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1.
Epilepsy Behav ; 127: 108551, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35051869

RESUMO

PURPOSE: The aim of the study was to examine prehospital capillary lactate in children as a diagnostic biomarker to differentiate epileptic seizures from febrile seizures, syncope, and psychogenic nonepileptic seizures (PNES). METHODS: Capillary lactate concentrations taken in a pediatric prehospital setting within 2 h of the paroxysmal event were compared retrospectively between patients with epileptic seizure, febrile seizure, syncope, and PNES, based on the final diagnosis from the hospitalization report. RESULTS: One hundred and two patients were included, 53 (52%) with epileptic seizures, 41 (40%) with febrile seizures, and 8 (8%) with syncope or PNES. Capillary lactate in patients with a final diagnosis of epileptic seizure was significantly increased in comparison to the concentrations in patients with febrile seizure (p < 0.0007) and in comparison to the concentrations in patients with syncope or PNES (p < 0.0204). The area under the ROC-curve was 0.71 (95% CI 0.61-0.80). For a cutoff concentration of prehospital capillary lactate >3.9 mmol/l (Youden index), the sensitivity was 49% and the specificity 92%. CONCLUSION: Prehospital capillary lactate concentrations are a useful tool for differentiating the nature of a paroxysmal event in children.


Assuntos
Serviços Médicos de Emergência , Convulsões Febris , Criança , Diagnóstico Diferencial , Eletroencefalografia , Humanos , Ácido Láctico , Convulsões Psicogênicas não Epilépticas , Estudos Retrospectivos , Convulsões/diagnóstico , Convulsões/psicologia , Convulsões Febris/complicações , Convulsões Febris/diagnóstico , Síncope/diagnóstico
2.
Pediatr Transplant ; 23(7): e13515, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31441187

RESUMO

A 4-month-old infant was declared brain-dead 2 days after being initiated on venoarterial ECMO for a refractory septic shock. All brain death diagnostic criteria were fulfilled according to French law, and parental consent was given for organ donation. The hospital where ECMO was initiated had no authorization for organ procurement, and the donor was then transferred to the local referral center for child organ recovery with our mobile ECMO team to maintain organ perfusion. The kidneys were recovered and successfully transplanted to a child who is now well and alive. Although the transport elements of this case report are of limited relevance to an international audience as no other country, to our knowledge, has this particular organization, it does show excellent collaboration between teams to realize the goal of organ donation for this family. This is the first case describing a successful inter-hospital transport for organ procurement of a brain-dead infant on ECMO. Brain-dead pediatric patients undergoing ECMO can be considered as potential organ donors to expand the donor pool.


Assuntos
Transplante de Rim , Choque Séptico/mortalidade , Obtenção de Tecidos e Órgãos/métodos , Morte Encefálica , Oxigenação por Membrana Extracorpórea , Febre , França , Humanos , Lactente , Relações Interinstitucionais , Masculino , Equipe de Assistência ao Paciente , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Doadores de Tecidos
3.
Soins Pediatr Pueric ; 37(292): 17-21, 2016.
Artigo em Francês | MEDLINE | ID: mdl-27664304

RESUMO

The paediatric mobile emergency and intensive care service care teams have expertise in taking care of children in life-threatening circumstances. At the Robert-Debré Hospital in Paris, the paediatric Smur is multi-skilled, specialising particularly in transporting neonates and infants with severe cardiac or respiratory difficulties. The pathologies handled are very varied and include both neonatal pathologies and trauma pathologies in older children.


