Efecto del bloqueo neuromuscular sobre la monitorización biespectral en los niños críticamente enfermos / Effect of neuromuscular blockade on the bispectral index in critically ill patients

INTRODUCCIÓN: Estudios previos sugieren que el bloqueo neuromuscular (BNM) altera la monitorización del índice biespectral (BIS) en los niños sedados. El objetivo fue analizar la repercusión del uso y suspensión del BNM en la monitorización BIS en niños críticamente enfermos. MÉTODOS: Estudio observacional prospectivo. Se incluyeron los niños que recibían perfusiones intravenosas de vecuronio con monitorización BIS. Se analizaron variables clínicas, diagnósticas, hemodinámicas, sedoanalgesia y relajantes musculares y parámetros del BIS. Se compararon los valores del BIS antes del uso de relajantes neuromusculares, durante su administración, antes de su retirada y durante las 24 h siguientes a su suspensión. RESULTADOS: Treinta y cinco pacientes (edad mediana 30 meses). El diagnóstico más frecuente fue cardiopatía (85%). Las indicaciones más frecuentes para iniciar relajantes neuromusculares fueron bajo gasto cardiaco (45%) y adaptación a ventilación mecánica (20%). El BNM no produjo cambios significativos en los valores del BIS. Se observó una disminución de los valores del electromiograma a las 6 h (34,9 ± 9,4 vs. 31,2 ± 7; p = 0,008) y a las 12 h del inicio de la perfusión de vecuronio (34,9 ± 9,4 vs. 28,6 ± 4,8; p = 0,006). Tras retirar el vecuronio hubo un ligero aumento significativo del BIS (de 42,7 ± 11 a 48,4 ± 14,5, p = 0,001), así como en las siguientes 6 y 12 h (51,3 ± 16,6; p = 0,015). No hubo diferencias en las dosis de sedantes o analgésicos, excepto del fentanilo, que fue disminuido tras retirar el vecuronio. CONCLUSIÓN: El BNM continuo produce pequeños cambios en los valores del BIS sin relevancia clínica, y no altera la monitorización del nivel de conciencia del BIS en los niños críticamente enfermos

INTRODUCTION: It has been suggested that neuromuscular blockade (NMB) affects the capacity of bispectral index (BIS) monitoring to measure consciousness in sedated children. Our aim was to analyse the impact of NMB on BIS values in critically ill children. METHODS: We conducted a prospective observational study of children monitored with a BIS system that received a continuous infusion of vecuronium. We analysed data on clinical, diagnostic and haemodynamic variables, sedatives, analgesics, muscle relaxants, and BIS parameters. We compared BIS parameters before the use of a muscle relaxant, during its administration, before its discontinuation and for the 24hours following the end of the infusion. RESULTS: The analysis included 35 patients (median age, 30 months). The most common diagnosis was heart disease (85%). The most frequent indication for initiation of NMB was low cardiac output (45%), followed by adaptation to mechanical ventilation (20%). Neuromuscular blockade did not produce a significant change in BIS values. We found a decrease was observed in electromyography values at 6hours (34.9 ± 9.4 vs. 31.2 ± 7; P=.008) and 12hours after initiation of NMB (34.9 ± 9.4 vs. 28.6 ± 4.8; P=.006). We observed a small significant increase in BIS after discontinuation of NMB (from 42.7 ± 11 to 48.4 ± 14.5, P=.001), and 6 and 12hours later (51.3 ± 16.6; P=.015). There were no differences in the doses of sedatives or analgesics except for fentanyl, of which the dose was lowered after discontinuation of vecuronium. CONCLUSION: Continuous NMB produces small changes on BIS values that are not clinically significant and therefore does not interfere with BIS consciousness monitoring in critically ill children

[Effect of neuromuscular blockade on the bispectral index in critically ill patients]. / Efecto del bloqueo neuromuscular sobre la monitorización biespectral en los niños críticamente enfermos.

INTRODUCTION: It has been suggested that neuromuscular blockade (NMB) affects the capacity of bispectral index (BIS) monitoring to measure consciousness in sedated children. Our aim was to analyse the impact of NMB on BIS values in critically ill children. METHODS: We conducted a prospective observational study of children monitored with a BIS system that received a continuous infusion of vecuronium. We analysed data on clinical, diagnostic and haemodynamic variables, sedatives, analgesics, muscle relaxants, and BIS parameters. We compared BIS parameters before the use of a muscle relaxant, during its administration, before its discontinuation and for the 24hours following the end of the infusion. RESULTS: The analysis included 35 patients (median age, 30 months). The most common diagnosis was heart disease (85%). The most frequent indication for initiation of NMB was low cardiac output (45%), followed by adaptation to mechanical ventilation (20%). Neuromuscular blockade did not produce a significant change in BIS values. We found a decrease was observed in electromyography values at 6hours (34.9 ± 9.4 vs. 31.2 ± 7; P=.008) and 12hours after initiation of NMB (34.9 ± 9.4 vs. 28.6 ± 4.8; P=.006). We observed a small significant increase in BIS after discontinuation of NMB (from 42.7 ± 11 to 48.4 ± 14.5, P=.001), and 6 and 12hours later (51.3 ± 16.6; P=.015). There were no differences in the doses of sedatives or analgesics except for fentanyl, of which the dose was lowered after discontinuation of vecuronium. CONCLUSION: Continuous NMB produces small changes on BIS values that are not clinically significant and therefore does not interfere with BIS consciousness monitoring in critically ill children.

