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Subject(s)
Humans , Child , Monitoring, Physiologic/methods , Critical Care/methods , Shock/diagnosis , Intensive Care Units, Pediatric , Hemodynamics/physiology , Cardiac Output, High/diagnosis , Cardiac Output, Low/diagnosis , Microcirculation/physiology , Blood Gas Monitoring, Transcutaneous/methods , Manometry/methods , Hypoxia/diagnosis , Atrial Natriuretic Factor/analysis , Troponin/analysisABSTRACT
Objetivo: Analizar la eficacia y tolerancia de la ventilación mecánica no invasiva (VMNI) a través de unas cánulas de oxigenoterapia de alto flujo en niños con insuficiencia respiratoria moderada y/o tras retirada de ventilación mecánica. Pacientes y métodos: Estudio clínico prospectivo observacional en el que se estudió a 34 pacientes de edades comprendidas entre 9 meses y 17 años, tratados con VMNI a través de unas cánulas nasales de oxigenoterapia de alto flujo de adulto. Se analizaron las siguientes variables: edad, sexo, frecuencia respiratoria, cardiaca, saturación de oxígeno, gasometría, mejoría clínica, tolerancia, aparición de complicaciones y fracaso del tratamiento. Resultados: Trece pacientes recibieron VMNI de forma programada tras la retirada de la ventilación mecánica y 21 por insuficiencia respiratoria. El 82,3% de los pacientes mejoraron clínicamente y/o toleraron la retirada de ventilación mecánica, aunque no se observó un cambio significativo en la frecuencia respiratoria, frecuencia cardiaca, pH, pCO2 ni saturación. En 6 pacientes (17,6%) la VMNI no fue efectiva y precisó cambio a mascarilla nasal o buconasal (5 pacientes) o intubación (1 paciente). Otros dos pacientes (5,9%) precisaron cambio de interfase a mascarilla nasal o nasobucal, uno por presentar erosión nasal y otro porque aunque mejoró clínicamente, presentaba fugas excesivas. La duración del tratamiento fue de 48 h (rango 1 a 312 h). Conclusiones: La VMNI a través de cánulas nasales de alto flujo es eficaz y bien tolerada en un importante porcentaje de niños tras retirada de ventilación mecánica o con insuficiencia respiratoria moderada (AU)
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 between9 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, pCO2 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 (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Oxygen Inhalation Therapy/instrumentation , Oxygen Inhalation Therapy/methods , Oxygen Inhalation Therapy/trends , Respiratory Insufficiency/therapy , Respiration, Artificial/classification , Respiration, Artificial/trends , Prospective StudiesABSTRACT
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.
Subject(s)
Positive-Pressure Respiration/instrumentation , Catheters , Child, Preschool , Equipment Design , Female , Humans , Male , Prospective Studies , Respiratory Insufficiency/therapyABSTRACT
Objetivos: analizar los factores pronósticos de evolución complicada de los niños con bronquiolitis aguda que requieren ingreso en cuidados intensivos pediátricos (UCIP). Pacientes y método: se realizó un estudio observacional retrospectivo de los niños con bronquiolitis ingresados en la UCIP entre 2000 y 2006. Se realizó un estudio univariable y multivariable para analizar los factores pronósticos de aparición de complicaciones, necesidad de ventilación mecánica, mortalidad e ingreso en UCIP mayor de 15 días. Resultados: se estudió a 110 pacientes; 72 (65,5%) tenían antecedentes personales de alto riesgo: prematuridad (39,1%), cardiopatía congénita (38,2%) y displasia broncopulmonar (16,3%). El 82,7% de los pacientes presentó complicaciones, el 26% precisó ventilación mecánica invasiva y el 3,6% murió. En un 16,4% de los pacientes el ingreso en UCIP fue mayor de 15 días. Los factores asociados a evolución complicada fueron el estado de gravedad clínico y la presencia de cardiopatía para la ventilación mecánica