Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department.

OBJECTIVE: We aimed to analyse the prevalence, characteristics, and management of simple and complex febrile seizures. The secondary objective was to compare the risk of underlying organic lesion and epilepsy in both types of seizures, with a particular focus on the different subtypes defining a complex febrile seizure. MATERIAL AND METHODS: We performed a retrospective cohort study including patients aged 0--16 years who were treated for febrile seizures in the paediatric emergency department of a tertiary hospital over a period of 5 years. Epidemiological and clinical variables were collected. Patients were followed up for at least 2 years to confirm the final diagnosis. RESULTS: We identified 654 patients with febrile seizures, with a prevalence of 0.20% (95% CI, 0.18-0.22); 537 (82%) had simple febrile seizures and 117 (18%) had complex febrile seizures. The clinical and epidemiological characteristics of both types were similar. Significantly more complementary tests were requested for complex febrile seizures: blood tests (71.8% vs 24.2% for simple febrile seizures), urine analysis (10.3% vs 2.4%), lumbar puncture (14.5% vs 1.5%), and CT (7.7% vs 0%). Similarly, admission was indicated more frequently (41.0% vs 6.1%). Underlying organic lesions (central nervous system infection, metabolic disease, tumour/intracranial space-occupying lesion, intoxication) were diagnosed in only 11 patients, 5 of whom had complex forms (4.3%; 95% CI, 0.6-7.9). Risk factors for developing epilepsy, identified in the multivariate analysis, were complex forms with recurrent seizures in a single attack (odds ratio [OR]: 4.94; 95% CI, 1.29-18.95), history of seizures (OR: 17.97; 95% CI, 2.26--143.10), and seizures presenting at atypical ages (OR: 11.69; 95% CI, 1.99-68.61). CONCLUSIONS: The systematic indication of complementary tests or hospital admission of patients with complex febrile seizures is unnecessary. The risk of epilepsy in patients with complex forms gives rise to the need for follow-up in paediatric neurology departments.

Convulsiones febriles simples y complejas, ¿son tan diferentes? Manejo y complicaciones en urgencias / Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department

Objetivo: Analizar la prevalencia, características y manejo de las convulsiones febriles simples y complejas. Secundariamente, comparar el riesgo de lesión orgánica subyacente y epilepsia entre ambos tipos de crisis y particularmente de cada subtipo que define una convulsión febril compleja. Material y método: Estudio de cohortes retrospectivo que incluye pacientes de 0-16 años que consultan por convulsión febril en urgencias pediátricas de un hospital terciario durante 5 años. Se recogen variables epidemiológicas y clínicas. Se realiza un seguimiento posterior mínimo de 2 años para confirmar el diagnóstico final. Resultados: Se incluyeron 654 convulsiones febriles, con una prevalencia del 0,20% (IC 95%: 0,18-0,22%); 537 fueron simples (82%) y 117 complejas (18%). Las características clínico-epidemiológicas de ambos tipos fueron similares. En las formas complejas se solicitaron significativamente más pruebas complementarias en forma de analíticas (71,8% vs. 24,2%), tóxicos (10,3% vs. 2,4%), punción lumbar (14,5% vs. 1,5%) y TAC (7,7% vs. 0%). Igualmente se indicó ingreso con mayor frecuencia (41,0% vs. 6,1%). No se diagnosticó ninguna lesión orgánica subyacente (infección del sistema nervioso central, enfermedad metabólica, tumor/lesión intracraneal ocupante de espacio, intoxicación) excepto 11 casos de epilepsia, 5 de ellas en las formas complejas (4,3%; IC 95%: 0,6-7,9%). En el análisis multivariable presentaron mayor riesgo de desarrollar epilepsia las formas complejas por ser recurrentes en el mismo proceso febril (odds ratio [OR]: 4,94; IC 95%: 1,29-18,95), aquellos con antecedentes de crisis previas (OR: 17,97; IC 95%: 2,26-143,10) y las manifestadas a edades atípicas (OR: 11,69; IC 95%: 1,99-68,61). Conclusiones: No está justificada la indicación sistemática de pruebas complementarias o ingreso en las convulsiones febriles complejas. El riesgo de epilepsia en las formas complejas hace necesario el seguimiento en neuropediatría. (AU)

