Structure and composition of microbial communities in the water column from Southern Gulf of Mexico and detection of putative hydrocarbon-degrading microorganisms.

This study assessed the bacterioplankton community and its relationship with environmental variables, including total petroleum hydrocarbon (TPH) concentration, in the Yucatan shelf area of the Southern Gulf of Mexico. Beta diversity analyses based on 16S rRNA sequences indicated variations in the bacterioplankton community structure among sampling sites. PERMANOVA indicated that these variations could be mainly related to changes in depth (5 to 180 m), dissolved oxygen concentration (2.06 to 5.93 mg L-1), and chlorophyll-a concentration (0.184 to 7.65 mg m3). Moreover, SIMPER and one-way ANOVA analyses showed that the shifts in the relative abundances of Synechococcus and Prochlorococcus were related to changes in microbial community composition and chlorophyll-a values. Despite the low TPH content measured in the studied sites (0.01 to 0.86 µL L-1), putative hydrocarbon-degrading bacteria such as Alteromonas, Acinetobacter, Balneola, Erythrobacter, Oleibacter, Roseibacillus, and the MWH-UniP1 aquatic group were detected. The relatively high copy number of the alkB gene detected in the water column by qPCR and the enrichment of hydrocarbon-degrading bacteria obtained during lab crude oil tests exhibited the potential of bacterioplankton communities from the Yucatan shelf to respond to potential hydrocarbon impacts in this important area of the Gulf Mexico.

A giant exoplanet orbiting a very-low-mass star challenges planet formation models.

Surveys have shown that super-Earth and Neptune-mass exoplanets are more frequent than gas giants around low-mass stars, as predicted by the core accretion theory of planet formation. We report the discovery of a giant planet around the very-low-mass star GJ 3512, as determined by optical and near-infrared radial-velocity observations. The planet has a minimum mass of 0.46 Jupiter masses, very high for such a small host star, and an eccentric 204-day orbit. Dynamical models show that the high eccentricity is most likely due to planet-planet interactions. We use simulations to demonstrate that the GJ 3512 planetary system challenges generally accepted formation theories, and that it puts constraints on the planet accretion and migration rates. Disk instabilities may be more efficient in forming planets than previously thought.

Seguimiento del protocolo de profilaxis de náuseas y vómitos postoperatorios en un hospital regional / Monitoring the protocol for postoperative nausea and vomiting prophylaxis in a regional hospital

Introducción: Las náuseas y vómitos postoperatorios (NVPO) tienen una incidencia de hasta el 80%, por lo que es necesario identificar a los pacientes que necesitan profilaxis, e instaurar medidas en función del riesgo. Nuestro objetivo es valorar el grado de adhesión al protocolo de profilaxis de NVPO de nuestro Hospital, tratando de identificar si existen factores que dificultan su cumplimiento. Material y Método: Estudio retrospectivo sobre 100 pacientes durante su estancia en la Unidad de Recuperación Postanestésica, tras ser sometidos a anestesia general. Se identifica el porcentaje de profilaxis no realizada correctamente y sus causas. Resultados: El 76 % de los pacientes recibieron algún fármaco antiemético. El cumplimiento del protocolo has sido únicamente del 15 %, siendo las causas la administración de un mayor número de fármacos de los indicados (48), seguido de la administración de un fármaco inadecuado (17), utilizar menos fármacos de los necesarios (14) y el momento inadecuado de la administración de la profilaxis (14). En algunos casos se han solapado al menos dos procedimientos incorrectos. Conclusiones. El porcentaje de cumplimento del protocolo es bajo. Sin embargo, en la mayoría de los casos se debe a un exceso de fármacos lo que indica una buena concienciación de la necesidad de profilaxis y una alta preocupación de los anestesiólogos de nuestro Hospital por este problema. La valoración de NVPO debería incluirse de forma rutinaria en la valoración preanestésica, mediante protocolos actualizados

