Indicadores de calidad de Cuidados Intensivos Pediátricos en España (estudio QuaCIP) / Indicators of the quality of Pediatric Intensive Care in Spain (QuaCIP Study)

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Diagnóstico y tratamiento con antibióticos nebulizados en la infección respiratoria relacionada con ventilación mecánica (VM) / Diagnosis and treatment with nebulized antibiotics in respiratory infection related with mechanical ventilation (MV)

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Epidemiología y hallazgos clínicos de la sepsis neonatal tardía en la unidad de cuidados intensivos pediátricos / Epidemiology and clinical findings in late-onset neonatal sepsis in the pediatric intensive care unit

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[Fluid and electrolyte disorders following surgery for brain tumors]. / Trastornos hidroelectrolíticos en postoperados de tumores cerebrales.

INTRODUCTION: Fluid and electrolyte disorders such as diabetes insipidus, salt wasting syndrome (SWS) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) can appear in the immediate postoperative period after surgery for brain tumors. Early diagnosis and treatment are important to prevent the potential adverse effects of these disorders on the central nervous system (CNS). OBJECTIVES: To determine the incidence and characteristics of fluid and electrolyte disorders in the immediate postoperative period after surgery for CNS tumors in children treated in our hospital. MATERIAL AND METHODS: We retrospectively analyzed clinical and laboratory data in all infants and children who underwent surgery for CNS tumors in our hospital from January 1998 to June 2005 and who met the laboratory criteria for diabetes insipidus, SWS or SIADH. RESULTS: Twenty-three electrolyte disorders were identified in 149 surgical patients (an incidence of 15.4%). The median age was 5 years and 3 months (from 6 months to 17 years) and 48.7% of the patients were male. The most frequent electrolyte disturbance was diabetes insipidus (65.2% of all electrolyte disorders). On average, onset of diabetes insipidus occurred 19 hours after surgery. Treatment with desmopressin was administrated in all patients. On average, diabetes insipidus was resolved 73 hours after diagnosis, except in one patient with permanent diabetes insipidus due to a surgical lesion of the hypothalamic-pituitary axis. The second most frequent electrolyte disturbance was SWS (26.1%) with a mean time of onset of 50.4 hours after surgery. On average, SWS was resolved 57.6 hours after administration of saline solutions. Only two patients developed SIADH, which was treated with water restriction and adequate sodium supply. Both cases of SIADH resolved spontaneously in the first 36 hours after diagnosis. At discharge, none of the patients showed neurological disturbances due to an electrolytic disorder. CONCLUSIONS: In our series, the most frequent electrolyte disorder after surgery for CNS tumors was diabetes insipidus. Early treatment with desmopressin almost always prevents hypernatremia. Unless there is a surgical lesion of the hypothalamic-pituitary axis, spontaneous resolution will take place in 3 days on average. The management of SWS and SIADH requires close monitoring of plasma sodium due to the risk of hyponatremia.

Trastornos hidroelectrolíticos en postoperados de tumores cerebrales / Fluid and electrolyte disorders following surgery for brain tumors

Introducción Entre las complicaciones que pueden aparecer en el postoperatorio inmediato de los tumores cerebrales destacan los trastornos hidroelectrolíticos (diabetes insípida, síndrome pierde sal y síndrome de secreción inadecuada de hormona antidiurética [SIADH]). Es importante su diagnóstico y tratamiento precoz de cara a prevenir los posibles efectos negativos que pueden tener sobre el propio sistema nervioso central (SNC). Objetivos Valorar la incidencia y características de los trastornos electrolíticos aparecidos en el postoperatorio inmediato de los niños intervenidos de tumores del SNC en nuestro centro. Material y métodos Análisis retrospectivo de las historias clínicas de niños intervenidos de tumores del SNC en nuestro centro entre enero de 1998 y junio de 2005, que en el postoperatorio cumplieron criterios analíticos de diabetes insípida, síndrome pierde sal o SIADH. Resultados Se detectaron 23 trastornos hidroelectrolíticos en 149 intervenciones (15,4 %). El 47,8 % fueron varones. La mediana de edad fue de 5 años y 3 meses (rango de 6 meses a 17 años). La alteración electrolítica más frecuente fue diabetes insípida (65,2 %). El trastorno apareció en una media de 19 h tras la cirugía. Se administró desmopresina en todos los casos, con resolución del cuadro en una media de 73 h tras el diagnóstico, excepto un caso de diabetes insípida permanente por lesión quirúrgica del eje hipotálamo- hipofisario. El síndrome pierde sal, con un 26,1 % de los casos, fue el segundo trastorno hidroelectrolítico en frecuencia. El tiempo medio de aparición tras la cirugía fue de 50,4 h. Se adecuó el aporte hidrosalino en todos los casos. El trastorno se resolvió en una media de 57,6 h tras su aparición. Sólo se detectaron 2 casos de SIADH que se trataron con restricción hídrica y adecuación de aportes de sodio. Ambos casos se resolvieron espontáneamente en las primeras 36 h tras el diagnóstico. Al alta ningún paciente presentaba alteraciones neurológicas secundarias al trastorno hidroelectrolítico. Conclusiones El trastorno hidroelectrolítico más frecuente en postoperados de tumores cerebrales en nuestra serie ha sido la diabetes insípida. El tratamiento precoz con desmopresina evita en la mayor parte de los casos la aparición de hipernatremia. Si no existe lesión quirúrgica del eje hipotálamo- hipofisario la resolución espontánea se produce en una media de 3 días. El manejo del síndrome pierde sal y el SIADH requiere una estrecha monitorización del sodio plasmático por la gran tendencia a la hiponatremia

