Avances en la monitorización de la sedoanalgesia / Advances in monitoring of sedoanalgesia

No disponible

Taponamiento cardiaco secundario a fibrinólisis con dosis bajas de rt-PA / Perioperative haemodynamic complications of ectopia cordis

No disponible

Utilización de cánulas nasales de alto flujo para la ventilación no invasiva en niños / Use of high-flow nasal cannula for non-invasive ventilation in children

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)

[Use of high-flow nasal cannula for non-invasive ventilation in children]. / Utilización de cánulas nasales de alto flujo para la ventilación no invasiva en niños.

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.

[Evaluation of a paediatric critical care training program for residents in paediatrics]. / Evaluación de un programa de formación en cuidados intensivos pediátricos para residentes de pediatría.

OBJECTIVE: To evaluate a training program in paediatric critical care for residents in paediatrics. METHODS: Description of a paediatric critical care training program for residents in paediatrics. To evaluate the results of the program an initial, and final written test, an evaluation by the physician responsible for the program, a self-evaluation by the residents, and a written survey on the quality of the training program, were performed. RESULTS: From April 1998 to August 2009, 156 residents were included in the training program. All residents showed an improvement between the initial and final written test; initial score (5.6+/-1.2), final score (8.6+/-0.7) (P<0.001). Only 14.1% of the residents answered at least 70 % of the questions correctly in the initial test, compared with 96.6 % in the final test (P<0.001). The score in final test was significantly higher than the self-evaluation by the residents (6.7+/-1.2) and the evaluation by the tutor (6.9+/-0.9) (P<0.001). There were no differences between the practical self-evaluation by the residents (6.2+/-1.0) and the practical evaluation by the tutor (6.7+/-0.9). Residents considered the training program as adequate: theoretical education (8.5+/-0.8), resident handbook (9+/-0.9), practical training (8.3+/-1.0), investigation (7.6+/-2.0) and human relationship (9.2+/-0.9). CONCLUSIONS: This training program is an useful educational method for training paediatric intensive care residents. The evaluation of the training program is essential to improve the education in paediatric residents.

Evaluación de un programa de formación en cuidados intensivos pediátricos para residentes de pediatría / Evaluation of a paediatric critical care training program for residents in paediatrics

Objetivo: Evaluar los resultados de un programa de formación en cuidados intensivos pediátricos para residentes de Pediatría. Métodos: Se diseñó un programa de formación en cuidados intensivos pediátricos para médicos residentes de Pediatría y se evaluaron los resultados con una prueba teórica escrita inicial y final, una evaluación por el médico responsable, una autoevaluación de los residentes y una encuesta escrita sobre la calidad del programa. Resultados: Desde abril del 1998 hasta agosto de 2009, se incluyeron a 156 residentes en el programa de formación. Los residentes mostraron mejoría entre la evaluación teórica inicial (5,6±1,2) y la final (8,6±0,7) (p<0,001). Un 14,1% contestó correctamente al menos el 70 % de las preguntas de la evaluación inicial y un 96,6 % de la final (p<0,001). La puntuación teórica final fue significativamente más alta que la autoevaluación de los residentes (6,7±1,2) y la evaluación de los tutores (6,9±0,9) (p<0,001). No hubo diferencias entre la autoevaluación práctica de los residentes (5,8±1,3) y la evaluación práctica del tutor (6,7±0,9). Los residentes consideraron adecuado el programa formativo: formación teórica (8,5±0,8), manual de residentes (9±0,9), educación práctica (8,3±1,0), investigación (7,6±2,0) y trato humano (9,2±0,9). Conclusiones: El programa descrito es un método educativo útil para la formación teórica y práctica de los residentes de Pediatría en cuidados intensivos. La evaluación del programa de entrenamiento es esencial para mejorar la formación de los residentes de Pediatría (AU)