Objective: We aimed to analyse the prevalence, characteristics, and management of simple and complex febrile seizures. The secondary objective was to compare the risk of underlying organic lesion and epilepsy in both types of seizures, with a particular focus on the different subtypes defining a complex febrile seizure. Material and methods: We performed a retrospective cohort study including patients aged 0-16 years who were treated for febrile seizures in the paediatric emergency department of a tertiary hospital over a period of 5 years. Epidemiological and clinical variables were collected. Patients were followed up for at least 2 years to confirm the final diagnosis. Results: We identified 654 patients with febrile seizures, with a prevalence of 0.20% (95% CI, 0.18-0.22); 537 (82%) had simple febrile seizures and 117 (18%) had complex febrile seizures. The clinical and epidemiological characteristics of both types were similar. Significantly more complementary tests were requested for complex febrile seizures: blood tests (71.8% vs 24.2% for simple febrile seizures), urine analysis (10.3% vs 2.4%), lumbar puncture (14.5% vs 1.5%), and CT (7.7% vs 0%). Similarly, admission was indicated more frequently (41.0% vs 6.1%). Underlying organic lesions (central nervous system infection, metabolic disease, tumour/intracranial space-occupying lesion, intoxication) were diagnosed in only 11 patients, 5 of whom had complex forms (4.3%; 95% CI, 0.6-7.9). Risk factors for developing epilepsy, identified in the multivariate analysis, were complex forms with recurrent seizures in a single attack (odds ratio [OR]: 4.94; 95% CI, 1.29-18.95), history of seizures (OR: 17.97; 95% CI, 2.26-143.10), and seizures presenting at atypical ages (OR: 11.69; 95% CI, 1.99-68.61). Conclusions: The systematic indication of complementary tests or hospital admission of patients with complex febrile seizures is unnecessary. [...] (AU)

[Perceived quality of care by frequent paediatric healthcare users: A qualitative approach]. / Calidad percibida en población hiperfrecuentadora infantil: una aproximación cualitativa.

INTRODUCTION: Assessing the perceived quality of a healthcare department by its users is essential in a quality management system. In Paediatric Emergency Departments (PED), the demand for urgent care has increased in recent years, as well as an increase in frequent attendance. Paying attention to the opinions of these habitual users by means of qualitative methodology is particularly suitable for assessing the quality of care and identifying opportunities to improve the PED. METHODS: Two focus groups were held with parents of patients (with and without a chronic disease) who visited the PED on 10or more occasions per year in a third level hospital. RESULTS: The participants were satisfied overall with the PED. The treatment received was very positively valued, and they never felt that they had received poorer care due to being frequent users. As main strengths, they also highlighted the professional expertise, the friendliness of staff, the quality of information given, the medication received on discharge from hospital, and the follow-up carried out by the PED. The major improvement opportunities identified included: the contagion risks, the lack of coordination between different levels of care, and the need to improve the inclusion of families in the health care process. CONCLUSIONS: Due to the contributions made by these parents, several improvement strategies have been introduced, such as the implementation of sharing information protocols in shift changes, professional training courses, the establishment of a liaison person between the PED and Primary Care, and a proposal to the Hospital Management Department to assess the identified needs.

Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department. / Convulsiones febriles simples y complejas, ¿son tan diferentes? Manejo y complicaciones en urgencias.

OBJECTIVE: We aimed to analyse the prevalence, characteristics, and management of simple and complex febrile seizures. The secondary objective was to compare the risk of underlying organic lesion and epilepsy in both types of seizures, with a particular focus on the different subtypes defining a complex febrile seizure. MATERIAL AND METHODS: We performed a retrospective cohort study including patients aged 0-16 years who were treated for febrile seizures in the paediatric emergency department of a tertiary hospital over a period of 5 years. Epidemiological and clinical variables were collected. Patients were followed up for at least 2 years to confirm the final diagnosis. RESULTS: We identified 654 patients with febrile seizures, with a prevalence of 0.20% (95% CI, 0.18-0.22); 537 (82%) had simple febrile seizures and 117 (18%) had complex febrile seizures. The clinical and epidemiological characteristics of both types were similar. Significantly more complementary tests were requested for complex febrile seizures: blood tests (71.8% vs 24.2% for simple febrile seizures), urine analysis (10.3% vs 2.4%), lumbar puncture (14.5% vs 1.5%), and CT (7.7% vs 0%). Similarly, admission was indicated more frequently (41.0% vs 6.1%). Underlying organic lesions (central nervous system infection, metabolic disease, tumour/intracranial space-occupying lesion, intoxication) were diagnosed in only 11 patients, 5 of whom had complex forms (4.3%; 95% CI, 0.6-7.9). Risk factors for developing epilepsy, identified in the multivariate analysis, were complex forms with recurrent seizures in a single attack (odds ratio [OR]: 4.94; 95% CI, 1.29-18.95), history of seizures (OR: 17.97; 95% CI, 2.26-143.10), and seizures presenting at atypical ages (OR: 11.69; 95% CI, 1.99-68.61). CONCLUSIONS: The systematic indication of complementary tests or hospital admission of patients with complex febrile seizures is unnecessary. The risk of epilepsy in patients with complex forms gives rise to the need for follow-up in paediatric neurology departments.

