU)

Introduction: Despite the efforts and the available evidence, moderate to severe acute postoperative pain (APP) continues to have a high prevalence in our setting. As part of a balanced or multimodal analgesia strategy, regional analgesia techniques offer adequate analgesic control with fewer undesirable effects (that the exclusive use of opioids), although they are not free of complications and do not apply to all surgeries. This study aimed to assess the efficacy of analgesic techniques for the treatment of moderate to intense APP, the incidence of complications associated with these techniques, and the relationship between APP and the presence of chronic pain. Patients and methods: This retrospective study included 728 patients in which analgesic techniques such as epidural analgesia, continuous perineural analgesia, and morphine Patient Controlled Analgesia (PCA) were indicated to treat moderate to severe APP between October 2018 and October 2020. The patients were evaluated by the APP service at 24 and 48 hours, the pain was recorded with the NRS (Numerical Rating Scale), and the study also registered the presence of adverse reactions and/or complications, the use of multimodal analgesia, and the consumption of morphine in equivalent intravenous doses. Pain levels were classified as mild (NRS: 0-3), moderate (NRS: 4-6) and intense (NRS greater than or equal to 7). Results: Approximately 60 % of all patients presented mild pain at 24 hours and 70 % at 48. Epidural analgesia in abdominal surgery presented 71.8 % mild pain on the first day and 83 % on the second. The surgeries with the highest levels of moderate and severe pain were spinal surgery using morphine PCA and knee replacement with continuous femoral nerve block. The morphine consumption recorded in the PCA was 25.8 mg (SD 18.4) at 24 hours and 18.6 mg (SD: 14.6) at 48 hours...(AU)

Implicación en Cataluña de los Servicios de Anestesiología y Reanimación en la pandemia por SARS-CoV-2. Una solución real coste-efectiva para una crisis sanitaria sin precedentes / Involvement in Catalonia of the Anaesthesiology and Resuscitation Services in the SARS-CoV-2 pandemic. A real, cost-effective solution to an unprecedented health crisis

No disponible

[Surgical management of the capsular contraction syndrome]. / Manejo quirúrgico del síndrome de contracción capsular.

PURPOSE/METHODS: To describe a surgical technique to treat severe capsular contraction syndrome. A secondary continuous curvilinear capsulorhexis was performed in four cases of capsular phymosis, attended in our clinic. CONCLUSIONS/RESULTS: All of them resolved with good anatomic and functional results, no recurrence occurred and best correct visual acuity BCVA was preserved after a twelve- month follow-up. This surgical procedure could solve severe capsular contraction syndrome occurring after continuous curvilinear capsulorhexis, phacoemulsification and intraocular lens implantation.

[Headache caused by endocranial hypotension secondary to sacrococcygeal trauma in a patient with a congenital arachnoid cyst]. / Cefalea por hipotensión endocraneal secundaria a un traumatismo sacrococcígeo en un paciente con un quiste aracnoideo congénito.

Headache caused by intracranial hypotension after sacrococcygeal trauma, is a rare syndrome with very similar symptoms and physiopathology to post dural puncture headache. In both situations, cerebrospinal fluid (CSF) leaks through a dural tear, leading to a decrease in its pressure. A 13 year old patient presented a frontal and occipital positional headache, after undergoing sacrococcygeal trauma. In magnetic resonance images, the presence of a spinal arachnoid diverticulum (cyst) and CSF leak were confirmed. After the establishment of conservative medical treatment, complete clinical remission was observed. The diagnosis of intracranial hypotension headache syndrome is mainly clinical, once other possible headache etiologies have been discarded. Magnetic resonance imaging can be used to detect small CSF leaks, and in this case, magnetic resonance imaging clearly showed the existence of an arachnoid cyst. The presence of some meningeal diverticulums such as arachnoid cyst, constitute a risk to undergo this syndrome, due to the possibility of its rupture by minor traumatisms. The initial treatment should be conservative, as the dural tear seals spontaneously and the liquid is reabsorbed.

