Asunto(s)
Recién Nacido , Derivación y Consulta/estadística & datos numéricos , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/estadística & datos numéricos , Factores de Edad , Causas de Muerte , Niño , Preescolar , Cultura , Familia/psicología , Humanos , Lactante , Unidades de Cuidado Intensivo Neonatal , Unidades de Cuidado Intensivo Pediátrico , Guías de Práctica Clínica como Asunto , Derivación y Consulta/tendencias , Religión , Donantes de Tejidos/psicología , Obtención de Tejidos y Órganos/tendencias , Reino UnidoRESUMEN
PURPOSE: The sublingual microcirculation can be visualised in real time using sidestream dark-field (SDF) imaging. Endothelial activation mediated through adhesion molecules may alter flow patterns in the microcirculation. We studied sublingual microcirculatory disturbances in children with meningococcal disease (MCD) and simultaneously measured plasma levels of adhesion molecules. METHOD: Twenty children admitted to the paediatric intensive care unit (PICU) with MCD were studied. Forty healthy children were controls. The sublingual microcirculation was assessed at admission and at timed intervals until extubation. The microvascular flow index (MFI), capillary density (CD), proportion of perfused vessels (PPV) and perfused vessel density (PVD) were measured using SDF imaging. Plasma intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin and P-selectin were measured at admission and at timed intervals during the course of PICU treatment. RESULTS: Significant reductions in MFI, CD, PPV and PVD were found in children with MCD compared with controls (p < 0.005). These differences had resolved prior to extubation. Initial MFI values predicted the duration of mechanical ventilation, irrespective of the stage of illness at the time of presentation to PICU. There were negative correlations between the ICAM-1, VCAM-1 and E-selectin levels and the microcirculatory MFI and PPV values at the time of admission to PICU (p < 0.005). CONCLUSIONS: Microcirculatory dysfunction is present in children with severe MCD with improvement alongside clinical recovery. Microcirculatory dysfunction correlated with markers of endothelial activation. Sublingual SDF imaging is feasible in children ventilated on PICU for severe sepsis and may prove useful in studies assessing illness severity and therapy.
Asunto(s)
Moléculas de Adhesión Celular/fisiología , Endotelio/metabolismo , Unidades de Cuidado Intensivo Pediátrico , Infecciones Meningocócicas/fisiopatología , Microcirculación/fisiología , Adolescente , Niño , Preescolar , Inglaterra , Femenino , Humanos , Lactante , Masculino , Infecciones Meningocócicas/complicaciones , Suelo de la Boca/irrigación sanguínea , Sepsis/fisiopatología , Índice de Severidad de la EnfermedadRESUMEN
SETTING: Twenty-one of 209 children admitted to the intensive care unit with meningococcal septicemia developed oliguric acute renal failure necessitating renal replacement therapy. PATIENTS: Twelve survivors underwent renal assessment at a median of 4.2 yrs postpresentation. RESULT: Two had abnormal glomerular filtration rate, proteinuria, and hypertension; one had isolated proteinuria; and one had an isolated renal parenchymal defect on DMSA scan. CONCLUSION: Long-term follow-up of this population is recommended.