[Impact of a strategy to improve the quality of care and risk management in a paediatric emergency department]. / Impacto de una estrategia de mejora de calidad asistencial y gestión de riesgos en un servicio de urgencias pediátricas.

INTRODUCTION: Emergency departments are a high risk area for the occurrence of adverse events. The aim of this study is to analyse the impact of a strategy to improve the quality assurance and risk management in the notification of incidents in our Unit, and describe the improvement actions developed from the reported incidents. MATERIAL AND METHODS: A retrospective observational study was developed during one year, divided into two periods: P1 (Start: training session and implementation of the risk management process), and P2 (Start: feed-back session of incidents reported in P1 and improvement actions developed). In each period, the number of reported incidents in relation to the number of emergencies attended (‰) and the descriptive data of each incident were recorded. The improvement actions developed from the incidents reported in P1 were described. RESULTS: The number of notifications from P1 (4.1‰; 95%CI 3.2-5.0‰) increased in P2 (10.9‰; 95%CI 9.8-10.2‰, P<.001). The most frequent incidents in P1 were medication (33.3%), and identification errors (25.9%): both were significantly reduced in P2 (16.9%, P=.001 and 9.3%, P<.001, respectively). In P2, prescription errors of the P1 were reduced (35.9% vs 62.9%, P=.02). The factors of "Knowledge and training" (23.5%) were the most frequent in P1, decreasing in P2 (7.4%, P<.001). CONCLUSION: It is considered that the implementation of a risk management process, and the promotion of a safety culture, through training and feed-back sessions to all professionals, contributed to increase the volume of notifications in our Unit. The voluntary and anonymous reporting of incidents is useful to identify risks, and plan corrective measures, contributing to improve quality assurance and patient safety.

Urgencias Pediátricas del Hospital Materno Infantil Gregorio Marañón / Pediatric Emergency Department of the Hospital Materno Infantil Gregorio Marañón

El presente documento refleja un resumen de la organización y actividad actual de la Unidad de Urgencias Pediátricas. Se describe la misión, visión y valores de la unidad. Se comenta la actividad asistencial, con la cartera de servicios, y las líneas de docencia e investigación. A continuación se expondrán las líneas estratégicas y de humanización ya emprendidas y futuras (AU)

This document summarizes the current organization and activity of the Pediatric Emergency Unit, describing its main mission, vision and values. The clinical assistance activities are described, including the services portfolio, and the teaching and research interests. Lastly, the document emphasizes the present and future directions of our humanization strategies (AU)

Asociación entre bronquiolitis moderada-grave y síndrome de secreción inadecuada de hormona antidiurética en urgencias / Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments

OBJETIVOS: Identificar precozmente y analizar las características de pacientes que precisan ingreso por bronquiolitis moderada o grave que cumplen criterios urinarios de SIADH. PACIENTES Y MÉTODOS: Estudio prospectivo observacional, realizado entre octubre de 2012-marzo de 2013 en urgencias pediátricas. Se incluyen menores de 12 meses con bronquiolitis moderada o grave que requieren ingreso. Se consideran criterios urinarios de SIADH: sodio urinario≥40mmol/l, osmolaridad urinaria>500 mOsm/kg y densidad urinaria>1.020g/l. Se recogen variables epidemiológicas y clínicas y se comparan 2 grupos definidos por cumplir o no criterios urinarios de SIADH. RESULTADOS: Se incluyen 126 pacientes con bronquiolitis moderada, 23 (18,6%) cumplen criterios urinarios de SIADH, ninguno grave ni menor de un mes. Los pacientes con criterios urinarios de SIADH tienen mayor incidencia de neumonía y/o atelectasia en la radiografía de tórax (21,7% vs. 1,9%; p = 0,002), peor respuesta al tratamiento con adrenalina (69,5% vs. 28,1%; p = 0,016), mayor asistencia respiratoria: oxigenoterapia de alto flujo (17,4% vs. 7,7%; p = 0,016) y ventilación mecánica no invasiva (13% vs. 5,8%; p = 0,034). Requieren más días oxigenoterapia (p = 0,02) y tratamiento broncodilatador (p = 0,04) y mayor ingreso en cuidados intensivos pediátricos (26,1% vs. 6,8%; p = 0,007). CONCLUSIONES: Los pacientes mayores de 1 mes con bronquiolitis moderada y con criterios urinarios de SIADH tienen peor evolución respiratoria, mayor necesidad de soporte respiratorio, ingreso en UCIP y más alteraciones radiográficas. Por ello recomendamos realizar determinaciones de orina a estos pacientes para detectar precozmente el desarrollo de SIADH y cuidar el manejo hidroelectrolítico, previniendo el desarrollo de complicaciones potencialmente graves