Estudio comparativo de la demanda asistencial urgente de los niños prematuros tardíos en un hospital secundario / Comparative study of the emergency department visits by late preterm in a second level hospital

Introducción: Los nacimientos pretérmino se han incrementado en las últimas décadas, debido principalmente a los «prematuros tardíos», nacidos entre las semanas 34 + 0 y 36 + 6 de edad gestacional. Estos recién nacidos son fisiológica y metabólicamente inmaduros y presentan un mayor riesgo de morbilidad y mortalidad, sobre todo en el periodo neonatal. Se han realizado pocos estudios sobre la morbilidad tardía en las consultas de urgencias hospitalarias. Objetivos: Evaluar la morbilidad tardía en los prematuros tardíos y compararla con la de los recién nacidos a término en el Hospital Universitario de Guadalajara. Material y métodos: Estudio descriptivo retrospectivo de dos grupos de niños: prematuros tardíos nacidos entre enero de 2008 y marzo de 2010 y recién nacidos a término en dicho periodo. La morbilidad fue registrada durante los 2 primeros años de vida. Resultados: En el periodo de estudio nacieron 306 prematuros tardíos en el Hospital Universitario de Guadalajara, 283 de los cuales se incluyeron en nuestro estudio. Observamos en ellos un mayor riesgo significativo de morbilidad tardía respecto a los recién nacidos a término, tanto en el número de consultas como en el consumo de recursos en el servicio de urgencias hospitalarias. La patología predominante fue respiratoria.Conclusiones: Los prematuros tardíos presentan mayor morbilidad que los recién nacidos a término durante los 2 primeros años de vida, principalmente en los primeros 6 meses (AU)

Introduction: Preterm birth has increased over the last decades in developed countries and «late preterm» infants, born between 34 + 0 and 36 + 6 gestation weeks, are the main contribution to this increment. They are physiologically and metabolically immature and they have a higher risk of morbidity and mortality. There are few studies of late morbidity about the emergency department visits. Objective: Evaluate the late preterm late morbidity compared with term infants at Guadalajara University Hospital. Material and methods: It was performed a retrospective and descriptive study of two groups of infants: Late preterm born between January 2008 and March 2010 and term infants. The morbidity was registered during the first 2 years of life. Results: In the study period 306 late preterm were born at Guadalajara University Hospital and 283 were included in our study. It was observed a higher risk of late morbidity compared with the term infants at number of visits and their cost in the emergency paediatric department. The predominant pathology was respiratory.Conclusions: Late preterm infants show higher morbidity than term infants in the first 2 years of live, mainly within first 6 month (AU)

[Assessment of learning in blind orotracheal intubation with Fastrach masks using a cumulative sum curves (CuSum) in the SimMan Universal Simulator]. / Evaluación del aprendizaje de intubación orotraqueal a ciegas a través de mascarillas Fastrach mediante curvas de sumas acumulativas (CuSum) en el Simulador Universal SimMan.

OBJECTIVE: To assess training in blind intubation with the Fastrach laryngeal mask in a simulation model by applying the cumulative sums (CuSum) method. MATERIAL AND METHODS: Six anaesthesiology resident doctors, with no previous experience of the technique, participated, three in their first year, and three in the second. The study was conducted with the help of the SimMan Universal Simulator. Fifty attempts by each one of them over a four month period, divided into two stages: the first 20 with minimum airway difficulty, and the next 30 with limitations of flexion-extension movements to <80°. An unacceptable failure rate was set at 10% after a second failed attempt. The time limit set to be considered a success was 60seconds. RESULTS: A total of 120 attempts in the first stages, and the remaining 180 in the second were analysed individually, all managing to achieve acceptable success rates of 90%: 84% in the first attempt and 13.33% in the second. A total of 2.66% failures were recorded. The learning curve showed that the residents began to achieve an acceptable 90% success rate in case number 25±11.76 of the 50 attempts. CONCLUSIONS: This statistical method and the SimMan simulator, used together, have demonstrated to be very useful tools in assessing learning curves in this technique.

