[Use of capnography in acute gastroenteritis]. / Utilidad del empleo de la capnografía en la gastroenteritis aguda.

OBJECTIVE: End-tidal carbon dioxide (PetCO(2)) is a good predictor of circulation and metabolism. There are different studies that suggest PetCO(2) monitoring is a valuable and reliable tool to follow acidosis in pediatric patients with diabetic ketoacidosis. Acute gastroenteritis can cause acidosis, therefore, capnography could be useful in these situations. The objective was to determine the relationship between PetCO(2) and bicarbonate (HCO3) in pediatric patients with acute gastroenteritis and acidosis. METHODS: Clinical, prospective, observational study from April 2006 to January 2007. Children with acute gastroenteritis and dehydration and pH < 7.30 and HCO3 < 20 meq/L in laboratory tests were included. Exclusion criteria included patients with not well tolerated capnography and respiratory illness. Initial and post treatment PetCO(2) and HCO3 were collected as well as demographic data, physical examination data, laboratory tests and hospitalization data. RESULTS: Twenty-five children were included in the final analysis (10 female, 15 male). The mean age was 11.6 + 10 months (1-144 months). The correlation between PetCO(2) and serum bicarbonate was statistically significant with a Pearson's correlation coefficient of r = 0.61 for initial values and r = 0.75 for post treatment values. CONCLUSIONS: Capnography offers a noninvasive measurement of acidosis in pediatric patients with acute gastroenteritis and dehydration.

[Use of high-flow nasal cannula for non-invasive ventilation in children]. / Utilización de cánulas nasales de alto flujo para la ventilación no invasiva en niños.

OBJECTIVE: To analyse the efficacy and tolerance of non-invasive mechanical ventilation (NIMV) via high-flow oxygen therapy nasal cannulae in children after withdrawal of mechanical ventilation and/or with moderate respiratory insufficiency. PATIENTS AND METHODS: A prospective observational clinical study including 34 children between 9 months and 17 years treated with NIMV via high-flow oxygen therapy nasal cannulae. The following variables were analysed: age, sex, respiratory rate, heart rate, oxygen saturation, blood gases, clinical improvement, tolerance, onset of complications and treatment failure. RESULTS: NIMV was used in 13 children after withdrawal of mechanical ventilation and in 21 with respiratory failure. A high percentage (82.3%) of patients improved clinically and/or allowed the mechanical ventilation to be withdrawn, but there were no significant changes in respiratory rate, heart rate, pH, pCO(2) or saturation. NIMV was not effective in 6 patients (17.6%) and required change to a nasal or buconasal mask (5 patients) or intubation (1 patient). Two patients (5.9%) required change of interface to a nasal or buconasal mask, one had nasal erosion, and another, although improved clinically, showed excessive leakage. The duration of treatment was 48 hours (range 1 to 312 hours). CONCLUSIONS: Non-invasive mechanical ventilation via high-flow oxygen therapy nasal cannulae is effective and well tolerated in a high percentage of children after withdrawal of mechanical ventilation or with moderate respiratory insufficiency.