OBJECTIVES: To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). PATIENTS AND METHODS: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. RESULTS: A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). CONCLUSIONS: Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities

[Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments]. / Asociación entre bronquiolitis moderada-grave y síndrome de secreción inadecuada de hormona antidiurética en urgencias.

OBJECTIVES: To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). PATIENTS AND METHODS: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40 mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020 g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. RESULTS: A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). CONCLUSIONS: Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities.

Enfisema retrofaríngeo espontáneo, una entidad rara a considerar / Spontaneous retropharyngeal emphysema: A rare clinical entity

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Utilidad de la procalcitonina en el diagnóstico precoz de apendicitis aguda / Usefulness of procalcitonin in early diagnosis of acute appendicitis

Introducción y objetivo: En los últimos años ha tratado de definirse la utilidad de los diferentes parámetros analíticos inflamatorios en el diagnóstico de la apendicitis aguda. El objetivo de este estudio es determinar el valor de la procalcitonina (PCT) en el diagnóstico precoz de esta entidad, comparándolo con los marcadores analíticos tradicionalmente solicitados en pacientes con dolor abdominal agudo (leucocitos/proteína C reactiva). Método: Estudio prospectivo analítico, durante el periodo comprendido entre julio y diciembre de 2011. Se incluyeron menores de 16 años con dolor abdominal y sospecha clínica de apendicitis. Se procedió al estudio de las variables analíticas (leucocitos, proteína C reactiva [PCR], PCT) y la elaboración de una curva ROC para los parámetros de laboratorio evaluados. Resultados: Se incluyeron 105 pacientes con una media de edad de 10,2 años (±3,3). El diagnóstico de apendicitis se confirmó por histología en el 39% (41/105), clasificándose el 42,5% como apendicitis perforada y el 11,5% como gangrenada. La cifra media de leucocitos fue significativamente mayor en el grupo con apendicitis (15,143/µL frente a 10,723/µL; p <0,001), al igual que el valor de la mediana de PCT (1,4 µg/L [rango: 0,7-6,1] frente a 0,6 µg/L [rango: 0,5-1,8]; p <0,05). El área bajo la curva ROC para la cifra de leucocitos fue de 0,76; los valores obtenidos para la PCR (0,63) y la PCT (0,6) fueron inferiores. La mayoría de los pacientes (94/105), así como los diagnosticados de apendicitis (31/41), mostraron valores de PCT normales. No obstante, el diagnóstico de apendicitis se confirmó en todos los que presentaron un aumento de la PCT, excepto en 2. Todas las apendicitis gangrenadas presentaron una elevación de la PCT. Conclusiones: La PCT no es un buen marcador precoz de apendicitis. No obstante, su elevación actúa como factor predictivo en el diagnóstico de apendicitis y su grado de evolución (AU)

Introduction and objective: Recent studies have tried to define the usefulness of different inflammatory laboratory parameters in the diagnosis of acute appendicitis. The objective of this study is to determine the value of procalcitonin (PCT) in the early diagnosis of this entity, compared with traditional laboratory markers in patients with acute abdominal pain (WBC/CRP). Methods: Prospective analytical study. Period: July to December 2011. Inclusion of children under 16 years with abdominal pain and clinical suspicion of appendicitis. Analytical analysis (leukocytes, CRP, PCT) and development of a ROC curve for laboratory parameters evaluated. Results: We included 105 patients with a mean age 10.2 years (± 3.3). The diagnosis of appendicitis was confirmed by histology in 39% (41/105), 42.5% of them were classified as perforated appendicitis and 11.5% as gangrenous. The average number of leukocytes was significantly higher in the group with appendicitis (15.143/μL vs 10.723/μL; p <0.001), like the median value of PCT (1.4 µg/L [0.7 to 6.1] vs 0.6 µg/L [0.5 to 1.8]; p <0.05). The area under the ROC curve for leukocyte count was 0.76; the values obtained for the PCR (0.63) and PCT (0.6) were lower. The majority of patients (94/105) and those diagnosed of appendicitis (31/41) showed normal PCT values. The diagnosis of appendicitis was confirmed in those with increased PCT, but 2. All patients with gangrenous appendicitis had elevation of PCT. Conclusions: PCT is not a good early marker of appendicitis. However, his elevation acts as a predictor for the diagnosis of appendicitis and its degree of evolution (AU)