Objective: To evaluate a training program in paediatric critical care for residents in paediatrics. Methods: Description of a paediatric critical care training program for residents in paediatrics. To evaluate the results of the program an initial, and final written test, an evaluation by the physician responsible for the program, a self-evaluation by the residents, and a written survey on the quality of the training program, were performed. Results: From April 1998 to August 2009, 156 residents were included in the training program. All residents showed an improvement between the initial and final written test; initial score (5.6±1.2), final score (8.6±0.7) (P<0.001). Only 14.1% of the residents answered at least 70 % of the questions correctly in the initial test, compared with 96.6 % in the final test (P<0.001). The score in final test was significantly higher than the self-evaluation by the residents (6.7±1.2) and the evaluation by the tutor (6.9±0.9) (P<0.001). There were no differences between the practical self-evaluation by the residents (6.2±1.0) and the practical evaluation by the tutor (6.7±0.9). Residents considered the training program as adequate: theoretical education (8.5±0.8), resident handbook (9±0.9), practical training (8.3±1.0), investigation (7.6±2.0) and human relationship (9.2±0.9). Conclusions: This training program is an useful educational method for training paediatric intensive care residents. The evaluation of the training program is essential to improve the education in paediatric residents (AU)

[The effect of helium on ventilator parameters: in vitro study with a Servoi ventilator]. / Efecto del helio sobre los parámetros de los respiradores en ventilación mecánica: estudio in vitro con el respirador Servoi.

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.

Efecto del helio sobre los parámetros de los respiradores en ventilación mecánica: estudio in vitro con el respirador Servoi / The effect of helium on ventilator parameters: in vitro study with a Servoi ventilator

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)

[Experience with high-flow nasal cannula oxygen therapy in children]. / Experiencia con la oxigenoterapia de alto flujo en cánulas nasales en niños.

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.

Experiencia con la oxigenoterapia de alto flujo en cánulas nasales en niños / Experience with high-flow nasal cannula oxygen therapy in children

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

[Energy expenditure in critically ill children: correlation with clinical characteristics, caloric intake, and predictive equations]. / Consumo calórico en el niño crítico: relación con las características clínicas, el aporte calórico y las fórmulas teóricas de cálculo de las necesidades.

OBJECTIVE: To study energy expenditure (EE) in critically ill infants and children and its correlation with clinical characteristics, treatment, nutrition, caloric intake, and predicted energy expenditure calculated through theoretical formulas. PATIENTS AND METHODS: A prospective observational study was conducted in critically ill infants and children. Indirect calorimetry measurements were performed using the calorimetry module of the S5 Datex monitor. Data on mechanical ventilation, nutrition, and caloric intake were registered. Theoretical equations of energy requirement (WHO/FAO, Harris-Benedict, Caldwell-Kennedy, Maffeis, Fleisch, Kleiber and Hunter) were calculated. The statistical analysis was performed using the SPSS 12.0 package. RESULTS: Sixty-eight EE determinations were performed in 43 critically ill infants and children aged between 10 days and 15 years old. Measured EE was 58.4 (18.4) kcal/kg/day, with wide individual variability. EE was significantly lower in infants and children who had undergone cardiac surgery than in the remainder. No correlation was found between EE and mechanical ventilation parameters, vasoactive drugs, sedatives, or muscle relaxants. A correlation was found between caloric intake and EE. In a high percentage of patients, predictive equations did not accurately estimate EE. The respiratory quotient was not useful to diagnose overfeeding or underfeeding. CONCLUSIONS: Wide individual variability in EE was found in critically ill infants and children. Predictive equations did not accurately estimate EE. Indirect calorimetry measured by a specific module is a simple method that could allow generalized use of EE measurement in critically ill pediatric patients undergoing mechanical ventilation.

[Efficacy of heliox therapy in respiratory insufficiency in infants and children]. / Eficacia del tratamiento con heliox en niños con insuficiencia respiratoria.

