RESUMEN
Bianchi's procedure experience for short bowel syndrome in children is positive. This technique is generally performed after the first year of life. Here the authors propose a case of gastroschisis with prenatal spontaneous closure of abdominal defect and vanishing gut presenting as intestinal atresia, absence of ileo-cecal valve, and residual short intestinal dilatation, treated by early gut lengthening (ILP).
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Intestinos/cirugía , Síndrome del Intestino Corto/cirugía , Dilatación Patológica , Femenino , Gastrosquisis/complicaciones , Humanos , Válvula Ileocecal/anomalías , Recién Nacido , Atresia Intestinal/complicaciones , Intestinos/anomalías , Síndrome del Intestino Corto/etiologíaRESUMEN
The object of this study was to evaluate the results of anatomical correction of transposition of the great arteries (TGA) in an inter-regional centre. The characteristics of 220 patients operated between 1985 and 2002 were analysed. Prenatal diagnosis of TGA was made in 38 patients (17%) including 36 of the 109 patients operated since 1995 (33%) and leading to earlier atrial septostomy in this situation (p= 0.046). Since 1995, the global early mortality of 12.3% has been significantly reduced to 5.5% (N= 6) including 4.4% (3/68 cases) of simple TGA (p= 0.002). In multivariate analysis, the only independent risk factor for early mortality was the occurrence of a major per-operative complication (p< 0.0001). The average follow-up was 4.8 +/- 4.5 years with an 86% survival at 5, 10 and 15 years and 97% survival at 5 years for patients operated after 1995. There were 22 reoperations including 14 on the right ventricular outflow tract. The non-reoperation rate at 10 years was 80% for simple TGA versus 70% in complex TGA (p= 0.0001). Survivors are asymptomatic with a normal ECG and normal LV function on echocardiography. Five patients have significant pulmonary stenosis and 4 have mild aortic regurgitation. The exercise stress tests performed between the ages of 7 and 10 were all normal. The authors conclude that that modern and reproducible management of TGA is possible in an inter-regional centre with results comparable to those of surgical centres of reference.
Asunto(s)
Procedimientos Quirúrgicos Cardiovasculares/métodos , Transposición de los Grandes Vasos/cirugía , Femenino , Francia , Humanos , Recién Nacido , Masculino , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Transposición de los Grandes Vasos/diagnóstico , Transposición de los Grandes Vasos/mortalidad , Resultado del TratamientoRESUMEN
OBJECTIVE: For 3 years we have used extracorporeal assistance in intensive care frequently. This study evaluates our results. METHOD: We studied the patient records for those treated between January 2002 and January 2005. The method used, indications and morbidity/mortality were analysed. RESULTS: We performed 24 circulatory assistance procedures in 20 patients (median age: 5 months), arterio-venous with oxygenation (n=18), veino-venous with oxygenation (n=3) or biventricular (n=3). The indications were post cardiotomy cardio-respiratory failure (Group I; n=20, 16 patients), pure respiratory failure (Group II: n=1), or pre-transplant/recovery (Group III: n=3). Five procedures (4 from group I and 1 from group III) required cardiac massage (no fatalities). The average duration of assistance was 7 +/- 6 days (2 to 20 days). Treatment was successfully discontinued in sixteen patients 80%), one of them thanks to heart transplant. Four (20%) died during assistance. The morbidity essentially consisted of further surgery for haemostasis, multiple transfusions, and infections. Three patients (15%) died later (1 at 17 months after discontinuation) from complications unrelated to the assistance. No neurological sequelae were noted in the survivors. CONCLUSION: These results confirm the usefulness of circulatory assistance when medical treatment has failed, particularly in the post-operative period of paediatric cardiac surgery or while awaiting transplantation.
Asunto(s)
Procedimientos Quirúrgicos Cardiovasculares , Circulación Extracorporea/métodos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Adolescente , Adulto , Niño , Preescolar , Femenino , Trasplante de Corazón , Humanos , Lactante , Recién Nacido , Masculino , Morbilidad , Periodo Posoperatorio , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Since 2005, forgoing live-support (FLS) is allowed by the French law (known as the Leonetti law) for end-of-life patients only. This study aims at describing the variations over time in the use of the following methods to end life: FLS, brain death and cardiopulmonary resuscitation failure (CPR failure). It is a single retrospective study from 2007 to 2012. The Cochran-Armitage trend test is used in the statistical analysis. Over six years, 263 of the 5100 children who were hospitalized in our intensive care unit died, which represents a 5.2% mortality rate. FLS increased yearly from 31% of the deaths in 2007, to 71% in 2012 (P=0.0008). The rate of CPR failure decreased over the same period (P=0.0015). The rate of brain death remained constant. Following to the Leonetti law, FLS increase, and palliative cares develop without any increase of mortality.