Introduction: Postoperative nausea and vomiting (PONV) have a high incidence, so it is necessary to identify the patients who need prophylaxis, establishing risk-based measures. Our objetive is to assess the degree of adherence to the protocol for PONV prophylaxis in our Hospital, trying to identify if there are factors that hinder the accomplishment. Material and Methods: We realized a retrospective study with 100 patients after general anesthesia, during their stay in the post-anesthesia recovery unit. We identified the percentage of prophylaxis not performed correctly and their causes. Results: 76% of patients received antiemetic drugs. The protocol accomplishment has been only 15%, and the causes were the administration of more drugs than indicated (48), the administration of an inappropriate drug (17), the use of fewer drugs than required (14) and the inappropriate timing of administration (14). In some cases they have overlapped at least two incorrect procedures. Conclusions: The acomplisment with our protocol was low. However, in most cases it was due to an excess of drugs, indicating that the anesthesiologists in our Hospital have a high concern for this problem. The assessment of PONV should be included routinely in the pre-anesthetic assessment, using updated protocols

Six Serum miRNAs Fail to Validate as Myotonic Dystrophy Type 1 Biomarkers.

Myotonic dystrophy type 1 (DM1) is an autosomal dominant genetic disease caused by expansion of a CTG microsatellite in the 3' untranslated region of the DMPK gene. Despite characteristic muscular, cardiac, and neuropsychological symptoms, CTG trinucleotide repeats are unstable both in the somatic and germinal lines, making the age of onset, clinical presentation, and disease severity very variable. A molecular biomarker to stratify patients and to follow disease progression is, thus, an unmet medical need. Looking for a novel biomarker, and given that specific miRNAs have been found to be misregulated in DM1 heart and muscle tissues, we profiled the expression of 175 known serum miRNAs in DM1 samples. The differences detected between patients and controls were less than 2.6 fold for all of them and a selection of six candidate miRNAs, miR-103, miR-107, miR-21, miR-29a, miR-30c, and miR-652 all failed to show consistent differences in serum expression in subsequent validation experiments.

Utilización del factor VII activado recombinante en niños no hemofílicos / Use of recombinant activated factor VII in non-hemophilic pediatric patients

Objetivo: El objetivo de este estudio es determinar la eficacia del factor VII activado recombinante (rFVIIa) en el tratamiento de la hemorragia incontrolable en niños no hemofílicos. Pacientes y método: Estudio retrospectivo y observacional de los niños no hemofílicos tratados con rFVIIa en nuestro hospital durante el periodo comprendido entre enero de 2005 y diciembre de 2011, como tratamiento coadyuvante de una hemorragia masiva incontrolable. Las variables estudiadas fueron las siguientes: edad, sexo, año de administración, número y cantidad de dosis, cese del sangrado y disminución de requerimientos transfusionales, valores de tiempo de protrombina, tiempo de tromplastina parcial activada, ratio internacional normalizada, recuento plaquetario y fibrinógeno en las 4 horas previas y posteriores a la administración de rFVIIa. Se realizó un análisis comparativo con la prueba de la χ2 o el test exacto de Fisher para las variables cualitativas y la prueba de la U de Mann-Whitney o el test de Wilcoxon para las cuantitativas. El nivel de significación se fijó en un valor de p <0,05. Resultados: Un total de 21 pacientes recibieron rFVIIa. El 74,1% tenía una cardiopatía congénita como patología de base, y la hemorragia quirúrgica cardiovascular fue la causa de sangrado más frecuente (47,6%). La dosis media utilizada fue de 93,4 ± 29,47 µg/kg. En el 81% de los casos se consiguió el control clínico del sangrado, y en el 71,4% disminuyeron las transfusiones post-rFVIIa de hematíes (p= 0,014) y plaquetas (p= 0,004). Ningún paciente desarrolló episodios tromboembólicos. La mortalidad global fue del 33%. Conclusiones: El uso de rFVIIa administrado como parte del tratamiento de una hemorragia incontrolable se asocia a un mejor control del sangrado y una disminución de los requerimientos de transfusión de productos sanguíneos, sin asociar efectos adversos (AU)

