Mild hypothermia attenuates lung edema and plasma interleukin-1ß in a rat mechanical ventilation-induced lung injury model.

Recent data suggest that deep hypothermia has protective effects on experimental induced lung injury. It is not well known if these effects persist with mild hypothermia. The authors hypothesized that mild hypothermia may attenuate lung injury and decrease local and systemic proinflammatory cytokines in a rat model of injurious mechanical ventilation (MV). Twelve Sprague-Dawley male adult rats were anesthetized, intubated, and randomly allocated to normothermia group (37°C) (NT) or mild hypothermia group (34°C) (MH). After 2 hours of deleterious MV (peak inspiratory pressure [PIP] 40 cm H(2)O, zero end-expiratory pressure [ZEEP], and inspiratory fraction of oxygen [Fio(2)] 100%), arterial blood gases, lung gravimetry, and histological study were obtained. Protein content, interleukin (IL)-1ß, and tumor necrosis factor (TNF)-α were measured in plasma and bronchoalveolar lavage (BAL) fluid. Subjects that underwent MH had a significant lower wet-to-dry lung weight ratio (8.32 ± 0.28 vs. 10.8 ± 0.49, P = .01), IL-1ß plasma concentration (0.6 ± 0.6 vs. 10.27 ± 2.80 pg/mL, P = .0048) and PaCO(2). There were no differences in terms of PaO(2), histological injury, or BAL protein content. In this model of injurious mechanical ventilation, subjects treated with mild hypothermia had less lung edema and lower plasma IL-1ß. Some of known beneficial effects of deep hypothermia can be obtained with mild hypothermia.

Syncope: a rare presentation of massive pulmonary embolism in a previously healthy girl.

Pulmonary embolism is a very infrequent event in previously healthy children, particularly in the outpatient scenario. This report involves a 7-year-old girl who presented to the emergency room after syncope. A prompt diagnostic workup showed a massive pulmonary embolism. A timely treatment initiation permitted a good and rapid response. She represented a diagnostic and treatment challenge, mainly because of the atypical presentation and the absence of known risk factors. Finally, a thorough study uncovered a nephrotic-range urine protein loss. At the beginning, the patient did not meet the whole nephrotic syndrome diagnostic requirements. The complete thombophilic study was normal. The clinical presentation, epidemiology, diagnostic tools and the treatment of pulmonary embolism are reviewed. We also discuss a recently described risk factor, present in our patient, as a potential role in the development of pulmonary embolism.

[Continuous hemofiltration in patients with abdominal complications of hemolytic uremic syndrome]. / Hemofiltración continua en pacientes con complicaciones abdominales del síndrome hemolítico urémico.

BACKGROUND: Close to one half of patients with hemolytic uremic syndrome (HUS) will require a dialytic therapy, mainly peritoneal dialysis (PD). In some cases, PD may have relative or absolute contraindications, usually when HUS is associated to severe intraabdominal complications. AIM: To report the results of continuous hemofiltration use, in children with abdominal complications of HUS. MATERIAL AND METHODS: Retrospective review of the files of 40 patients that were admitted to our pediatric unit with HUS, since 1995. Six children had relevant intra-abdominal complications and were treated with continuous hemofiltration (CHF). Four additional children, with similar HUS related complications and treated with CHF before 1995, were included in the analysis. RESULTS: The age of the patients ranged from 5 to 66 months old. An arterio-venous CHF was performed in four and veno-venous CHF in six children. The duration of CHF was 93.2 hours in average. Adequate control of volemia was achieved in every patient; diafiltration with peritoneal dialysis solution was added in five patients, to improve azotemia. Four patients had complications related to the vascular access or the anticoagulation procedure. The procedure was terminated due to improvement of diuresis in five cases, transfer to PD in four and a cardiorespiratory arrest in one. Only one patient developed a chronic renal failure during the follow up. CONCLUSIONS: CHF is an effective and safe alternative of acute renal replacement therapy in the management of renal failure in pediatric cases with HUS, aggravated with abdominal complications.

Efectos protectores de la hipotermia moderada en modelo de injuria pulmonar inducida por ventilación mecánica / Protector effects of moderated hypothermia in model of pulmonary injury caused by mechanical ventilation