Asunto(s)
Cuidados para Prolongación de la Vida/normas , Pediatría/normas , Privación de Tratamiento/normas , Muerte Encefálica , Reanimación Cardiopulmonar/estadística & datos numéricos , Niño , Preescolar , Cuidados Críticos/ética , Cuidados Críticos/normas , Femenino , Francia , Mortalidad Hospitalaria , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico , Legislación Médica , Cuidados para Prolongación de la Vida/ética , Cuidados para Prolongación de la Vida/legislación & jurisprudencia , Masculino , Cuidados Paliativos , Pediatría/ética , Pediatría/legislación & jurisprudencia , Órdenes de Resucitación , Insuficiencia del Tratamiento , Privación de Tratamiento/ética , Privación de Tratamiento/legislación & jurisprudenciaRESUMEN
Pertussis is a leading cause of death from community infections in infant. Life-threatening clinical presentations of pertussis can associate multiple organ system failure with respiratory distress. The question of the optimal management of these severe forms of pertussis, in order to reduce the high mortality rate, is raised by the clinicians caring for such patients. We report the case of a 1 month infant who was admitted to the pediatric intensive care unit (PICU) for a severe pertussis. He presented with an acute respiratory distress syndrome, a severe pulmonary hypertension was treated initially with mechanical ventilation and nitric oxide. At day 4 (D4), a cardiogenic shock occurred and, despite epinephrine and norepinephrine infusion, fluid expansion, the hemodynamic condition worsened with two episodes of cardiac arrest. The child was then successfully resuscitated, and, facing the extreme hemodynamic instability, extracorporeal membrane oxygenation (ECMO) was considered. ECMO allowed epinephrine and norepinephrine to be progressively discontinued, and protective mechanical ventilation. ECMO withdrawal was possible at D9, with milrinone as the sole inotropic agent. Weaning from mechanical ventilation was possible on D15 and the total length of stay in PICU was 20days. While the analysis of the literature, through limited experiences on the use of ECMO in children with severe pertussis does not allow concluding definitively on the utility of ECMO in this situation, the contribution of ECMO in the favourable outcome for our patient was considerable. This is an argument, to our opinion, for considering ECMO in the management of those very instable patients.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Tos Ferina/terapia , Cardiotónicos/uso terapéutico , Cuidados Críticos , Humanos , Hipertensión Pulmonar/etiología , Lactante , Masculino , Milrinona/uso terapéutico , Respiración Artificial , Síndrome de Dificultad Respiratoria/etiología , Resucitación , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia , Vasoconstrictores/uso terapéuticoRESUMEN
Steroids are indicated in paediatric intensive care as anti-inflammatory drugs or for substitutive treatment. During septic shock, the incidence of adrenal insufficiency (AI) varies between 18 à 52%, depending on the relative or absolute nature of the AI. Contrary to adults, for whom long courses of low doses of corticosteroids were shown to reduce mortality and increased shock reversibility, particularly in those with a negative synacthene test, no study provided sufficient evidence to show a benefit of steroids in terms of outcome in children with septic shock. In neonates, AI occurs frequently after cardiac surgery and the administration of steroids can improve haemodynamic condition. The recommended dose of hydrocortisone during septic shock or after cardiac surgery is 30 to 100 mg/m(2)/d. Dexamethasone is efficient to reduce postextubation stridor in children and neonate and the rate of reintubations in neonate. During croup, oral or parenteral steroids reduce clinical symptoms. Dexamethasone also reduces the incidence of severe chronic lung disease and the duration of tracheal intubation in premature infants. However the high incidence of side effects, particularly on the central nervous system, makes steroids currently not recommended for bronchopulmonary dysplasia. At last, steroids are indicated for severe asthma and for bacterial meningitis. In this latter indication, dexamethasone was shown to improve neurological outcome, indeed mortality in Haemophilus influenzae and Streptococcus pneumoniae meningitis.