[Consensus document on vaccination against influenza in health care workers]. / Consenso sobre la vacunación frente a la gripe en el personal sanitario.

Health care workers (HCW) are included each year among risk groups for vaccination against influenza. However, vaccination coverage among this group in our country is very low, not exceeding 25%. Convinced that one of the best tools to increase this coverage among professionals in our country are the scientific evidence, 19 scientific societies and associations professionals bringing together health professionals more directly related to influenza as an health problem, and the General Nursing Council, met to discuss and develop this consensus document in order to inform HCW about the appropriateness of their vaccination against influenza and the benefits that flow from it for themselves, for their patients and for the rest of the population. This recommendation is based on 3 pillars: argument of necessity, ethics and exemplary.

[Transpyloric enteral nutrition in critically-ill children (I): technic and indications]. / Nutrición enteral transpilórica en el niño críticamente enfermo (I): técnica e indicaciones.

OBJECTIVE: To study the utility and efficacy of transpyloric enteral nutrition (TEN) in critically-ill children by analyzing the factors that determine enteral tolerance. PATIENTS AND METHODS: We performed a prospective, observational study between 1994 and 2002 of all critically-ill children admitted to our pediatric intensive care unit who received TEN. The indications for enteral nutrition, type of nutrition and its duration were studied. RESULTS: A total of 286 patients (8.4 % of patients admitted to the PICU in the study period), aged between 3 days and 17 years received TEN. Fifty-five children (19.2 %) were aged less than 1 month and 165 (27.7 %) were aged less than 6 months. Seventy percent received TEN exclusively. The most frequent indication for TEN was mechanical ventilation in 255 children (89.2 %). One hundred seventy-six patients (61.5 %) received TEN in the postoperative period after cardiac surgery. The mean duration of TEN was 15.4 25 days, the maximum volume of nutrition was 118.7 41 ml/kg/day, and the maximum caloric intake was 88.6 26.7 kcal/kg/day. During TEN, 227 patients received sedation (79.3 %), and 124 were administered muscle relaxants (43.3 %), with no increase in complications. CONCLUSIONS: TEN is a useful method of nutrition in critically-ill children.

[Transpyloric enteral nutrition in critically-ill children (II): complications]. / Nutrición enteral transpilórica en el niño críticamente enfermo (II): complicaciones.

OBJECTIVE: To study tolerance to transpyloric enteral nutrition (TEN) and the incidence of secondary complications in critically-ill children. PATIENTS AND METHODS: We performed a prospective, observational study between 1994 and 2002 of all critically-ill children admitted to our pediatric intensive care unit who received TEN. Tolerance and complications were analyzed. RESULTS: Of 286 patients aged between 3 days and 17 years who received TEN, gastrointestinal complications occurred in 13.6 %, abdominal distention and/or excessive gastric residue in 8 % and diarrhea in 6.3 %. Diarrhea was associated with shock (p 0.01), abdominal distension and/ or excessive gastric residue (p 0.008), hypophosphatemia (p 0.001), and duration of TEN (p < 0.001). TEN was discontinued in 2.1 % of the patients because of gastrointestinal complications. Thirty-two patients (11.2 %) died during TEN. No relationship was found between the characteristics of nutrition and complications and mortality. CONCLUSIONS: TEN is a well tolerated method of nutrition in critically-ill children that produces few complications.

[Prognostic value of the pediatric index of mortality (PIM) score and lactate values in critically-ill children]. / Valor pronóstico de la puntuación PIM (índice pediátrico de mortalidad) y del ácido láctico en niños críticamente enfermos.

OBJECTIVE: To analyze and compare the prognostic value of the pediatric index of mortality (PIM) score and lactate values on admission to a pediatric intensive care unit (PICU). PATIENTS AND METHODS: We performed a prospective study of 500 consecutive children: 237 girls (47.4 %) and 263 boys (52.6 %) with a mean age of 51.5 59.7 (range: 3 days-18 years) admitted to our PICU. PIM scores and blood lactate concentrations were determined on admission. The predictive ability of PIM and lactate concentrations in relation to mortality and length of stay in the PICU were analyzed. RESULTS: Thirty-six patients (7.2 %) died. According to the PIM score, the mean probability of death in children who died was 23.6 % 28.9, which was significantly higher than that in surviving children (3.4 % 7.3; p < 0.001). The area under the ROC curve for PIM was 0.81 0.03 (95 % CI: 0.74-0.89). Lactate level in nonsurvivors was 4.9 % 3.5 mmol/L, which was significantly higher than that in survivors (1.9 % 1.5 mmol/L; p < 0.001). The area under the ROC curve for blood lactate was 0.76 0.04 (95 % CI: 0.67-0.85). No statistically significant differences were found between either ROC curves. In survivors, a significant relationship was found between PIM score and length of stay in the PICU while in nonsurvivors an inverse relationship was found between blood lactate concentrations and length of stay. CONCLUSIONS: Both PIM score and blood lactate concentrations on admission to the PICU have a moderate prognostic value in critically-ill children. The prognostic value of the PIM score is greater than that of blood lactate concentration but is more difficult to obtain, whereas blood lactate determination is fast and easy.

[Evaluation of basic and advanced pediatric resuscitation courses]. / Evaluación de los cursos de reanimación cardiopulmonar básica y avanzada en pediatría.

AIM: To evaluate the efficacy of the teaching of basic and advanced pediatric life support courses. MATERIALS AND METHODS: From February 1994 to October 1996, 23 courses on the theory and practice of pediatric life support were organized: 6 were basic courses given to 265 trainees and 17 were advanced courses given to 409 trainees. Trainees were given a multiple-choice theory evaluation before and at the end of the course. Practical evaluation of basic and advanced life support skills was also performed. Teachers and students filled in a questionnaire to evaluate their satisfaction with the course. RESULTS: In basic life support courses mean score of the initial theory evaluation was 6.6 (1.7) and the final score was 9.3 (0.9) (p < 0.001). In advanced life support courses mean score of the initial evaluation was 25.7 (5.5) out of a maximum of 40, and the final score was 36.2 (2.5) (p < 0.001). In the practical evaluation of both basic and advanced courses the mean scores for all cardiopulmonary resuscitation maneuvers were higher than the minimum required value (3 out of a maximum of 5). The evaluation of the course by teachers and pupils yielded high scores for theoretical and practical content, as well as for the methodology used. The evaluation was useful for rectifying the deficiencies encountered. CONCLUSIONS: Basic and advanced pediatric life support courses are a useful method for providing training in the theory and practice of cardiopulmonary resuscitation to health personnel and the general population. Trainees and teachers were satisfied with the teaching and methodology. Evaluations of theory and practice and the questionnaire were useful in the quality control of the courses.