Effect of neuromuscular blockade on the bispectral index in critically ill patients.

INTRODUCTION: It has been suggested that neuromuscular blockade (NMB) affects the capacity of bispectral index (BIS) monitoring to measure consciousness in sedated children. Our aim was to analyse the impact of NMB on BIS values in critically ill children. METHODS: We conducted a prospective observational study of children monitored with a BIS system that received a continuous infusion of vecuronium. We analysed data on clinical, diagnostic and haemodynamic variables, sedatives, analgesics, muscle relaxants, and BIS parameters. We compared BIS parameters before the use of a muscle relaxant, during its administration, before its discontinuation and for the 24h following the end of the infusion. RESULTS: The analysis included 35 patients (median age, 30 months). The most common diagnosis was heart disease (85%). The most frequent indication for initiation of NMB was low cardiac output (45%), followed by adaptation to mechanical ventilation (20%). Neuromuscular blockade did not produce a significant change in BIS values. We found a decrease was observed in electromyography (EMG) values at 6h (34.9±9.4 vs 31.2±7; P=.008) and 12h after initiation of NMB (34.9±9.4 vs 28.6±4.8; P =.006). We observed a small significant increase in BIS after discontinuation of NMB (from 42.7±11 to 48.4±14.5, P=.001), and 6 and 12h later (51.3±16.6; P=.015). There were no differences in the doses of sedatives or analgesics except for fentanyl, of which the dose was lowered after discontinuation of vecuronium. CONCLUSION: Continuous NMB produces small changes on BIS values that are not clinically significant and therefore does not interfere with BIS consciousness monitoring in critically ill children.

Corrigendum: Sleep Characteristics of the Staff Working in a Pediatric Intensive Care Unit Based on a Survey.

[This corrects the article DOI: 10.3389/fped.2017.00288.].

Sleep Characteristics of the Staff Working in a Pediatric Intensive Care Unit Based on a Survey.

The objective is to evaluate the sleep characteristics of the staff working in a pediatric intensive care unit (PICU). They were asked to complete an anonymous survey concerning the characteristics and quality of their sleep, as well as the impact of sleep disturbances on their work and social life, assessed by Functional Outcomes of Sleep Questionnaire (FOSQ)-10 questionnaire. The response rate was 84.6% (85% females): 17% were doctors, 57% nurses, 23% nursing assistants, and 3% porters. 83.8% of them worked on fix shifts and 16.2% did 24-h shifts. 39.8% of workers considered that they had a good sleep quality and 39.8% considered it to be poor or bad. The score was good in 18.2% of the staff and bad in 81.8%. Night shift workers showed significantly worse sleep quality on both the objective and subjective evaluation. There was a weak concordance (kappa 0.267; p = 0.004) between the perceived quality of sleep and the FOSQ-10 evaluation. Sleep disorders affected their emotional state (30.2% of workers) and relationships or social life (22.6%). In conclusion, this study finds that a high percentage of health professionals from PICU suffer from sleep disorders that affect their personal and social life. This negative impact is significantly higher in night shift workers. Many health workers are not aware of their bad sleep quality.

Relación entre apolipoproteínas (APO A1 y APO B100) y el perfil lipídico tradicional como marcadores de riesgo cardiovascular en mujeres / Relation apolipoproteins (APO A1 and APO B100) and the profile lipid traditional with markers of risk cardiovascular in women

La enfermedad arterial coronaria, ha sido la principal causa de muerte en hombres de edad media y mujeres de mayor edad. Se determinó el valor predictivo de la apolipoproteínas (APO A1, APO B100) para comparar su capacidad diagnóstica con el perfil lipídico tradicional. Las apolipoproteínas se analizaron nefelométricamente y el perfil lipídico tradicional por métodos colorimétricos y la fórmula de fridewald. Los triglicéridos (Tg) resultaron ser mejores marcadores (p<0.025), presentaron valor predictivo positivo 82 por ciento, capacidad diagnóstica 87 por ciento, especificidad 80 por ciento, sensibilidad 93 por ciento. La APO B100 no resultó ser un buen marcador de riesgo. La correlación entre Tg y LDLc con APO B100 fue significativa (p<0.05). Los resultados obtenidos sugieren que los Tg constituyen un mejor marcador para determinar riesgo cardiovascular en mujeres