Mutación CCDC103: una variante rara como causa de discinesia ciliar primaria / CCDC103 mutation: a rare variant as cause of primary ciliary dyskinesia

Introducción. La discinesia ciliar primaria (DCP) es un conjunto de enfermedades caracterizadas por una disfunción de las estructuras ciliadas del epitelio bronquial y gonadal. Puede deberse a que los cilios sean inmóviles, tengan un movimiento ineficaz o, menos frecuentemente, a la ausencia total de los mismos. Como consecuencia de esta disfunción se producen las manifestaciones clínicas: bronquiectasias, sinusitis crónica y, en ocasiones, esterilidad en los varones. Se trata de la segunda causa más frecuente de enfermedad congénita respiratoria, por detrás de la fibrosis quística, con una herencia autosómica recesiva. Actualmente se están intentando identificar y definir los genes y mutaciones causantes de la enfermedad. Paciente. Se presenta un caso de DCP asociada a situs inversus en el que el diagnóstico se estableció por estudio genético. Presentamos el caso por la singularidad de la sospecha diagnóstica desde el periodo neonatal, por haberse realizado el diagnóstico a los 2 años, 9 meses (antes que la edad media habitual) y por la escasa prevalencia de la variante encontrada en la población europea. Resultados. Se identifica en este caso, en homozigosis, una variante: c.461A>C (p.H154P) en el gen CCDC103 (NM-213607.2), rara, ya que se encuentra en un 0,1% de la población europea (AU)

Introduction. Primary ciliary dyskinesia (DCP) englobes a set of diseases in which the microscopic cells in the respiratory and gonadal system do not function normally. This dysfunction is produced by immotile cilia, abnormal movement or, less frequent, absence of cilia at all. This ciliary dysfunction produces the different clinic manifestations, such as: chronic sinusitis, bronchiectasis and sometimes infertility in men. It usually follows autosomal recessive genetic inheritance. The genes responsible of this disorder are actually being identified. Patient. We present a case of DCP asociated to situs inversus, in wich the diagnosis was established with genetic study. This is a singular case, because the diagnosis was done sooner than the medium age (2 years and 9 months old), it was also suspected in the neonatal period and the low prevalence of this variant. Results. Exome sequencing identified a homozygous missense variant in CCDC103 (C.461A>C, p.H154P). This is a rare variant which only occurs in approximately 0.1% of european population (AU)

Ibuprofeno endovenoso. Seguridad y utilización en población con comorbilidad / No disponible

La oferta en el mercado farmacéutico de antiinflamatorios no esteroideos (AINE) que se puedan administrar por vía endovenosa es escasa. La formulación de ibuprofeno endovenoso nos ofrece una nueva opción terapéutica que nos permite utilizar una vía de administración en aquellos periodos en los que la vía oral no es posible o no es la más deseable, minimizando los efectos secundarios de este AINE, que ya por sus características tiene un muy buen perfil de seguridad. Más de 40 años de experiencia con ibuprofeno utilizado como un medicamento de venta libre en la práctica clínica, en aproximadamente 80 países de todo el mundo, ha servido para valorar a lo largo del tiempo la eficacia y seguridad de este fármaco. El mes de junio de 2009, el ibuprofeno por vía intravenosa (Caldolor®) fue aprobado por la FDA de Estados Unidos para el tratamiento del dolor leve-moderado como agente único, y del dolor moderado-severo como un complemento a los opioides y como antipirético. La administración endovenosa implica el uso a corto plazo, por lo que las ventajas son indiscutibles dado que muchos de sus efectos adversos están asociados a la cronicidad de su administración. Con un buen manejo adaptando sus indicaciones a los distintos grupos de pacientes (comorbilidad) y situaciones de riesgo (perioperatorio), el ibuprofeno endovenoso es una excelente opción terapéutica analgésica, antiinflamatoria y antipirética. En este capítulo, a través de una revisión de la literatura disponible en GoPubMed® hasta febrero 2016, haciendo referencia al uso tanto por vía oral como endovenosa del ibuprofeno, analizamos la seguridad de este fármaco por vía endovenosa (AU)