Objective: Determinate the efficacy of recombinant activated factor VII (rFVIIa) in the treatment of uncontrollable bleeding in non-hemophilic pediatric patients. Patients and methods: Retrospective observational study of non-hemophilic children treated with rFVIIa in our hospital during the period January 2005 to December 2011, as adjunctive therapy for uncontrollable massive bleeding. Study variables: age, sex, year of administration, number and amount of dose, cessation of bleeding and decreased transfusion requirements, values of prothrombin time, activated partial tromplastina time, international normalized ratio, platelet count and fibrinogen in 4 hours before and after administration of rFVIIa. Comparative analysis was permorfed with the chi-square test or Fisher exact test for qualitative variables and Mann-Whitney U-test or Wilcoxon quantitative. Significance level p <0.05. Results: 21 patients received rFVIIa. 74.1% had congenital heart disease as underlying disease, cardiovascular surgical bleeding being the most common cause of bleeding (47.6%). The average dose was 93.4 ± 29.47 µg/kg. 81% achieved clinical control of bleeding, and decreased 71.4% post-rFVIIa transfusion of red blood cells (p= 0.014) and platelet count (p= 0.004). No patients developed thromboembolic events. Overall mortality was 33%. Conclusions: The use of rFVIIa administered as a part of the treatment of uncontrollable bleeding is associated with better control of bleeding and decreased transfusion requirements of blood products, without being associated with undesirable side effects (AU)

Tumor edematoso de Pott, ¿una entidad olvidada? / Pott’s puffy tumour: a forgotten condition?

No disponible

Neumoencéfalo intraventricular secundario a fístula de líquido cefalorraquídeo / Intraventricular pneumocephalus secondary to a cerebrospinal fluid fistula

No disponible

Insuficiencia respiratoria aguda como inicio de hemosiderosis pulmonar idiopática en un lactante / Acute respiratory insufficiency as debut of idiopathic pulmonary hemosiderosis in an infant

No disponible

Saturación cerebral de oxígeno como marcador hemodinámico en la cirugía cardíaca / Regional cerebral oxygen saturation as a marker of hemodynamic state following cardiac surgery

Introducción: La saturación cerebral de oxígeno (SrcO2) es una medida del estado de perfusión y oxigenación. El objetivo ha sido analizar la relación entre la SrcO2 y varios parámetros hemodinámicos y respiratorios. Pacientes y métodos Entre octubre del 2011 y julio del 2012, se intervino a 43 niños que fueron incluidos en un estudio prospectivo, observacional y descriptivo. Se midieron la SrcO2 y la presión arterial media (PAM), y se realizaron gasometrías en sangre arterial y venosa. Se determinaron la saturación arterial (SaO2), la saturación venosa (SvcO2), la presión arterial de oxígeno (paO2) y anhídrido carbónico (paCO2), y el lactato, y se calcularon la paO2/FiO2, el índice de oxigenación (IO) y la extracción tisular de oxígeno (ETO2). Estas medidas fueron correlacionadas con la SrcO2, determinándose además la concordancia (índice Kappa) entre esta variable y las que resultaron significativas en el análisis de correlación. Resultados: La edad y el peso fueron de 27,3 meses y 9,2 kg. Se encontraron una correlación positiva de la SrcO2 con la SvcO2 (r = 0,73, p < 0,01) y con la PAM (r = 0,59, p < 0,01), y una correlación negativa con la ETO2 (r = −0,7, p < 0,01). La SrcO2 no se correlacionó con las variables respiratorias. El análisis de concordancia estableció un índice Kappa aceptable (> 0,4) entre la SrcO2 y la SvcO2, y entre la SrcO2 y la ETO2. Conclusiones: La SrcO2 se relaciona estadísticamente con variables hemodinámicas como la PAM, la SvcO2 y la ETO2, pero no con variables respiratorias (AU)