invasiva; el peso<5kg para las complicaciones; la cardiopatía y la necesidad de ventilación mecánica invasiva para larga duración de ingreso, y la ventilación mecánica invasiva y el antecedente de prematuridad para la mortalidad. Conclusiones: los niños con bronquiolitis que ingresan en UCIP presentan una elevada tasa de complicaciones, precisan frecuentemente ventilación mecánica, tienen una duración de ingreso prolongada, y su mortalidad es baja. Los factores que mejor predicen el pronóstico son la gravedad de la insuficiencia respiratoria en el momento de ingreso del niño en la UCIP, la presencia de cardiopatía y el antecedente de prematuridad (AU)
Objective: To analyse the prognostic factors for complications in children with bronchiolitis admitted to a pediatric intensive care unit (PICU). Patients and method: A retrospective study was performed on children with bronchiolitis admitted into a PICU between 2000 and 2006. Univariate and multivariate analysis were performed to study the prognostic factors of complications, mechanical ventilation requirements, mortality and PICU stays of more than 15 days. Results: A total of 110 patients were studied, of whom 72 (65.5%) had high risk factors: prematurity (39.1%), cardiac disease (38.2%) and bronchopulmonary dysplasia (16.3%). A total of 82.7% of patients had complications; 26% need invasive mechanical ventilation and the mortality was 3.6%, and 16.4% stayed in PICU for more than 15 days. Factors associated with mechanical ventilation were the clinical Wood-Downes score and heart disease. A weight less than 5kg was associated with complications; heart disease and invasive mechanical ventilation were associated with a longer PICU stay; prematurity and mechanical ventilation were associated with mortality. Conclusions: Children with bronchiolitis admitted into the PICU had a high frequency of complications, often needed mechanical ventilation and had long stays in the PICU, but the mortality is low. The best prognostic factors on admission into the PICU were the acute respiratory insufficiency score, the presence of heart disease and were premature at birth(AU)
Subject(s)
Humans , Infant , Bronchiolitis/complications , Intensive Care Units, Pediatric , Retrospective Studies , PrognosisABSTRACT
OBJECTIVE: To analyze the changes in respiratory parameters in a Servoi ventilator with heliox. MATERIAL AND METHODS: In vitro study with a Servoi (Maquet) ventilator in volume controlled (VC), pressure controlled (PC) and volume control regulated by pressure (VCPR) modes connected to an artificial lung. A heliox tank with a fixed concentration of helium 70 % and oxygen 30 % was connected to the air inlet of the ventilator. The ventilator was set in VC mode with tidal volumes of 30, 50, 100, 250 and 500 ml; in PC mode with pressure of 20 and 30 cmH(2)O and in VCPR mode with tidal volume of 150 ml. In each case FiO(2) of 21, 30, 40, 50, 60, 70, 80, 90 and 100 % was used. The FiO(2), inspired and expired tidal volume and inspiratory pressure measured by the ventilator and a pitot spirometer (Datex_S5) were compared. RESULTS: In VC and VCPR modes the increase in helium produced a progressive decrease in the pressure needed to administrate the set volume. Heliox also produced a decrease in the tidal volume measured by the spirometer and the tidal expired volume measured by the respirator. In PC mode, heliox produced a progressive increase in the inspired tidal volume, increasing the differences between inspired and expired tidal volumes. CONCLUSIONS: Heliox used with Servoi ventilator produces a decrease in inspiratory pressures in VC and VCPR modes, and an increase in inspiratory tidal volume in PC mode. In all modes heliox reduced the expired tidal volume measured by the ventilator and the spirometer. These changes should be borne in mind if heliox is used with this ventilator.