Assuntos
Serviços de Saúde da Criança/organização & administração , Cuidados Críticos/organização & administração , Serviços Médicos de Emergência/organização & administração , Criança , França , Humanos , Transporte de Pacientes/organização & administração
4.
J Am Coll Emerg Physicians Open ; 2(2): e12395, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33718927

RESUMO

STUDY OBJECTIVE: In prehospital and emergency settings, vasoactive medications may need to be started through a peripheral intravenous catheter. Fear of extravasation and skin injury, with norepinephrine specifically, may prevent or delay peripheral vasopressor initiation, though studies from adults suggest the actual risk is low. We sought to study the risk of extravasation and skin injury with peripheral administration of norepinephrine in children in the prehospital setting. METHODS: We performed a retrospective study of pediatric patients (≤18 years) who received a vasopressor during prehospital transport. We collected data from retrieval and hospital records from 2 pediatric medical retrieval teams in the Paris/Ile-de-France region. Patients were eligible if they had documentation of distributive or obstructive shock and administration of norepinephrine through a peripheral catheter (intravenous or intraosseous) during retrieval. The primary outcomes were the occurrence of extravasation and evidence of skin injury. We also examined approach to norepinephrine administration (concentration, duration, proximal vs distal site) and hospital outcomes. RESULTS: Over a 3-year-period, 37 pediatric patients received norepinephrine through a peripheral catheter (33 intravenous, 4 intraosseous). Median patient age was 1.8 years. Thirty-two patients (86.5%) had septic shock. The median total duration of norepinephrine infusion was almost 4 hours. One patient (2.7%, 95% confidence interval 0.5%, 13.8%) had suspected extravasation from a 24-gauge intravenous catheter in the hand, with local skin hypoperfusion. Skin changes were noted after 135 minutes of norepinephrine infusion. Perfusion normalized after catheter removal, and there were no other sequelae. CONCLUSIONS: In a 3-year sample of pediatric patients from a large metropolitan area, we found only 1 patient with evidence of any harm with peripheral administration of norepinephrine. This finding is consistent with the adult literature but requires multicenter and multiyear investigation before a firm recommendation for this practice can be made.

5.
Pediatr Pulmonol ; 56(5): 1230-1236, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33350599

RESUMO

OBJECTIVE: To describe the evolution over a 12-year period of a pediatric intensive care unit transport team's (PICU-TT) experience of pediatric and neonatal interhospital transportation on high-frequency oscillation ventilation (HFOV). METHODS: This was a monocentric retrospective observational study from January 2006 to December 2017. All patients aged under 18 years old who were transported on HFOV by the Robert Debré Hospital PICU-TT were included. RESULTS: Over a 12-year period, 125 patients were transported on HFOV, including 107 newborns and 18 children. Median (range) age and weight were 9 days (1 h-9 years) and 3.3 (0.6-39) kg, respectively. Initial median oxygenation index, SpO2 /FiO2 ratio and mean airway pressure were 32, 91, and 18 cmH2 O, respectively, without significant difference between values before and after transport. Adverse events occurred during 28 transportations (22%) including three recovered cardiac arrests and one death. Overall survival rate at discharge was 74%, 78% in neonates and 56% in pediatrics, respectively. HFOV transportation rate increased over the last four years of the study for neonates and remained stable for older children. Extra-corporeal membrane oxygenation (ECMO) initiation rate on arrival decreased and survival rate increased significantly during the last four years of the study (p < .05). CONCLUSION: This study showed the feasibility of HFOV transportation by a PICU-TT, despite some challenges. A trend towards using ECMO more than HFOV for the most severe respiratory and/or circulatory failures was seen over the 12-year period. The HFOV transportation rate has increased for less severe neonatal patients.


Assuntos
Ventilação de Alta Frequência , Adolescente , Criança , Oxigenação por Membrana Extracorpórea , Humanos , Recém-Nascido , Ventilação com Pressão Positiva Intermitente , Pediatria , Estudos Retrospectivos
6.
Arch Dis Child ; 104(4): 322-327, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29860227