Introduction: Regional cerebral oxygen saturation (rSO2) is a measure of the general state of perfusion and oxygenation. We aim to analyze the relationship between this and various hemodynamic and respiratory parameters. Patients and methods: Forty-three patients, operated on between October 2011 and July 2012, were included in this prospective observational descriptive study. The following parameters were measured: mean arterial pressure, both arterial and central venous oxygen saturation and partial pressures of oxygen and carbon dioxide, and lactate levels. From these parameters, the oxygenation index and the oxygen extraction ratio were calculated. These measurements were studied to evaluate whether rSO2 correlated significantly with the other parameters. Results: The average age and weight of the patients were 27.3 months and 9.2 kg, respectively. The rSO2 correlated positively with both central venous oxygen saturation (r = 0.73, P<0.01) and mean arterial pressure (r = 0.59, P<0.01), and negatively with the oxygen extraction ratio (r =−0.7, P<0.01). No correlation was found with the respiratory parameters. Concordance analysis established an acceptable Kappa index (> 0.4) between the rSO2 and central venous oxygen saturation, and between the rSO2 and oxygen extraction ratio. Conclusions: Regional cerebral oxygen saturation correlates well with hemodynamic parameters- mean arterial pressure, venous saturation, and the tissue oxygen extraction. However, it does not correlate with respiratory parameters (AU)

[Regional cerebral oxygen saturation as a marker of hemodynamic state following cardiac surgery]. / Saturación cerebral de oxígeno como marcador hemodinámico en la cirugía cardíaca.

INTRODUCTION: Regional cerebral oxygen saturation (rSO2) is a measure of the general state of perfusion and oxygenation. We aim to analyze the relationship between this and various hemodynamic and respiratory parameters. PATIENTS AND METHODS: Forty-three patients, operated on between October 2011 and July 2012, were included in this prospective observational descriptive study. The following parameters were measured: mean arterial pressure, both arterial and central venous oxygen saturation and partial pressures of oxygen and carbon dioxide, and lactate levels. From these parameters, the oxygenation index and the oxygen extraction ratio were calculated. These measurements were studied to evaluate whether rSO2 correlated significantly with the other parameters. RESULTS: The average age and weight of the patients were 27.3 months and 9.2 kg, respectively. The rSO2 correlated positively with both central venous oxygen saturation (r=0.73, P<.01) and mean arterial pressure (r=0.59, P<.01), and negatively with the oxygen extraction ratio (r=-0.7, P<.01). No correlation was found with the respiratory parameters. Concordance analysis established an acceptable Kappa index (> 0.4) between the rSO2 and central venous oxygen saturation, and between the rSO2 and oxygen extraction ratio. CONCLUSIONS: Regional cerebral oxygen saturation correlates well with hemodynamic parameters - mean arterial pressure, venous saturation, and the tissue oxygen extraction. However, it does not correlate with respiratory parameters.

Trombosis de senos venosos cerebrales en una niña con leucemia linfoblástica, portadora de la variante de la protrombina G20210A / Cerebral sinovenous thrombosis in a girl with acute lymphoblastic leukaemia carrying the prothrombin G20210A variant

Aunque la trombosis de senos venosos cerebrales es rara, se asocia con mayor frecuencia en niños con leucemia linfoblástica aguda. Se aporta el caso de una niña de 7 años que desarrolla una trombosis masiva de senos venosos cerebrales en el día 22 del tratamiento de inducción de leucemia linfoblástica aguda de alto riesgo. Clínicamente se manifestaron de forma progresiva cefalea, disminución del nivel de conciencia y hemiplejía izquierda. El estudio de trombofilia posterior reveló heterocigosis para la variante de la protrombina G20210A en la niña y en la madre. Se analizan los factores protrombóticos encontrados en el caso antes y después de la trombosis. Se confirma la importancia de investigar precozmente tanto los factores de riesgo de trombosis adquiridos como los estados de trombofilia primaria en niños con leucemia linfoblástica. Esta estrategia podría ayudar a identificar a pacientes de especial riesgo e instaurar en ellos tromboprofilaxis(AU)