Subject(s)
Helium/adverse effects , Oxygen/adverse effects , Tidal Volume/drug effects , Ventilators, Mechanical , Airway Resistance , Humans , Lung , Lung Volume Measurements , Oxygen Inhalation Therapy , Respiration, Artificial , Respiratory Mechanics , SpirometryABSTRACT
Objetivo: Analizar las modificaciones de los parámetros en el respirador Servoi con distintas concentraciones de héliox. Material y métodos: Estudio experimental en el que se utilizó un respirador Servoi (Maquet) en modalidades de volumen control (VC), presión control (PC) y volumen controlado regulado por presión (VCRP) conectado a un pulmón de artificial. El héliox se administró mediante una bombona con el 70 % de helio y el 30 % de oxígeno conectada a la entrada de aire del respirador. Se programó el respirador en VC con volúmenes corrientes de 30, 50, 100, 250 y 500 ml, en PC con presión de 20 y 30 cmH2O, y en VCRP con volumen corriente de 150 ml. En cada modalidad se programó una FiO2 de 21, 30, 40, 50, 60, 70, 80, 90 y 100 % y se comparó el volumen corriente inspirado, el espirado y la presión inspiratoria pico medidas por el respirador y por un espirómetro colocado entre la tubuladura y el pulmón de prueba y conectado a un monitor Datex_S5. Resultados: En modalidad de VC y VCRP el aumento de la concentración de helio produjo una disminución progresiva del pico de presión necesario para administrar el volumen programado y una disminución en el volumen corriente medido por el espirómetro y el volumen espirado medido por el respirador. En modalidad de PC el héliox produjo un aumento progresivo del volumen corriente inspirado con incremento en las diferencias entre el volumen corriente inspirado y el espirado. Conclusiones: La administración de héliox en el respirador Servoi produce una disminución de las presiones inspiratorias en las modalidades de VC y VCRP y un aumento del volumen corriente inspirado en la modalidad de PC. En todas las modalidades produce una falsa disminución en el volumen corriente espirado medido por el respirador y el espirómetro. Es necesario tener en cuenta estas alteraciones si se utiliza héliox con este respirador (AU)
Objective: To analyze the changes in respiratory parameters in a Servoi ventilator with heliox. Material and methods: In vitro study with a Servoi (Maquet) ventilator in volume controlled (VC), pressure controlled (PC) and volume control regulated by pressure (VCPR) modes connected to an artificial lung. A heliox tank with a fixed concentration of helium 70 % and oxygen 30 % was connected to the air inlet of the ventilator. The ventilator was set in VC mode with tidal volumes of 30, 50, 100, 250 and 500 ml; in PC mode with pressure of 20 and 30 cmH2O and in VCPR mode with tidal volume of 150 ml. In each case FiO2 of 21, 30, 40, 50, 60, 70, 80, 90 and 100 % was used. The FiO2, inspired and expired tidal volume and inspiratory pressure measured by the ventilator and a pitot spirometer (Datex_S5) were compared. Results: In VC and VCPR modes the increase in helium produced a progressive decrease in the pressure needed to administrate the set volume. Heliox also produced a decrease in the tidal volume measured by the spirometer and the tidal expired volume measured by the respirator. In PC mode, heliox produced a progressive increase in the inspired tidal volume, increasing the differences between inspired and expired tidal volumes. Conclusions: Heliox used with Servoi ventilator produces a decrease in inspiratory pressures in VC and VCPR modes, and an increase in inspiratory tidal volume in PC mode. In all modes heliox reduced the expired tidal volume measured by the ventilator and the spirometer. These changes should be borne in mind if heliox is used with this ventilator (AU)
Subject(s)
Humans , Helium/pharmacokinetics , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Ventilators, Mechanical/standards , Intensive Care Units, Pediatric , Risk FactorsABSTRACT
OBJECTIVE: To analyze the efficacy of a high-flow oxygen therapy system in children with moderate respiratory failure and/or high oxygen requirements. PATIENTS AND METHODS: We performed a prospective, observational clinical study of patients treated with a high-flow oxygen therapy system via nasal cannulae. The following variables were analyzed: clinical severity score, respiratory rate, heart rate, clinical improvement, oxygen saturation, blood gases, complications, and the need for ventilation after starting the treatment. RESULTS: Eighteen treatments were studied in 16 patients (two girls and 14 boys) aged between 2 and 156 months. With the high-flow oxygen therapy system, respiratory rate slightly decreased from 34.5 bpm to 32.2 bpm (p<0.04) and O2 saturation increased from 90.2% to 93.5% (p<0.02). Fourteen patients showed a clinical improvement and/or tolerated the change from the previous respiratory assistance. The duration of treatment was 3 days (range: 6 hours to 25 days). Mild complications (initial irritability and excessive humidity) were observed in two patients, but treatment interruption was not required. No secondary respiratory tract infections were observed. The system was withdrawn in four patients, due to lack of improvement in two patients, deterioration after initial improvement in one patient, and failure of the system's temperature regulation in one patient. CONCLUSIONS: The high-flow oxygen therapy system is effective in a large percentage of children with high oxygen requirements and/or moderate respiratory failure.