RESUMO

OBJECTIVE: We aimed to determine paediatric hospital preparedness for a mass casualty disaster involving children in both prehospital and hospital settings. The study findings will serve to generate recommendations, guidelines and training objectives. DESIGN AND SETTING: The AMAVI-PED study is a cross-sectional survey. An electronic questionnaire was sent to French physicians with key roles in specialised paediatric acute care. RESULTS: In total, 81% (26 of 32) of French University Hospitals were represented in the study. A disaster plan AMAVI with a specific paediatric emphasis was established in all the paediatric centres. In case of a mass casualty event, paediatric victims would be initially admitted to the paediatric emergency department for most centres (n=21; 75%). Paediatric anaesthesiologists, paediatric surgeons and paediatric radiologists were in-house in 20 (71%), 5 (18%) and 12 (43%) centres, respectively. Twenty-three (82%) hospitals had a paediatric specialised mobile intensive care unit and seven (25%) of these could provide a prehospital emergency response. Didactic teaching and simulation exercises were implemented in 20 (71%) and 22 (79%) centres, respectively. Overall, physician participants rated the level of readiness of their hospital as 6 (IQR: 5-7) on a 10-point readiness scale. CONCLUSION: Paediatric preparedness is very heterogeneous between the centres. Based on the study findings, we suggest that a national programme must be defined and guidelines generated.


Assuntos
Planejamento em Desastres/normas , Serviço Hospitalar de Emergência/normas , Hospitais Pediátricos/normas , Terrorismo , Criança , Cuidados Críticos/organização & administração , Cuidados Críticos/normas , Estudos Transversais , Planejamento em Desastres/organização & administração , Serviço Hospitalar de Emergência/organização & administração , França , Hospitais Pediátricos/organização & administração , Humanos , Unidades de Terapia Intensiva Pediátrica/organização & administração , Unidades de Terapia Intensiva Pediátrica/normas , Incidentes com Feridos em Massa , Ferimentos e Lesões/terapia
7.
BMJ Open ; 9(11): e034052, 2019 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727669

RESUMO

OBJECTIVES: Premedication practices for neonatal tracheal intubations have not yet been described for neonatal transport teams. Our objective is to describe the use of sedation/analgesia (SA) for tracheal intubations and to assess its tolerance in neonates transported by medical transport teams in France. SETTING: This prospective observational study was part of the EPIPPAIN 2 project and collected around-the-clock data on SA practices in neonates intubated by all five paediatric medical transport teams of the Paris region during a 2-month period. Intubations were classified as emergent, semiemergent and non-emergent. Sedation level and conditions of intubation were assessed with the Tonus, Reactivity, Awareness and Conditions of intubation to Help in Endotracheal intubation Assessment (TRACHEA score). The scores range from 0 to 10 representing an increasing ladder from adequate to inadequate sedation, and from excellent to very poor conditions of intubation. PARTICIPANTS: 40 neonates intubated in 28 different centres. RESULTS: The mean (SD) age was 34.9 (3.9) weeks, and 62.5% were intubated in the delivery room. 30/40 (75%) of intubations were performed with the use of SA. In 18/30 (60.0%) intubations performed with SA, the drug regimen was the association of sufentanil and midazolam. Atropine was given in 19/40 intubations. From the 16, 21 and 3 intubations classified as emergent, semiemergent and non-emergent, respectively, 8 (50%), 19 (90.5%) and 3 (100%) were performed with SA premedication. 79.3% of intubations performed with SA had TRACHEA scores of 3 or less. 22/40 (55%) infants had at least one of the following adverse events: muscle rigidity, bradycardia below 100/min, desaturation below 80% and nose or pharynx-larynx bleeding. 7/24 (29.2%) of those who had only one attempt presented at least one of these adverse events compared with 15/16 (93.8%) of those who needed two or more attempts (p<0.001). CONCLUSION: SA premedication is largely feasible for tracheal intubations performed in neonates transported by medical transport teams including intubations judged as emergent or semiemergent. TRIAL REGISTRATION NUMBER: NCT01346813; Results.