Introduction Fluid and electrolyte disorders such as diabetes insipidus, salt wasting syndrome (SWS) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) can appear in the immediate postoperative period after surgery for brain tumors. Early diagnosis and treatment are important to prevent the potential adverse effects of these disorders on the central nervous system (CNS). Objectives To determine the incidence and characteristics of fluid and electrolyte disorders in the immediate postoperative period after surgery for CNS tumors in children treated in our hospital. Material and methods We retrospectively analyzed clinical and laboratory data in all infants and children who underwent surgery for CNS tumors in our hospital from January 1998 to June 2005 and who met the laboratory criteria for diabetes insipidus, SWS or SIADH. Results Twenty-three electrolyte disorders were identified in 149 surgical patients (an incidence of 15.4 %). The median age was 5 years and 3 months (from 6 months to 17 years) and 48.7 % of the patients were male. The most frequent electrolyte disturbance was diabetes insipidus (65.2 % of all electrolyte disorders). On average, onset of diabetes insipidus occurred 19 hours after surgery. Treatment with desmopressin was administrated in all patients. On average, diabetes insipidus was resolved 73 hours after diagnosis, except in one patient with permanent diabetes insipidus due to a surgical lesion of the hypothalamic-pituitary axis. The second most frequent electrolyte disturbance was SWS (26.1 %) with a mean time of onset of 50.4 hours after surgery. On average, SWS was resolved 57.6 hours after administration of saline solutions. Only two patients developed SIADH, which was treated with water restriction and adequate sodium supply. Both cases of SIADH resolved spontaneously in the first 36 hours after diagnosis. At discharge, none of the patients showed neurological disturbances due to an electrolytic disorder. Conclusions In our series, the most frequent electrolyte disorder after surgery for CNS tumors was diabetes insipidus. Early treatment with desmopressin almost always prevents hypernatremia. Unless there is a surgical lesion of the hypothalamic- pituitary axis, spontaneous resolution will take place in 3 days on average. The management of SWS and SIADH requires close monitoring of plasma sodium due to the risk of hyponatremia

[Supraventricular tachycardia in infants and children]. / Taquicardia paroxística supraventricular en el niño y el lactante.

INTRODUCTION: Supraventricular tachycardia (SVT) is the second most frequent form of arrhythmia in pediatrics after extrasystole. OBJECTIVES: 1. To determine the clinical characteristics and treatment of SVT in infants and children. 2. To determine treatment response and the drugs used. METHOD: A retrospective review of 61 cases of SVT requiring PICU admission (1999-2004) was performed. PICU admission was due to persistent SVT after vagal maneuvers. RESULTS: There were 61 patients and 39 were boys (63.9%). The mean age was 2.1 years (SD +/- 3.1). Twelve patients had congenital heart disease (19.7%); three (4.9%) were admitted after heart surgery, and the remaining patients had no antecedents (60.7%). The mean cardiac frequency was 238 beats/min (SD +/- 42.86). Heart failure (HF) was observed in 14 patients (23%). Statistically significant differences were found between the presence of HF and time since onset (p < 0.01) and younger age (p < 0.01). The most frequent diagnosis was SVT due to re-entry in 28 patients (45.9%). Medical treatment was required in 46 patients (75.4%) and response was achieved in 35 (57.4%). At crisis the first drug used was adenosine triphosphate (ATP) in 35 patients (61.4%) with good response in 21 (36.8%). As maintenance therapy digoxin was used in 29 patients (50.9%) without relapses in 22 (78.6%). Radiofrequency ablation was required in 17 patients (27.9%), and there were three relapses (17.6%). The ages of patients who underwent ablation ranged from 3.5 days to 13 years. CONCLUSIONS: 1. HF was observed mainly in infants. 2. Most of the patients had good response to ATP therapy. 3. Radiofrequency ablation was mainly required in patients aged more than 1 year.