Subject(s)
Oxygen Inhalation Therapy/methods , Respiratory Insufficiency/therapy , Adolescent , Catheterization , Child , Child, Preschool , Female , Humans , Infant , Male , Prospective StudiesABSTRACT
Objetivo. Analizar la eficacia de un sistema de oxigenoterapia de alto flujo en niños con insuficiencia respiratoria moderada y/o necesidades elevadas de oxígeno. Pacientes y métodos.Estudio clínico prospectivo observacional en el que se incluyeron los pacientes tratados con un sistema de oxigenoterapia de alto flujo en cánulas nasales. Se analizaron las siguientes variables: puntuación de gravedad clínica, frecuencia respiratoria, cardíaca, mejoría clínica, saturación de oxígeno, gasometría, aparición de complicaciones y necesidad de ventilación no invasiva tras el inicio del tratamiento. Resultados. Se estudiaron 18 tratamientos en 16 pacientes, 2 niñas y 14 niños, de edades comprendidas entre 2 meses y 13 años. Con el sistema de alto flujo se observó una ligera disminución de la frecuencia respiratoria de 34,5 a 32,2 resp./min; p < 0,04, y un aumento de la saturación de oxígeno (SatO2) del 90,2 al 93,5 %; p < 0,02. Un total de 14 pacientes mejoraron clínicamente y/o permitieron el cambio desde la asistencia respiratoria previa. La duración del tratamiento fue de 3 días (rango 6 h a 25 días). En 2 pacientes se observaron complicaciones leves que no obligaron a suspender el tratamiento (irritabilidad inicial y excesiva humedad). No se observaron infecciones respiratorias secundarias. En cuatro pacientes el sistema fue retirado: en dos por falta de mejoría, en otro por empeoramiento tras mejoría inicial, y en el cuarto por fallo en la regulación de temperatura del aparato. Conclusiones. El sistema de oxigenoterapia de alto flujo es eficaz en un elevado porcentaje de niños con necesidades elevadas de oxígeno y/o insuficiencia respiratoria moderada
Objective. To analyze the efficacy of a high-flow oxygen therapy system in children with moderate respiratory failure and/or high oxygen requirements. Patients and methods. We performed a prospective, observational clinical study of patients treated with a high-flow oxygen therapy system via nasal cannulae. The following variables were analyzed: clinical severity score, respiratory rate, heart rate, clinical improvement, oxygen saturation, blood gases, complications, and the need for ventilation after starting the treatment. Results. Eighteen treatments were studied in 16 patients (two girls and 14 boys) aged between 2 and 156 months. With the high-flow oxygen therapy system, respiratory rate slightly decreased from 34.5 bpm to 32.2 bpm (p < 0.04) and O2 saturation increased from 90.2 % to 93.5 % (p < 0.02). Fourteen patients showed a clinical improvement and/or tolerated the change from the previous respiratory assistance. The duration of treatment was 3 days (range: 6 hours to 25 days). Mild complications (initial irritability and excessive humidity) were observed in two patients, but treatment interruption was not required. No secondary respiratory tract infections were observed. The system was withdrawn in four patients, due to lack of improvement in two patients, deterioration after initial improvement in one patient, and failure of the system's temperature regulation in one patient. Conclusions. The high-flow oxygen therapy system is effective in a large percentage of children with high oxygen requirements and/or moderate respiratory failure
Subject(s)
Male , Female , Child , Humans , Oxygen Inhalation Therapy/methods , Respiratory Insufficiency/therapy , Prospective Studies , Critical Care/methods , Intensive Care Units, Pediatric/trends , Severity of Illness IndexABSTRACT