Productos homeopáticos: la importancia de una correcta información / Homeopathic products: The importance of correct information

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Una causa inusual de obstrucción intestinal en niños: hematoma intestinal secundario a heparina de bajo peso molecular / An unusual cause of intestinal obstruction in children: intestinal haematoma due to low molecular weight heparin

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Sospecha de infección urinaria en el lactante menor de 3 meses: ¿cuándo realizar una punción lumbar? / Suspicion of urinary tract infection among 0-3 monthinfants: when to perform a lumbar puncture?

Objetivo: Estudiar la incidencia de meningitis bacteriana en lactantes menores de 3 meses con sospecha de infección urinaria. Métodos: Estudio retrospectivo mediante revisión de historias clínicas de todos los niños menores de 3 meses en los que se obtuvo un sedimento de orina por sondaje vesical patológico en el servicio de urgencias. Se realizó una punción lumbar a todos los niños menores de 1 mes y a todos los niños con afectación del estado general durante el periodo comprendido entre octubre de 2004 y julio de 2010. Resultados: El estudio incluyó a 290 pacientes con sospecha de infección urinaria. El 76% eran niños y el 24% niñas; un 43% de los pacientes eran menores de 1 mes. La infección de orina se confirmó por urocultivo en 230 niños, y 9 (3,2%) de ellos asociaban bacteriemia. Se realizó una punción lumbar en 167 pacientes (58%), entre los que se encontraron 7 (4%) casos de pleocitosis, cuyo cultivo de líquido cefalorraquídeo fue negativo, y 1 caso de meningitis por Escherichia coli en un neonato de 24 días, con urocultivo positivo para el mismo germen. Conclusiones: La incidencia de meningitis bacteriana en niños menores de 3 meses con sospecha de infección de orina en el estudio fue del 0,6%. Es importante reconsiderar la realización de una punción lumbar sistemática en estos pacientes, aunque parece prudente mantener su indicación en los menores de 1 mes y en los casos de sospecha por clínica o analítica de infección bacteriana severa(AU)

Objective: To study the rate of bacterial meningitis among infants aged 0-3 months with suspicion of urinary tract infection. Methods: This retrospective chart review involved all children younger than 3 months with pathologic rapid urine testing by urethral catheterization in the emergency department. Lumbar puncture was performed in all children <1 month and every child 1-3 months with septic appearance. The study was conducted from October 2004 to July 2010.Results: The study sample included 290 children with suspicion of urinary tract infection, of whom 76% boys and 24% girls; 43% of all patients were younger than one month. Urinary tract infection was confirmed by positive urine culture in 230 children, 9 of whom (3.2%) had bacteraemia associated. Lumbar puncture was performed on 167 patients (58%), of whom 7 (4%) had CSF pleocytosis. All CSF cultures were negative except of a case of a neonate 24 days old with meningitis and urinary tract infection caused by Escherichia coli. Conclusions: The incidence of bacterial meningitis among infants aged 0-3 months with suspicion of urinary tract infection was 0.6% in our study. It is important to reconsider the performance of lumbar puncture systematically in these children, although it is still need in children aged less than 1 month and in cases where there is clinical or laboratory test suspicion of serious bacterial infection(AU)

