Malaltia de Kikuchi-Fujimoto amb afectació axil·lar / Enfermedad de Kikuchi-Fujimoto con afectación axilar / Kikuchi-Fujimoto disease with axillary involvement

Introducció. La malaltia de Kikuchi-Fujimoto, o limfadenitisnecrosant histiocítica, és una malaltia rara i benigna quesol autolimitar-se.Cas clínic. Pacient de 12 anys amb febre de llarga duradad’origen desconegut i una adenopatia axil·lar. L’anàlisi desang no mostrava alteracions específiques de l’origen etiològic del quadre. L’ecografia a la zona axil·lar va evidenciarun conglomerat adenopàtic de 5x7 cm amb signes inflamatoris. Es va fer una tomografia per emissió de positrons -tomografia computada (PET-TC) que mostrava adenopatiessupra- i infradiafragmàtiques hiperactives amb una taxametabòlica moderada-alta; l’adenopatia axil·lar presentavaun centre no metabòlic, suggestiu de necrosi. El diagnòsticdefinitiu de malaltia de Kikuchi-Fujimoto es va establirmitjançant la biòpsia d’un gangli limfàtic, que també vaconduir a la resolució clínica del quadre.Comentaris. Mitjançant aquest cas s’espera poder millorarla pràctica clínica dels pediatres davant d’un cas de febreamb una adenopatia, en què cal excloure causes més freqüents com malalties infeccioses, inflamatòries, autoimmunitàries o oncològiques, i facilitar-los la comprensió dela malaltia de Kikuchi-Fujimoto, ja que sovint no estan familiaritzats amb el diagnòstic d’aquesta entitat i això condueix a cursos inadequats d’antibiòtics i a un augment deltemps fins al diagnòstic definitiu. Cal remarcar que l’extirpació de l’adenopatia sol establir el diagnòstic i resoldre la clínica. (AU)

Introducción. La enfermedad de Kikuchi-Fujimoto, o linfadenitisnecrotizante histiocítica, es una enfermedad rara y benigna quesuele autolimitarse.Caso clínico. Niño de 12 años con fiebre de larga duración deorigen desconocido y una adenopatía axilar. El análisis de sangreno mostraba alteraciones específicas del origen etiológico delcuadro. La ecografía a nivel axilar evidenció un conglomeradoadenopático de 5x7 cm con signos inflamatorios. Se realizó unatomografía de positrones - tomografía computarizada (PET-TC)que mostraba adenopatías supra e infradiafragmáticas vas con una tasa metabólica moderada-alta; la adenopatía axilarpresentaba un centro no metabólico, sugestivo de necrosis. Eldiagnóstico definitivo de enfermedad de Kikuchi-Fujimoto se estableció mediante la biopsia de un ganglio linfático, que tambiéncondujo a la resolución clínica del cuadro.Comentarios. Mediante este caso, se espera poder mejorar la práctica clínica de los pediatras frente a un caso de fiebre con unaadenopatía, donde se tienen que excluir causas más frecuentescomo enfermedades infecciosas, inflamatorias, autoinmunes u oncológicas, y facilitarles comprensión de la enfermedad de KikuchiFujimoto, ya que a menudo no están familiarizado con el diagnóstico de esta entidad y ello conduce a cursos inadecuados deantibióticos y un aumento del tiempo hasta el diagnóstico definitivo. Remarcar que la extirpación de la adenopatía suele establecerel diagnóstico y resuelve la clínica. (AU)

Introduction. Kikuchi-Fujimoto disease, or histiocytic necrotizinglymphadenitis, is a rare and benign self-limited disease.Case report. 12-year-old child with long-lasting fever of unknownorigin and one axillary adenopathy. The blood tests failed to identify the etiological origin of the condition. Axillary ultrasoundshowed a 5x7 cm adenopathy conglomerate with inflammatorysigns. A PET-CT was performed reporting hyperactive supra andinfradiaphragmatic adenopathies with a moderate-high metabolicrate; the axillary adenopathy presented a non-metabolic center,suggestive of necrosis. The definitive diagnosis of Kikuchi-Fujimoto disease was established by biopsy of a lymph node, whichalso led to the clinical resolution of the condition.Comments. Through this case, we aimed at improving the clinicalpractice of pediatricians in the presence of a case of fever with anadenopathy, where more frequent causes such as infectious, inflammatory, autoimmune, or oncologic diseases should be excluded; and to provide a better understanding of Kikuchi-Fujimotodisease, as the diagnosis of this entity is often unfamiliar, whichleads to inappropriate courses of antibiotics and increased timebefore final diagnosis. The excision of the adenopathy usually establishes the diagnosis and resolves the symptoms. (AU)