Presentamos un caso de tuberculosis pulmonary en un lactante de mes y medio de edad que ingresa por presentar un cuadro clínico respiratorio progresivo, fiebre y rechazo al alimento. La radiografía de tórax pone de manifiesto un aumento de densidad en la región posterior de hemitórax izquierda, que ejerce un 'efecto masa' en el mediastino posterior. Se muestran las características de esa imagen; se establece el diagnóstico diferencial de las masas localizadas en el mediastino posterior; se destaca la radiografía de tórax como una prueba muy sensible para el diagnóstico de la tuberculosis pulmonar; por último, se señala la pauta de actuación ante una imagen de estas características, así como la importancia en pediatría de ciertas técnicas consideradas agresivas, como la fibrobroncoscopia, pero que en realidad son pruebas sencillas y con una gran productividad diagnóstica y terapéutica
We present a case of pulmonary tuberculosis in a month-and-a-half-old infant who was admitted to the hospital with progressive respiratory problems, fever and food refusal. Chest radiography revealed evidence of increased density in the posterior region of left hemithorax, causing a 'mass effect' in posterior mediastinum. The features of this image are shown, and the authors discuss the differential diagnosis of masses localized inposterior mediastinum, stressing the fact ches radiography is a highly sensitive technique for the diagnosis of pulmonary tuberculosis. Finally, the y point out the approach that should be adopted in the case of images with these features, as well as the importance in pediatrics of certain techniques, such as fiberoptic bronchoscopy, that are considered to be aggressive but, in reality, are simple tests with a high diagnostic and therapeutic yield
Subject(s)
Male , Infant , Humans , Tuberculosis, Pulmonary , Radiography, Thoracic , Diagnosis, Differential , BronchoscopyABSTRACT
Necrotizing fasciitis is a severe infection, with systemic involvement and tissue necrosis. The clinical course is rapid and often fatal. Although this entity is uncommon, early recognition and treatment is essential to improve prognosis. Necrotizing fasciitis should be suspected when there are symptoms of toxicity and there is severe pain, frequently out of proportion to the clinical findings. In addition, in the last few years the incidence of invasive disease due to Streptococcus pyogenes in children has increased. Treatment is based on life support, aggressive debridement, and antimicrobial therapy. Intravenous immunoglobulin (IVIG) as adjunctive therapy seems useful and reduces mortality. The case of an infant with necrotizing fasciitis of four extremities is presented.
Subject(s)
Fasciitis, Necrotizing , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/therapy , Humans , Infant , MaleABSTRACT
La fascitis necrosante es una infección grave, con afectación sistémica y necrosis de tejidos, con un curso rápido y con frecuencia fatal. Aunque es una entidad poco frecuente, debe ser sospechada y tratada precozmente ya que mejora el pronóstico. Pensaremos en ella ante un cuadro tóxico con dolor desproporcionado a los hallazgos en la exploración. La incidencia de enfermedad invasiva por Streptococcus pyogenes en niños está en aumento en los últimos años. El tratamiento se basa en medidas de soporte, desbridamiento quirúrgico amplio y antibioterapia; la asociación de inmunoglobulina inespecífica intravenosa parece beneficiosa, reduciendo la mortalidad. Se presenta el caso de un lactante con fascitis necrosante de las cuatro extremidades
Necrotizing fasciitis is a severe infection, with systemic involvement and tissue necrosis. The clinical course is rapid and often fatal. Although this entity is uncommon, early recognition and treatment is essential to improve prognosis. Necrotizing fasciitis should be suspected when there are symptoms of toxicity and there is severe pain, frequently out of proportion to the clinical findings. In addition, in the last few years the incidence of invasive disease due to Streptococcus pyogenes in children has increased. Treatment is based on life support, aggressive debridement, and antimicrobial therapy. Intravenous immunoglobulin (IVIG) as adjunctive therapy seems useful and reduces mortality. The case of an infant with necrotizing fasciitis of four extremities is presented