RESUMEN
OBJECTIVE: Asses if Abdominal Compartment Syndrome (ACS) increases the morbidity and mortality of the Pediatric Intensive Care Unit patients and if early recognition and intervention with decompressive therapy will alter outcome and decrease mortality. SETTING: Pediatric Intensive Care Unit of the University Pediatric Hospital-UPR. PATIENTS: All patients admitted to the PICU from July 1, 1999 to June 30, 2002 were enrolled in the study. Those having a distended and/or tense abdomen on physical examination were identified at risk for intra-abdominal hypertension (IAH). IAH was diagnosed if the intra-abdominal pressure (IAP) was above 10 mmHg and with ACS if the IAH was accompanied by: hemodynamic instability, oliguria or anuria, metabolic acidosis and respiratory deterioration. MEASUREMENTS AND MAIN RESULTS: 1052 patients were admitted to PICU. Ten patients with evidence of ACS were identified with an incidence of 0.9. Ages ranged from 6 weeks to 12.3 years. Peak intravesical pressure measurements ranged from 17 to 39 mmHg. Inspiratory pressure was raised from a mean of 21.2 to 32.0 cmH2O. The PCO2 increased from a mean of 35.1 to 63 torr and the pH decreased from a mean of 7.40 to 7.12. Overall mortality was 40for this patient population. CONCLUSIONS: The outcome of pediatric critical care patients depends on multiple variables. Now there is evidence that in a select group of patients IAH and ACS play a significant role in their morbidity and mortality. This makes it mandatory for clinicians taking care of this population to be increasingly aware of this condition.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/terapia , Abdomen , Niño , Preescolar , Diagnóstico Precoz , Unidades de Cuidado Intensivo PediátricoAsunto(s)
Infecciones Bacterianas/diagnóstico , Crup/diagnóstico , Laringitis/diagnóstico , Síndrome de Dificultad Respiratoria/etiología , Traqueítis/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Infecciones Bacterianas/complicaciones , Crup/complicaciones , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Laringitis/complicaciones , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/diagnóstico , Traqueítis/complicaciones , Virosis/diagnósticoAsunto(s)
Epiglotitis/diagnóstico , Laringitis/diagnóstico , Enfermedad Aguda , Niño , Preescolar , Terapia Combinada , Epiglotitis/terapia , Femenino , Humanos , Lactante , Masculino , Estudios ProspectivosRESUMEN
The efficacy of theophylline in preventing severe apnea was evaluated in 17 low-birthweight infants (mean weight, 1,400 gm). Apnea was detected and accurately quantified by 13-hour pneumogram recordings and correlated with serum theophylline levels. Nursing observations coupled with on-line alarm systems detected only 39% of severe apneic episodes as compared to the pneumogram recording technique. Theophylline in six hourly oral doses(1.5 to 4.0 mg/kg) yielded two-hour serum concentrations of 6.6 to 11.0 mug/ml which completely controlled apneic spells exceeding 20 seconds in duration and markedly reduced 10- 19-second apneic episodes and any resultant bradycardia. At these serum levels, toxicity was not observed. Therapy with theophylline should be instituted at a dose of 2 to 3 mg/kg every six hours and the optimum therapeutic dose should be individualized as determined by objective quantitation of apnea and serum theophylline concentration.