¿Cuáles son los factores predictores de fracaso de ventilación no invasiva más fiables en una unidad de cuidados intensivos pediátricos? / What are the most reliable predictive factors of non-invasive ventilation failure in paediatric intensive care units?

Introducción: La ventilación no invasiva (VNI) se ha convertido en un tratamiento habitual de la insuficiencia respiratoria aguda (IRA). Nuestro objetivo ha sido identificar factores predictores de fracaso de VNI para detectar precozmente a los pacientes en los que no tendrá éxito. Pacientes y métodos: Estudio de cohortes prospectivo que incluyó a todos los pacientes con IRA que recibieron VNI como tratamiento inicial entre 2005 y 2009, en una unidad de cuidados intensivos pediátricos de 14 camas de un hospital universitario de tercer nivel. Se recogieron datos clínicos e información sobre la VNI, previamente a su inicio, a las 2, 8, 12 y 24 horas. La razón entre saturación de hemoglobina y fracción de oxígeno inspirada (S/F) se calculó retrospectivamente. Se definió fallo de VNI como necesidad de intubación o necesidad de rescate con presión binivel (BLPAP). Se realizaron análisis estadísticos univariable y multivariable. Resultados: Un total de n = 282 pacientes recibieron soporte no invasivo, presión continua = 71, BLPAP = 211. El porcentaje de éxito de la muestra global fue 71%. Los pacientes tratados con BLPAP vs. presión continua, aquellos con S/F más elevados a las 2horas (odds ratio 0,991, IC 95%: 0,986-0,996, p = 0,001) y los mayores de 6 meses (hazard ratio 0,375, IC 95% 0,171-0,820, p = 0,014), presentaron menor riesgo de fracaso. Los pacientes con frecuencias cardíacas más altas y mayor presión positiva inspiratoria en vía aérea a las 2horas (odds ratio 1,021, IC 95%: 1,008-1,034, p = 0,001; hazard ratio 1,214, IC 95%: 1,046-1,408, p = 0,011) presentaron mayor riesgo de fracaso. Conclusiones: La edad < 6 meses, S/F, frecuencia cardíaca y presión positiva inspiratoria en la vía aérea a las 2 horas son factores predictores independientes de fracaso de VNI inicial en pacientes con IRA admitidos en una unidad de cuidados intensivos pediátricos

Introduction: Despite there being limited evidence, non-invasive ventilation (NIV) has become a common treatment for acute respiratory failure (ARF). The aim of this study was to identify the predictive factors of NIV failure, in order to enable early detection of patients failing the treatment. Patients and methods: Prospective cohort study was conducted that included all ARF patients that received NIV as the initial treatment between 2005 and 2009 in a fourteen-bed Paediatric Intensive Care Unit (PICU) of a tertiary university hospital. Information was collected about the NIV, as well as clinical data prior to NIV, at 2, 8, 12, and 24hrs. The haemoglobin saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio (S/F) was retrospectively calculated. NIV failure was defined as the need for intubation or requiring rescue with bi-level pressure (BLPAP). Univariate and multivariate statistical analyses were performed. Results: A total of 282 patients received non-invasive support, with 71 receiving Continuous Pressure (CPAP), and 211 with BLPAP treatment. The overall success rate was 71%. Patients receiving BLPAP vs. CPAP, patients with higher S/F ratios at 2 hours (odds ratio [OR] 0.991, 95% CI 0.986-0.996, P = .001], and patients older than 6 months (Hazard ratio [HZ] 0.375, 95% CI 0.171-0.820, P = .014], were also more likely to fail. Patients with higher heart rates (HR) at 2hours (OR 1.021, 95% CI [1.008-1.034], P = .001) and higher inspiratory positive airway pressure (IPAP) at 2hours were more prone to failure (HZ 1.214, 95% CI [1.046-1.408], P = .011). Conclusions: Age below 6 months, S/F ratio, HR, and IPAP at 2 hours are independent predictive factors for initial NIV failure in paediatric patients with ARF admitted to the PICU

Comparison in the Management of Respiratory Failure due to Bronchiolitis in a Pediatric ICU Between 2010 and 2016.