Assuntos
Analgésicos Opioides/uso terapêutico , Intubação Intratraqueal/métodos , Pré-Medicação/estatística & dados numéricos , Atropina/uso terapêutico , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Intubação Intratraqueal/efeitos adversos , Masculino , Midazolam/uso terapêutico , Dor/epidemiologia , Dor/etiologia , Paris , Estudos Prospectivos , Sufentanil/uso terapêutico
8.
PLoS One ; 12(3): e0170100, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28278217

RESUMO

BACKGROUND: Hypothermia initiated in the first six hours of life in term infants with hypoxic ischemic encephalopathy reduces the risk of death and severe neurological sequelae. Our study's principal objective was to evaluate transport predictors potentially influencing arrival in NICU (Neonatal Intensive Care Unit) at a temperature ≥35-<36°C. METHODOLOGY/PRINCIPAL FINDINGS: A multi-centric, prospective cohort study was conducted during 18 months by the three Neonatal Transport Teams and 13 NICUs. Newborns were selected for inclusion according to biological and clinical criteria before transport using passive hypothermia using a target temperature of ≥35-<36°C. Data on 120 of 126 inclusions were available for analysis. Thirty-three percent of the children arrived in NICU with the target temperature of ≥35-<36°C. The mean temperature for the whole group of infants on arrival in NICU was 35.4°C (34.3-36.5). The median age of all infants on arrival in NICU was 3h03min [2h25min-3h56min]. Three infants arrived in NICU with a temperature of <33°C and eleven with a temperature ≥37°C. Adrenaline during resuscitation was associated with a lower mean temperature on arrival in NICU. CONCLUSIONS/SIGNIFICANCE: Our strategy using ≥35-<36°C passive hypothermia combined with short transport times had little effect on temperature after the arrival of Neonatal Transport Team although did reduce numbers of infants arriving in NICU in deep hypothermia. For those infants where hypothermia was discontinued in NICU our strategy facilitated re-warming. Re-adjustment to a lower target temperature to ≥34.5-<35.5°C may reduce the proportion of infants with high/normothermic temperatures.


Assuntos
Hipotermia , Hipóxia-Isquemia Encefálica/fisiopatologia , Unidades de Terapia Intensiva Neonatal , Transporte de Pacientes/estatística & dados numéricos , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Transferência de Pacientes , Estudos Prospectivos , Temperatura
10.
PLoS One ; 8(2): e57478, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23468997

RESUMO

BACKGROUND: Atropine has is currently recommended to facilitate haemodynamic stability during critical care intubation. Our objective was to determine whether atropine use at induction influences ICU mortality. METHODOLOGY/PRINCIPAL FINDINGS: A 2-year prospective, observational study of all first non-planned intubations, September 2007-9 in PICU and Intensive Care Transport team of Hôpital Robert Debré, Paris, 4 other PICUs and 5 NICUs in the Paris Region, France. Follow-up was from intubation to ICU discharge. A propensity score was used to adjust for patient specific characteristics influencing atropine prescription. 264/333 (79%) intubations were included. The unadjusted ICU mortality was 7.2% (9/124) for those who received atropine compared to 15.7% (22/140) for those who did not (OR 0.42, 95%CI 0.19-0.95, p=0.04). One child died during intubation (1/264, 0.4%). Two age sub-groups of neonates (≤28 days) and older children (>28 days, <8 years) were examined. This difference in mortality arose from the higher mortality in children aged over one month when atropine was not used (propensity score adjusted OR 0.22, 95%CI 0.06-0.85, p=0.028). No effect was seen in neonates (propensity score adjusted OR 1.3, 95%CI 0.31-5.1 p=0.74). Using the propensity score, atropine maintained the mean heart rate 45.9 bpm above that observed when no atropine was used in neonates (95%CI 34.3-57.5, p<0.001) and 43.5 bpm for older children (95%CI 25.5-61.5 bpm, p<0.001). CONCLUSIONS/SIGNIFICANCE: Atropine use during induction was associated with a reduction in ICU mortality in children over one month. This effect is independent of atropine's capacity to attenuate bradycardia during intubation which occurred similarly in neonates and older children. This result needs to be confirmed in a study using randomised methodology.


Assuntos
Atropina/uso terapêutico , Bradicardia/fisiopatologia , Cuidados Críticos , Bradicardia/mortalidade , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos
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