In the pharmaceutical market we have only a few nonsteroidal antiinflammatory drugs (NSAIDs) that can be administered intravenously. The formulation of intravenous ibuprofen offers a new therapeutic option that allows us to use a route of administration in those periods when the oral route is not possible or is not the most desirable, minimizing the side effects of NSAIDs, which already for their features has a very good safety profile. More than 40 years of experience with ibuprofen used as a nonprescription drug in clinical practice in approximately 80 countries around the world has served to assess over time the effectiveness and safety of this fármaco (1). The month of june 2009, ibuprofen intravenously (Caldolor®) was approved by the US FDA for the treatment of mild to moderate pain as a single agent and pain of moderate to severe pain as an adjunct to opioids and as antipirético (2). Intravenous administration involves short-term use so that the benefits are indisputable since many of its adverse effects are associated with chronic administration. With good management to adapt its indications to different groups of patients (comorbidity) and risk (perioperative). Intravenous ibuprofen is an excellent analgesic, whith antipyretic and anti-inflammatory therapeutic action. In this chapter, through a review of the available literature on GoPubMed® until february 2016 referring to the use of both oral and intravenous ibuprofen, we analyze the safety of this drug intravenously (AU)

Morbilidad a largo plazo en prematuros tardíos: estudio comparativo en un hospital secundario / Long term morbidity late preterm: a comparative study in a secondary hospital

Introducción. Los nacimientos pretérmino se han incrementado en las últimas décadas: la principal contribución es debida a los ‘prematuros tardíos’, los nacidos entre las 34+0 y 36+6 semanas de edad gestacional. Son fisiológica y metabólicamente inmaduros y presentan un mayor riesgo de morbimortalidad. Objetivos. Evaluar la morbilidad tardía en los prematuros tardíos comparándola con la de los recién nacidos a término en el Hospital Universitario de Guadalajara. Material y métodos. Estudio descriptivo prospectivo de dos cohortes de niños: los prematuros tardíos nacidos entre enero de 2008 y marzo de 2010 y los recién nacidos a término en ese periodo. La morbilidad fue registrada durante los dos primeros años de vida. Resultados. En el periodo de estudio, 306 prematuros tardíos nacieron en el Hospital Universitario de Guadalajara y 283 fueron incluidos en nuestro estudio. Observamos un significativo mayor riesgo de morbilidad tardía al comparar con los recién nacidos a término tanto en el número de ingresos como de reingresos hospitalarios. La patología predominante fue respiratoria en todos los rangos de edad. Conclusiones. Los prematuros tardíos presentan una mayor morbilidad que los recién nacidos a término durante los dos primeros años de vida, principalmente en los primeros seis meses (AU)

Introduction. Preterm birth has increased over the last decades in developed countries; the principal contribution to this increase has been from ‘late preterm’ infants, born at 34+0 - 36+6 weeks gestation. They are physiologically and metabolically immature and they are at a higher risk of morbidity and mortality. Objective. To evaluate the late preterm late morbidity compared with term infants at Guadalajara University Hospital. Material and methods. It was performed a prospective and descriptive study of two cohorts of infants: Late preterm born between January 2008 and March 2010 and term infants. The morbidity was registered during the first two years of life. Results. In the study period 306 late preterm were born at Guadalajara University Hospital and 283 were included in our study. We have observed significantly higher morbidity compared with the term infants in admission and readmission rate. The predominant pathology was respiratory in all age ranges. Conclusions. Late preterm infants have higher morbidity than term infants in the first two years of live, mainly within the first six month (AU)

[Asymptomatic pulmonary artery sling: Noninvasive diagnosis]. / Sling de la arteria pulmonar asintomático: diagnóstico no invasivo.