Heliox como tratamiento del crup moderado / Heliox as treatment for mild croup

Objetivos: El heliox (mezcla de helio y oxígeno) atraviesa mejor que el oxígeno una obstrucción de la vía respiratoria. El objetivo de este estudio fue evaluar la eficacia de la administración de heliox en el crup. Material y método: Ensayo clínico, abierto y aleatorizado, realizado entre octubre de 2006 y noviembre de 2007 en niños con crup moderado, según la puntuación de la escala de Taussig. Se administró una dosis única de dexametasona de 0,3 mg/kg por vía oral. Se aleatorizaron los pacientes en dos grupos: grupo A, de control, y grupo B, en el que se administró heliox 70/30 durante 1 hora. Se analizó la escala de Taussig y la frecuencia respiratoria al ingreso, a los 60 y a los 120 minutos, así como la necesidad de adrenalina nebulizada de rescate, la tasa de ingreso y la reconsulta en las siguientes 72 horas. Resultados: Se incluyeron en el estudio 47 pacientes, 23 en el grupo A y 24 en el grupo B. Ambos grupos eran homogéneos. La puntuación de la escala de Taussig al inicio, a los 60 y a los 120 minutos (grupo A/grupo B) fue de 6,22/6,21, 3,74/2,63(p= 0,02) y 2,17/1,46 (p= 0,17), respectivamente. La frecuencia respiratoria al inicio, a los 60 y a los 120 minutos (grupo A/grupo B) fue de 37,48/39,13, 35,61/30,67 (p= 0,04), 32,17/29 (p= 0,16),respectivamente. Precisaron adrenalina nebulizada de rescate 5 pacientes del grupo A frente a 1 paciente del grupo B (p= 0,01). Ingresaron 2 pacientes del grupo A y 1 paciente del grupo B (p= 0,609). Acudieron al servicio de urgencias en las siguientes 72 horas 2 pacientes del grupo A y 2 del grupo B (p= 1). Conclusión: El tratamiento coadyuvante con heliox a la terapia esteroidea en el crup moderado mejora la clínica de esta afección (AU)

Objectives: Heliox (a mixture of helium and oxygen) crosses an obstruction of the airways better than oxygen. The objective of the study was to evaluate the efficacy of the administration of heliox in croup. Material and method: A randomized, open clinical trial carried out between October 2006 and November 2007, in children with moderate croup as per Taussig scale. A single dose of 0.3 mg/kg of dexamethasone was administered orally. The patients were randomized in two groups, control group A and group B, administering heliox 70/30 during one hour. The Taussig scale and the respiratory frequency upon admission were analyzed, 60‘ and 120‘; as well as the need of nebulized rescue adrenaline, the admission rate, and the re- consultation within the following 72 hours. Results: Forty-seven patients were included in the study; 23 in group A and 24 in group B. Both groups were homogenous. Thei nitial Taussig scale, 60‘ and 120‘ (group A/group B) was of 6.22/6.21; 3.74/2.63 (p= 0.02); 2.17/1.46 (p= 0.17) respectively. The respiratory frequency at the beginning, 60‘ and 120‘ (group A/group B) was of 37.48/39.13; 35.61/30.67 (p= 0.04); 32.17/29 (p= 0.16) respectively. Five patients from group A needed nebulized rescue adrenaline versus 1 patient from group B (p= 0.01). Two patients from group A were admitted and 1 patient from group B (p= 0.609). In the following 72 hours, 2 patients from group A and two patients from group B came to our emergency room (p= 1). Conclusion: The coadjuvant treatment with heliox to the steroid therapy in moderate croup improves the clinical results of the latter (AU)

[Heliox-driven bronchodilator nebulization in the treatment of infants with bronchiolitis]. / Heliox como fuente de nebulización del tratamiento broncodilatador en lactantes con bronquiolitis.

INTRODUCTION: Heliox is a helium-oxygen mixture which improves laminar flow and decreases airway resistance and the work of breathing. The aim of this study was to assess the effects of salbutamol or epinephrine nebulization driven by heliox in infants with moderate-to-severe bronchiolitis. MATERIALS AND METHODS: This prospective, observational, interventional, controlled and randomized study included ninety-six children who came to our pediatric emergency department with first episode of moderate-to-severe bronchiolitis. The patients were randomized to receive salbutamol or epinephrine nebulized with either oxygen (control group) or heliox (70% helium and 30% oxygen) as the driving gas. Heart rate, respiratory rate, pulse oximetry oxygen saturation and clinical score were measured before and after the treatment period. We also reported hospitalization rates and the number of patients who returned to the emergency department in the following seventy two hours. RESULTS: There were no significant differences between both groups. The only statistically significant difference was that, in the heliox group, patients with severe bronchiolitis needed a lower number of nebulizations than infants in the control group. CONCLUSIONS: According to our study, heliox-driven salbutamol or epinephrine is not an effective therapy in patients with acute bronchiolitis.