OBJECTIVE: To analyze response to heliox therapy in critically ill infants and children with upper and/or lower airway respiratory insufficiency. PATIENTS AND METHODS: Sixty-five patients, aged between 12 days and 8 years old, treated with heliox through facial mask, nasal prongs or non-invasive ventilation were studied. Diagnoses were bronchiolitis (25), upper postextubation respiratory insufficiency (19), respiratory insufficiency after airway surgery (14), and croup-laryngotracheomalacia (7). Response to heliox treatment was measured by the change in clinical scores, respiratory rate, heart rate, pulse oximetry, blood gas analysis, and the need for non-invasive and invasive mechanical ventilation. RESULTS: Fifty-four patients (83.1 %) improved after heliox therapy, with statistically significant differences in clinical score (from 8.7 to 5.5), respiratory rate (from 51.4 to 38.8 rpm), and heart rate (from 161.6 to 145.6 bpm). No changes were observed in saturation or blood gas analysis. After heliox therapy, 29.8 % of patients required non-invasive ventilation and 26.5 % required intubation. Patients with bronchiolitis and those aged less than 1 year had a lesser response to heliox therapy and more frequently required non-invasive ventilation. No significant differences were found in intubation requirements. No adverse effects were observed. CONCLUSIONS: Heliox therapy improved clinical scores in infants and children with upper and lower airway respiratory insufficiency, but a significant percentage of patients needed non-invasive or invasive mechanical ventilation.

Consumo calórico en el niño crítico: relación con las características clínicas, el aporte calórico y las fórmulas teóricas de cálculo de las necesidades / Energy expenditure in critically ill children: correlation with clinical characteristics, caloric intake, and predictive equations

Objetivo Estudiar el consumo calórico en niños críticos, analizando su correlación con las características clínicas, los tratamientos que reciben, el tipo de nutrición y el aporte calórico y valorar la utilidad de las fórmulas teóricas de cálculo de las necesidades energéticas. Pacientes y métodos Estudio analítico de una cohorte prospectiva en niños críticos. Se midió el consumo calórico mediante el módulo de calorimetría indirecta del monitor Datex S5 y se recogieron los datos de la asistencia respiratoria, tipo de nutrición y aporte calórico. Se calcularon las necesidades calóricas teóricas utilizando las fórmulas de la Organización Mundial de la Salud/Organización de la Naciones Unidas para la Alimentación y la Agricultura (OMS/FAO), Harris-Benedict, Caldwell-Kennedy, Maffeis, Fleisch, Kleiber y Hunter. Se realizó estudio estadístico con el paquete SPSS 12.0. Resultados Se realizaron 68 determinaciones de consumo calórico en 43 niños críticos, de edades entre 10 días y 15 años. El consumo calórico fue de 58,4 (18,4) kcal/kg/día con gran variabilidad interindividual. Los niños sometidos a cirugía cardíaca tuvieron un consumo calórico significativamente inferior al resto. No se observó relación entre el consumo calórico con las características de la ventilación mecánica, la administración de fármacos vasoactivos, sedantes ni relajantes musculares. Existió correlación entre el aporte y el consumo calórico. Las fórmulas teóricas no valoraron bien el consumo calórico en un importante porcentaje de pacientes. El cociente respiratorio no permitió diagnosticar la sobrenutrición e infranutrición. Conclusiones Existe una gran variabilidad en el consumo calórico en los niños críticos y las fórmulas teóricas no lo valoran adecuadamente. La calorimetría indirecta realizada por un módulo específico es un método sencillo que puede permitir la generalización de la medición del consumo calórico en los niños críticos con ventilación mecánica

Objective To study energy expenditure (EE) in critically ill infants and children and its correlation with clinical characteristics, treatment, nutrition, caloric intake, and predicted energy expenditure calculated through theoretical formulas. Patients and methods A prospective observational study was conducted in critically ill infants and children. Indirect calorimetry measurements were performed using the calorimetry module of the S5 Datex monitor. Data on mechanical ventilation, nutrition, and caloric intake were registered. Theoretical equations of energy requirement (WHO/FAO, Harris-Benedict, Caldwell-Kennedy, Maffeis, Fleisch, Kleiber and Hunter) were calculated. The statistical analysis was performed using the SPSS 12.0 package. Results Sixty-eight EE determinations were performed in 43 critically ill infants and children aged between 10 days and 15 years old. Measured EE was 58.4 (18.4) kcal/kg/day, with wide individual variability. EE was significantly lower in infants and children who had undergone cardiac surgery than in the remainder. No correlation was found between EE and mechanical ventilation parameters, vasoactive drugs, sedatives, or muscle relaxants. A correlation was found between caloric intake and EE. In a high percentage of patients, predictive equations did not accurately estimate EE. The respiratory quotient was not useful to diagnose overfeeding or underfeeding. Conclusions Wide individual variability in EE was found in critically ill infants and children. Predictive equations did not accurately estimate EE. Indirect calorimetry measured by a specific module is a simple method that could allow generalized use of EE measurement in critically ill pediatric patients undergoing mechanical ventilation