The anomalous origin of the left pulmonary branch known as pulmonary artery sling (PAS) is a rare form of vascular ring, a congenital heart disease in which the left pulmonary artery originates from the right pulmonary artery and runs posterior to the trachea, encircling it, and goes leftwards between the trachea and oesophagus to reach the left pulmonary hilum. The clinical outcome depends on the associated tracheal lesions and cardiac anomalies. The majority of patients (90%) have respiratory symptoms in the first year of life, due to tracheal stenosis (chronic stridor and wheezing), and with a high mortality rate if there is no surgical intervention. Other major congenital heart diseases are present in up to 50% of patients with this rare vascular ring. We present a case of this rare disease in an asymptomatic 3-year-old girl, without any associated congenital heart disease and the findings in the echocardiography and tomography that made the non-invasive diagnosis possible.

Transporte interhospitalario pediátrico y neonatal en un hospital secundario / Pediatric and neonatal interhospital transport in a secondary hospital

Introducción: Las unidades de cuidados intensivos pediátricos son áreas donde se concentran personal y equipo especializado en el manejo de niños críticos. Éstos, a menudo, deben ser trasladados hacia estas zonas en busca de procedimientos diagnósticos o terapéuticos. Tales desplazamientos pueden añadir un riesgo adicional a estos pacientes. Objetivos: Conocer las características del transporte interhospitalario pediátrico y neonatal en nuestra provincia. Material y métodos: Estudio observacional retrospectivo de los pacientes que precisaron traslado interhospitalario desde el 1 de enero de 2006 hasta el 30 de junio de 2012. Analizamos las siguientes variables: sexo, edad, fecha y hora, etnia, diagnóstico clínico, centro receptor y características del médico que realizó el traslado. Resultados: Se realizaron 245 traslados de carácter urgente, el 35,5% en periodo neonatal y el 64,5% pediátrico. En el transporte pediátrico, las principales causas de traslado fueron el traumatismo con o sin afectación encefálica (22,2%), la patología neurológica no traumática (16,5%) y la patología respiratoria (15,8%). En el transporte neonatal, las causas más importantes fueron la patología respiratoria grave que requiere ventilación asistida (25,3%) y la prematuridad (23%). Se presentaron efectos adversos en el 0,8% de los traslados. Conclusiones: Aunque la mayoría del personal médico que realizó el traslado no posee formación específica, el número de complicaciones fue significativamente pequeño. El transporte de los niños gravemente enfermos a un centro pediátrico de atención terciaria puede llevarse a cabo de forma más segura con un equipo especializado en cuidados críticos pediátricos que con equipos que no están capacitados específicamente en transporte pediátrico (AU)

Introduction: Pediatric intensive care units have developed as treatment areas with a concentration of specialized equipment and personnel. Critically ill children often need to be moved to these critical care areas for diagnostic or therapeutic procedures. Such transport may pose additional risk to the critically ill patient. Objetives: To determine the characteristics of pediatric and neonatal interhospital transport in our province. Material and methods: Retrospective observational study of pediatric and neonatal patients who required interhospital transfer from January 1, 2006 to June 30, 2012. We analyzed the following variables: sex, age, date and time, ethnicity, clinical diagnosis, and characteristics of the receiving facility physician who performed the transfer. Results: A total of 245 emergency transports were realized, 35.5% in neonatal period and 64.5% in pediatric period. In the pediatric transport, the trauma with or without head injury (22.2%), non-traumatic neurological disorders (16.5%) and respiratory pathology (15.8%) were the reasons for interhospital transport. In the neonatal transport, severe respiratory disease requiring assisted ventilation (25.3%) and prematurity (23%) were the most important causes. The incidence of significant adverse events was 0.8% Conclusions: Although most of the medical staff who performed the transfer does not have specific training, the number of complications was significantly smaller. Transport of critically ill children to a pediatric tertiary care center can be conducted more safely with a pediatric critical care specialized team than with teams not specifically trained in pediatric transport (AU)