Taquicardia paroxística supraventricular en el niño y el lactante / Supraventricular tachycardia in infants and children

Introducción La taquicardia paroxística supraventricular (TPSV) es la arritmia más frecuente en pediatría por detrás de las extrasístoles. Objetivos 1. Determinar las características clínicas y el tratamiento. 2. Objetivar la respuesta al tratamiento y los fármacos utilizados. Método Estudio retrospectivo de 61 casos con ingreso en la unidad de cuidados intensivos pediátrica (UCIP) de 1999 a 2004. Criterio de ingreso: TPSV sin respuesta a maniobras vagales. Resultados Se seleccionaron 61 pacientes, 39 varones (63,9 %). Edad media: 2,1 años (DE ± 3,1). Doce tuvieron antecedentes de cardiopatía congénita (19,7 %); tres (4,9 %) ingresaron poscirugía cardíaca; y los restantes sin antecedentes (60,7 %). La frecuencia cardíaca media fue de 238 lat./min (DE ± 42,86). Catorce pacientes (23 %) presentaron insuficiencia cardíaca (IC). Existieron diferencias estadísticamente significativas entre la presencia de IC y las horas de evolución (p < 0,01) y con la menor edad (p < 0,01). El diagnóstico más frecuente fue TPSV por reentrada (28 casos 45,9 %). Precisaron tratamiento médico 46 pacientes (75,4 %), 35 respondieron (57,4 %). Para tratar la crisis aguda se utilizó trifosfato de adenosina (ATP) en 35 casos (76 %) con buena respuesta en 21 (60 %). Para el mantenimiento se indicó digital en 29 casos (50,9 %), sin recaídas 22 casos (78,6 %). Necesitaron ablación 17 pacientes (27,9 %); recayeron tres (17,6 %). El rango de edades en los que se realizó la ablación fue de 3,5 días hasta 13 años. Conclusiones 1. La insuficiencia cardíaca se presentó preferentemente en lactantes. 2. La mayoría de pacientes respondieron al tratamiento con ATP. 3. La ablación fue necesaria preferentemente en pacientes de edad superior a un año

Introduction Supraventricular tachycardia (SVT) is the second most frequent form of arrhythmia in pediatrics after extrasystole. Objectives 1. To determine the clinical characteristics and treatment of SVT in infants and children. 2. To determine treatment response and the drugs used. Method A retrospective review of 61 cases of SVT requiring PICU admission (1999-2004) was performed. PICU admission was due to persistent SVT after vagal maneuvers. Results There were 61 patients and 39 were boys (63.9 %). The mean age was 2.1 years (SD ± 3.1). Twelve patients had congenital heart disease (19.7 %); three (4.9 %) were admitted after heart surgery, and the remaining patients had no antecedents (60.7 %). The mean cardiac frequency was 238 beats/min (SD ± 42.86). Heart failure (HF) was observed in 14 patients (23 %). Statistically significant differences were found between the presence of HF and time since onset (p < 0.01) and younger age (p < 0.01). The most frequent diagnosis was SVT due to re-entry in 28 patients (45.9 %). Medical treatment was required in 46 patients (75.4 %) and response was achieved in 35 (57.4 %). At crisis the first drug used was adenosine triphosphate (ATP) in 35 patients (61.4 %) with good response in 21 (36.8 %). As maintenance therapy digoxin was used in 29 patients (50.9 %) without relapses in 22 (78.6 %). Radiofrequency ablation was required in 17 patients (27.9 %), and there were three relapses (17.6 %). The ages of patients who underwent ablation ranged from 3.5 days to 13 years. Conclusions 1. HF was observed mainly in infants. 2. Most of the patients had good response to ATP therapy. 3. Radiofrequency ablation was mainly required in patients aged more than 1 year