Eficacia del tratamiento con heliox en niños con insuficiencia respiratoria / Efficacy of heliox therapy in respiratory insufficiency in infants and children

Objetivo Analizar la respuesta al heliox en niños con insuficiencia respiratoria de vías altas o bajas. Pacientes y métodos Se estudiaron 65 niños, entre 12 días y 8 años de edad, con los diagnósticos de bronquiolitis (25), insuficiencia respiratoria alta postextubación (19), insuficiencia respiratoria tras cirugía de la vía aérea (14) y laringitis-laringotraqueomalacia (7), que recibieron tratamiento con heliox mediante mascarilla, cánulas nasales o ventilación no invasiva. Se analizó la respuesta al heliox mediante la valoración de puntuaciones clínicas de gravedad, frecuencia respiratoria, frecuencia cardíaca, saturación, gasometría, y necesidad de ventilación no invasiva e invasiva. Resultados Un total de 54 pacientes (83,1 %) mejoraron con heliox, produciéndose una disminución estadísticamente significativa en la puntuación de gravedad clínica de 8,7 a 5,5, la frecuencia respiratoria de 51,4 a 38,8 resp./min y la frecuencia cardíaca de 161,6 a 145,6 lat./min. No se produjo modificación en la saturación ni en la gasometría. Un 29,8 % de los pacientes requirieron posteriormente ventilación no invasiva, y un 26,5 % requirieron intubación. Los niños menores de un año y los diagnosticados de bronquiolitis tuvieron una menor respuesta al heliox y precisaron con mayor frecuencia ventilación no invasiva tras el tratamiento con heliox. No existieron diferencias en la necesidad de ventilación invasiva. El heliox fue bien tolerado sin producir efectos secundarios. Conclusiones El tratamiento con heliox mejora la sintomatología clínica de los niños con insuficiencia respiratoria de vía altas y bajas, pero a pesar de ello un porcentaje importante requiere ventilación mecánica no invasiva o invasiva

Objective To analyze response to heliox therapy in critically ill infants and children with upper and/or lower airway respiratory insufficiency. Patients and methods Sixty-five patients, aged between 12 days and 8 years old, treated with heliox through facial mask, nasal prongs or non-invasive ventilation were studied. Diagnoses were bronchiolitis (25), upper postextubation respiratory insufficiency (19), respiratory insufficiency after airway surgery (14), and croup-laryngotracheomalacia (7). Response to heliox treatment was measured by the change in clinical scores, respiratory rate, heart rate, pulse oximetry, blood gas analysis, and the need for non-invasive and invasive mechanical ventilation. Results Fifty-four patients (83.1 %) improved after heliox therapy, with statistically significant differences in clinical score (from 8.7 to 5.5), respiratory rate (from 51.4 to 38.8 rpm), and heart rate (from 161.6 to 145.6 bpm). No changes were observed in saturation or blood gas analysis. After heliox therapy, 29.8 % of patients required non-invasive ventilation and 26.5 % required intubation. Patients with bronchiolitis and those aged less than 1 year had a lesser response to heliox therapy and more frequently required non-invasive ventilation. No significant differences were found in intubation requirements. No adverse effects were observed. Conclusions Heliox therapy improved clinical scores in infants and children with upper and lower airway respiratory insufficiency, but a significant percentage of patients needed non-invasive or invasive mechanical ventilation

[Middle latency auditory evoked potentials in critical care children: preliminary study]. / Potenciales evocados auditivos de latencia media en el niño críticamente enfermo: estudio preliminar.