Se ha establecido que el empleo inapropiado de la ventilación mecánica (VM) es capaz de generar daño pulmonar y de amplificar una noxa pulmonar pre-existente. Éste fenómeno mecánico, denominado injuria pulmonar inducida por VM (VILI), es capaz de gatillar consecuencias biológicas locales y a distancia. La hipotermia ha sido empleada en situaciones clínicas que generan un desequilibrio entre la entrega y el consumo tisular de oxígeno, debido a su capacidad de reducir este último. Nuestro objetivo fue determinar el efecto de la hipotermia moderada (HM) sobre marcadores biológicos de VILI e intercambio gaseoso.Se emplearon 12 ratas Sprague-Dawley machos adultas. Tras ser anestesiadas se intubaron y ventilaron mecánicamente en modalidad presión control, PIM 40 cmH2O, ZEEP, FR 60/min, TIM 25 por ciento, FIO2 100 por ciento. Los animales se aleatorizaron a grupos normotermia (N) (37 ± 1ºC) y HM (34 ± 1ºC), medido a nivel de esófago torácico. Se registró gasometría arterial, gravimetría, análisis histológico y medición de concentración de proteínas, interleukina (IL)-1[beta] (IL-1b) y factor de necrosis tumoral (TNF)-[alfa] (TNF-a) en el sobrenadante del lavado bronco alveolar (LBA) y plasma.Los animales con HM redujeron relación peso húmedo/seco y la PaCO2, respecto a los animales normotérmicos, no siendo significativa la mejoría de la PaO2. Hubo además una reducción de los niveles sistémicos de citoquinas inflamatorias en el grupo HM. No hubo diferencias respecto al score histológico de daño pulmonar ni de concentración de proteínas en LBA. En este modelo experimental la HM provocó una reducción del agua extravascular pulmonar y citoquinas inflamatorias plasmáticas, lo que refleja menor daño, asociado a una disminución significativa en la PaCO2. Estos hechos ameritan la realización de nuevos estudios que demuestre su rol como terapia adyuvante al manejo ventilatorio de pulmones agudamente dañados, ampliando el tradicional rol de la HM en cuidados críticos.

The inadequate use of Mechanical Ventilation (MV) has proved to generate lung damage and to increase a pre-existing pulmonary injury. This mechanical event, called ventilator induced lung injury (VILI), can generate local and distant biological effects. Hypothermia has been used in clinical situations, which result in an imbalance between oxygen consumption (VO2) and delivery (DO2) due to its ability to reduce VO2. Our objective was to determine the effect of Moderate Hypothermia (MH) on biological markers of VILI and in gas exchange.Twelve Sprague-Dawley adult male rats were used. After anesthesia, the rats were randomly assigned to normothermia (37ºC) and MH (34ºC), which was induced by surface cooling. They were cannulated and mechanically ventilated with controlled pressure ventilation, PIP 40 cmH2O, ZEEP, (PEEP=0) RR 60/min, Ti 25 percent, FIO2 100 percent. The esophageal temperature was maintained within ± 1°C. Arterial blood gases, lung gravimetry, histological analysis and measurement of protein content, IL-1b and TNF-a were registered in the bronchoalveolar lavage (BAL) supernatant, both cytokines were also measured in plasma.The animals with MH showed a significant reduction in the wet lung weight/dry lung weight ratio and the PaCO2, in relation to the normothermic animals. There was also a reduction of the inflammatory systemic cytokines in the MH group. There were no differences in PaO2, histological score and protein content in BAL. In this experimental model, MH reduced extra vascular lung water, which reflects lesser damage associated to a significative reduction in PaCO2 and inflammatory systemic cytokines. These facts justify new studies, which would prove its role as an aid in the ventilatory management of severely damaged lungs, increasing the traditional role of MH in critical care.

Hacia el desarrollo de un programa nacional de prevención de accidentes / Toward the development of a national programme in accidents prevention

Las recomendaciones enbozadas en este programa son ambiciosas pero la naturaleza del problema en Chile lo requiere. Hay pocos problemas de salud pública que tocan a tantos chilenos como lo hacen los accidentes. Algo que también hace diferente el tema, es el amplio número de disciplinas interrelacionadas en el control de esta epidemia. Una intervención, comienza con el conocimiento capitalizado durante las fases de vigilancia e investigación, para determinar el cómo, quién y porqué de un accidente. Todos tenemos nuestra parte en este gran desafío. Como comunidad, debemos proveernos los recursos y apoyar a nuestros líderes, creando conciencia en el núcleo que nos rodea

Estudio microscópico de fenómenos biológicos asociados a infecciones por cateteres venosos centrales / Microscopic study of biological phenomenae associated to infections related to central venous catheters

Las complicaciones infecciosas son la principal limitación del uso de cateteres venosos centrales. Se presenta aquí un estudio descriptivo, mediante microscopía de barrido, de la formación de una matriz biológica en el interior y exterior del catéter como condicionante de la adherencia y crecimiento de bacterias, comprobándose que es un fenómeno que se presenta con alta frecuencia al permanecer estos dispositivos de poliuretano en el medio intravascular y subcutáneo. En este estudio preliminar se observa una adecuada correlación ente la observación de colonización del catéter por microscopía y el resultado de cultivo semicuantitativo de la punta de éste. La colonización del catéter, si bien representa uno de los eventos iniciales asociados a infección, no siempre se acompaña de signos clínicos o de bacteremia