Although cerebral venous thrombosis is rare, it is more commonly associated with children suffering from acute lymphoblastic leukaemia. We report the case of a 7-year-old girl who developed massive cerebral sinovenous thrombosis on day 22 of induction therapy for high-risk acute lymphoblastic leukaemia. Clinical symptoms were gradual onset of headache, decreasing consciousness, and ensuing left hemiplegia. A subsequent prothrombotic study revealed a heterozygous prothrombin G20210A variant in the child and mother. We analysed the prothrombotic factors found in the case before and after thrombosis. We confirm the importance of early exploration of patients for clinical predisposing risk factors of thrombosis and primary prothrombotic states in children with acute lymphoblastic leukaemia. This might help identify patients at particular risk from thrombosis and so administer thromboprophylaxis(AU)

Extracción de oxígeno como predictor de mortalidad en pacientes con ventilación con alta frecuencia / Oxygen extraction as a predictor of mortality in patients on high frequency ventilation

Introducción: La ventilación con alta frecuencia (VAFO) puede reducir el gasto cardíaco. Analizamos su repercusión hemodinámica e identificamos factores pronósticos de mortalidad. Pacientes y métodos: Entre enero del 2003 y diciembre del 2010, incluimos a 48 niños con fallo respiratorio sometidos a VAFO. El diseño del estudio fue prospectivo, observacional y descriptivo. Los criterios de inclusión se basaron en la existencia de hipoxemia. Las variables estudiadas fueron: presiones arterial y venosa central, pH arterial, saturación venosa e índice de extracción de oxígeno; haciéndose determinaciones previas a la VAFO, durante y antes de pasar a convencional. Se identificaron factores pronósticos mediante un análisis bivariante y determinamos un modelo predictivo de mortalidad. Resultados: La edad fue de 21 (4-72) meses. Al ingreso, las escalas de PRISM y Murray fueron de 33 y de 2,8, la PaO2/FiO2 de 61 y el índice de oxigenación de 35. Tras la VAFO, se obtuvo un aumento del pH (p>0,001), de la presión arterial media (p<0,001) y de la saturación venosa, y un descenso de la presión venosa y de la extracción de O2 (p < 0,001). Los factores pronósticos de mortalidad a las 24 h de iniciar la VAFO fueron: FiO2, PaO2/FiO2, índice de oxigenación, shunt, pH, presiones venosa central y arterial media, saturación venosa y extracción de O2. El modelo creado a las 12 h, compuesto por la SvcO2 y el ETO2, fue capaz de pronosticar la muerte con una probabilidad del 92,3%. Conclusiones: La VAFO mejora la hemodinámica. El modelo a las 12 h es el que mejor nos predice la muerte(AU)

Introduction: The high frequency oscillatory ventilation (HFOV) may reduce cardiac output. The haemodynamics were analysed and predictors of mortality identified. Patients and methods: A total of 48 children with respiratory failure undergoing HFOV between January 2003 and December 2010 were included. The study design was prospective, observational, and descriptive. Inclusion criteria were based on the existence of hypoxemia. The variables studied were: arterial and central venous pressure, arterial pH, venous saturation and oxygen extraction ratio, with determinations performed prior to HFOV, during, and before turning to conventional ventilation. Prognostic factors were identified by bivariate analysis and a predictive model of mortality was developed. Results: The mean age was 21 [4 to 72] months. On admission, PRISM scales and Murray were 33 and 2.8, PaO2/FiO2 of 61 and oxygenation index of 35. After HFOV an increase in pH (P<0.001), mean arterial pressure (P<0.001) and venous saturation, and decreased venous pressure and O2 extraction (P<0.001), was obtained. The prognostic factors of mortality at 24hours after starting HFOV were: FiO2, PaO2/FiO2, oxygenation index, shunt, pH, central venous pressure and mean arterial pressure, venous saturation, and O2 extraction. The model developed at 12hours, consisting of EtO2 and SvcO2 was able to predict death with a probability of 92.3%. Conclusions: HFOV improves haemodynamics. The model at 12hours is the best predictor of death(AU)