BACKGROUND: Middle latency auditory evoked potentials (MLAEP) reflect changes in electroencephalogram waves after an auditory signal and represent the earliest cortical response to acoustic stimulus. They are therefore used to measure variations in the level of consciousness. MLEAP have been used to measure the depth of anesthesia during surgical procedures, but experience in critical care patients is very limited. OBJECTIVE: To analyze the utility of MLAEP for monitoring the level of sedation in critically ill children. METHODS: Level of consciousness was monitored through MLAEP by placing special headphones and three sensors situated in the frontal and preauricular regions. Simultaneously, the level of sedation was measured using the COMFORT scale and the Bispectral Index (BIS) in distinct clinical situations. RESULTS: We studied six critically ill children in whom MLAEP helped us to evaluate the level of consciousness: light sedation, natural sleep, deep sedation, sedation in a paralyzed child, and brain death. MLAEP showed a good correlation with the COMFORT scale and BIS in light and deep sedation and were effective in the early detection of brain death in one patient. In the paralyzed patient, MLAEP was able to detect undersedation. In one patient, a pacemaker interfered with the MLAEP signal. CONCLUSIONS: MLAEP can be useful in evaluating the level of consciousness and sedation in critically ill children. Further studies with larger samples are required to analyze the limitations and reproducibility of this type of monitoring in children of different ages.

[Use of the Bispectral Index in monitoring critically-ill children]. / Aplicación del índice biespectral en la monitorización del niño enfermo crítico.

The Bispectral Index (BIS) is a single numeric value that indicates the depth of hypnosis by estimating the level of electrical activity in the brain through analysis of the frequency bands in the electroencephalogram. The BIS was primarily developed to monitor the level of hypnosis during surgery and has recently begun to be used in critically-ill patients. Currently, there is little experience of the BIS in critically-ill children. We present 6 cases that illustrate the utility of BIS monitoring in the PICU. We assessed sedation and analgesia during mechanical ventilation with and without neuromuscular block in two patients, and the effect of anesthetic agents during a surgical procedure in the PICU. The BIS was also useful in the continuous monitoring of the level of consciousness in a patient with encephalitis and in the early detection of brain death. Pacer-induced artefacts in the BIS value are also described. We conclude that BIS monitoring may be a useful, noninvasive method for assessing the level of hypnosis in critically-ill children.

Aplicación del índice biespectral en la monitorización del niño enfermo crítico / Use of the bispectral index in monitoring critically-ill children

El índice biespectral (BIS) es un número que evalúa el grado de hipnosis al estimar el nivel de actividad eléctrica cerebral mediante el análisis de las frecuencias de las ondas del electroencefalograma (EEG). Desarrollado fundamentalmente para controlar la hipnosis durante la cirugía, ha empezado a utilizarse en los pacientes críticos, aunque hay muy poca experiencia en niños. Presentamos 6 casos en que el BIS permitió ajustar la sedación de 2 pacientes que recibían analgésicos, con y sin relajación muscular, controlar la sedación durante una intervención quirúrgica realizada en la unidad de cuidados intensivos pediátricos (UCIP), monitorizar de manera continuada el estado de consciencia en una niña con encefalitis y detectar precozmente el estado de muerte encefálica. También observamos que el marcapasos cardíaco produce interferencias que pueden alterar el valor del BIS. Concluimos que el BIS es un método no invasivo que puede ser útil para la monitorización del estado de consciencia de los niños enfermos críticos

The Bispectral Index (BIS) is a single numeric value that indicates the depth of hypnosis by estimating the level of electrical activity in the brain through analysis of the frequency bands in the electroencephalogram. The BIS was primarily developed to monitor the level of hypnosis during surgery and has recently begun to be used in critically-ill patients. Currently, there is little experience of the BIS in critically-ill children. We present 6 cases that illustrate the utility of BIS monitoring in the PICU. We assessed sedation and analgesia during mechanical ventilation with and without neuromuscular block in two patients, and the effect of anesthetic agents during a surgical procedure in the PICU. The BIS was also useful in the continuous monitoring of the level of consciousness in a patient with encephalitis and in the early detection of brain death. Pacer-induced artefacts in the BIS value are also described. We conclude that BIS monitoring may be a useful, noninvasive method for assessing the level of hypnosis in critically-ill children