BACKGROUND: In recent years, respiratory support in severe bronchiolitis has changed in several aspects: increased use of noninvasive ventilation, new equipment, and implementation of high-flow nasal cannula therapy. OBJECTIVE: To analyze the effectiveness of the changes progressively introduced in the respiratory support of patients with bronchiolitis to reduce the intubation rate. METHODS: This was a retrospective, observational, descriptive study. Patients admitted to the pediatric ICU of Hospital Sant Joan de Déu (Barcelona, Spain) with respiratory failure due to bronchiolitis in the 2010-2011 and 2016-2017 periods were included. Exclusion criteria were the following: patients who were previously intubated and tracheostomized and patients > 1 y. Data collected were demographic, clinical, and ventilatory variables, including the type, equipment used, and length of the respiratory support received. RESULTS: A total of 161 subjects were included: 53 in the 2010-2011 period and 108 in the 2016-2017 period. No clinical differences were observed except the incidence of previous apnea, a diagnosis of sepsis, and procalcitonin values on admission that were higher in the first period. High-flow nasal cannula use before pediatric ICU admission was significantly higher in 2016-2017. A significant increase in the use of the total face mask was observed. The need for invasive ventilation decreased from 37.7% to 17.5%. In the multivariate study, use of interfaces other than the total face mask was identified as the only independent predictive factor for noninvasive ventilation failure, with an odds ratio of 2.5, 95% CI 1.04-6.2 (P = .040). CONCLUSIONS: An important reduction in invasive ventilation was observed. An independent predictive factor for noninvasive ventilation failure was in using an interface other than the total face mask. Implementation of high-flow nasal cannula has not been identified as an independent protective factor for intubation.

[What are the most reliable predictive factors of non-invasive ventilation failure in paediatric intensive care units?] / ¿Cuáles son los factores predictores de fracaso de ventilación no invasiva más fiables en una unidad de cuidados intensivos pediátricos?

INTRODUCTION: Despite there being limited evidence, non-invasive ventilation (NIV) has become a common treatment for acute respiratory failure (ARF). The aim of this study was to identify the predictive factors of NIV failure, in order to enable early detection of patients failing the treatment. PATIENTS AND METHODS: Prospective cohort study was conducted that included all ARF patients that received NIV as the initial treatment between 2005 and 2009 in a fourteen-bed Paediatric Intensive Care Unit (PICU) of a tertiary university hospital. Information was collected about the NIV, as well as clinical data prior to NIV, at 2, 8, 12, and 24hrs. The haemoglobin saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio (S/F) was retrospectively calculated. NIV failure was defined as the need for intubation or requiring rescue with bi-level pressure (BLPAP). Univariate and multivariate statistical analyses were performed. RESULTS: A total of 282 patients received non-invasive support, with 71 receiving Continuous Pressure (CPAP), and 211 with BLPAP treatment. The overall success rate was 71%. Patients receiving BLPAP vs. CPAP, patients with higher S/F ratios at 2hours (odds ratio [OR] 0.991, 95% CI 0.986-0.996, P=.001], and patients older than 6 months (Hazard ratio [HZ] 0.375, 95% CI 0.171-0.820, P=.014], were also more likely to fail. Patients with higher heart rates (HR) at 2hours (OR 1.021, 95% CI [1.008-1.034], P=.001) and higher inspiratory positive airway pressure (IPAP) at 2hours were more prone to failure (HZ 1.214, 95% CI [1.046-1.408], P=.011). CONCLUSIONS: Age below 6 months, S/F ratio, HR, and IPAP at 2hours are independent predictive factors for initial NIV failure in paediatric patients with ARF admitted to the PICU.