[Oxygen extraction as a predictor of mortality in patients on high frequency ventilation]. / Extracción de oxígeno como predictor de mortalidad en pacientes con ventilación de alta frecuencia.

INTRODUCTION: The high frequency oscillatory ventilation (HFOV) may reduce cardiac output. The haemodynamics were analysed and predictors of mortality identified. PATIENTS AND METHODS: A total of 48 children with respiratory failure undergoing HFOV between January 2003 and December 2010 were included. The study design was prospective, observational, and descriptive. Inclusion criteria were based on the existence of hypoxemia. The variables studied were: arterial and central venous pressure, arterial pH, venous saturation and oxygen extraction ratio, with determinations performed prior to HFOV, during, and before turning to conventional ventilation. Prognostic factors were identified by bivariate analysis and a predictive model of mortality was developed. RESULTS: The mean age was 21 [4 to 72] months. On admission, PRISM scales and Murray were 33 and 2.8, PaO(2)/FiO(2) of 61 and oxygenation index of 35. After HFOV an increase in pH (P<.001), mean arterial pressure (P<.001) and venous saturation, and decreased venous pressure and O(2) extraction (P<.001), was obtained. The prognostic factors of mortality at 24 hours after starting HFOV were: FiO(2), PaO(2)/FiO(2), oxygenation index, shunt, pH, central venous pressure and mean arterial pressure, venous saturation, and O(2) extraction. The model developed at 12 hours, consisting of EtO(2) and SvcO(2) was able to predict death with a probability of 92.3%. CONCLUSIONS: HFOV improves haemodynamics. The model at 12 hours is the best predictor of death.

[Cerebral sinovenous thrombosis in a girl with acute lymphoblastic leukaemia carrying the prothrombin G20210A variant]. / Trombosis de senos venosos cerebrales en una niña con leucemia linfoblástica, portadora de la variante de la protrombina G20210A.

Although cerebral venous thrombosis is rare, it is more commonly associated with children suffering from acute lymphoblastic leukaemia. We report the case of a 7-year-old girl who developed massive cerebral sinovenous thrombosis on day 22 of induction therapy for high-risk acute lymphoblastic leukaemia. Clinical symptoms were gradual onset of headache, decreasing consciousness, and ensuing left hemiplegia. A subsequent prothrombotic study revealed a heterozygous prothrombin G20210A variant in the child and mother. We analysed the prothrombotic factors found in the case before and after thrombosis. We confirm the importance of early exploration of patients for clinical predisposing risk factors of thrombosis and primary prothrombotic states in children with acute lymphoblastic leukaemia. This might help identify patients at particular risk from thrombosis and so administer thromboprophylaxis.

Marcadores pronósticos de mortalidad en el postoperatorio de las cardiopatías congénitas / Prognostic markers of mortality after congenital heart defect surgery

Introducción: Identificar los factores de riesgo de mortalidad postoperatoria para establecer indicaciones de oxigenación con membrana extracorpórea en niños cardiópatas. Pacientes y métodos: Entre abril del 2007 y junio del 2009 fueron intervenidos 186 niños con circulación extracorpórea. Se determinaron en sangre arterial y venosa, al ingreso en UCIP y a las 22 horas, el pH, la pCO2, la SatO2 y el exceso base, y el CO2 en aire espirado. El lactato se midió en quirófano, al ingreso en UCIP y durante el postoperatorio, para determinar el tiempo en que se mantuvo elevado, su pico máximo, y la velocidad de variación. Se calculó además, la diferencia arteriovenosa de la saturación de oxígeno, su extracción tisular, la fracción de espacio muerto y el shunt intrapulmonar. Resultados: La mortalidad hospitalaria fue del 13,4%. Se identificaron como factores de riesgo de mortalidad, la edad, el tiempo de extracorpórea, el score inotrópico; el lactato al ingreso, su pico máximo, la velocidad de variación y el tiempo en que estuvo elevado; la saturación venosa, el exceso de base, el espacio muerto, la extracción de oxígeno, y el shunt intrapulmonar. Las variables que mostraron mayor valor predictivo de mortalidad fueron el tiempo de extracorpórea, el lactato al ingreso y su pico máximo. En el análisis multivariante se detectaron como variables independientes de mortalidad, un pico de lactato de 6,3mmol/l y un tiempo hiperlactacidemia de 24 h. Conclusiones: La elevación máxima del lactato posee una alta capacidad predictiva de mortalidad y nos permitirá iniciar precozmente la oxigenación con membrana extracorpórea(AU)

Introduction: Our aim is to identify risk factors for mortality after surgery for congenital heart disease in children, in order to establish indications for extracorporeal membrane oxygenation (ECMO). Patients and methods: One hundred and eighty six children underwent cardiac surgery with extracorporeal circulation from April 2007 to June 2009. The following parameters were measured serially during their stay in Paediatric Intensive Care (PICU): Arterial and venous blood pH, pCO2, base excess, oxygen saturation, arterio-venous oxygen saturation difference, oxygen extraction ratio, ventilatory dead space and intrapulmonary shunting. Results: Hospital mortality was 13,4%. The following risk factors for mortality were identified: age, bypass time, inotropic score, lactate level upon arrival in PICU including its peak value and its rate of variation, mixed venous saturation, base excess, ventilatory dead space, oxygen extraction ratio, and intrapulmonary shunting. However, the strongest predictors of mortality were bypass time, lactate levels upon admission on PICU, and the peak lactate level. Multivariate analysis showed a lactate level of 6.3mmol/l and a high blood lactate for 24hours to be independent predictors of mortality. Conclusions: The peak lactate level is a strong predictor of mortality. As such, it would be a useful indicator of the need for ECMO support(AU)

[Prognostic markers of mortality after congenital heart defect surgery]. / Marcadores pronósticos de mortalidad en el postoperatorio de las cardiopatías congénitas.

INTRODUCTION: Our aim is to identify risk factors for mortality after surgery for congenital heart disease in children, in order to establish indications for extracorporeal membrane oxygenation (ECMO). PATIENTS AND METHODS: One hundred and eighty six children underwent cardiac surgery with extracorporeal circulation from April 2007 to June 2009. The following parameters were measured serially during their stay in Paediatric Intensive Care (PICU): Arterial and venous blood pH, pCO2, base excess, oxygen saturation, arterio-venous oxygen saturation difference, oxygen extraction ratio, ventilatory dead space and intrapulmonary shunting. RESULTS: Hospital mortality was 13,4%. The following risk factors for mortality were identified: age, bypass time, inotropic score, lactate level upon arrival in PICU including its peak value and its rate of variation, mixed venous saturation, base excess, ventilatory dead space, oxygen extraction ratio, and intrapulmonary shunting. However, the strongest predictors of mortality were bypass time, lactate levels upon admission on PICU, and the peak lactate level. Multivariate analysis showed a lactate level of 6.3mmol/l and a high blood lactate for 24hours to be independent predictors of mortality. CONCLUSIONS: The peak lactate level is a strong predictor of mortality. As such, it would be a useful indicator of the need for ECMO support.