RESUMO
BACKGROUND: The purpose of this work was to determine the safety and feasibility of noninvasive support in children with acute respiratory failure (ARF) during interhospital ground transport. METHODS: This was a prospective, single-center observational clinical study in the pediatric transport unit of a tertiary-care pediatric hospital. We included all subjects with ARF transported from November 2010 to March 2013. A specific noninvasive support protocol was used for all cases. Transport ventilators used were the Crossvent 2+ and Oxylog 3000; interfaces were an oronasal mask, nasopharyngeal tube, or nasal prongs. RESULTS: A total of 288 children diagnosed with ARF were transported. Fifty-four subjects (19%) were transported with invasive ventilation, 50 with CPAP, 58 with NIV, and 126 (44%) with oxygen cannula or nebulization. The median age was 3.4 months (interquartile range 1.2-17 months). ARF was mainly due to bronchiolitis (58%), asthma (15%), and pneumonia (15%). Stabilization time, which is defined as the time between the arrival in the parking lot of the referring hospital and departure, was lower with noninvasive support than with invasive ventilation (median 48 min vs 83 min, P < .001). Median transport time was 35 min (interquartile range 20-65). Noninvasive ventilation and oronasal interface use rose progressively during the study period (P < .001 for the NIV and P < .036 for the interface). One complication was observed: One subject required intubation during transport. Evolution of subjects transferred while receiving noninvasive support was recorded in the receptor hospitals: 21% of subjects were intubated, and 55% continued with NIV. CONCLUSIONS: NIV seems to be a safe and feasible technique during pediatric ground transport. Careful patient selection, adequate material, and a well-trained transport team are crucial to minimize risks to the patient.
Assuntos
Ventilação não Invasiva/métodos , Transferência de Pacientes/métodos , Insuficiência Respiratória/terapia , Transporte de Pacientes/métodos , Doença Aguda , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Ventilação não Invasiva/instrumentação , Estudos Prospectivos , Insuficiência Respiratória/etiologia , Fatores de TempoRESUMO
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Assuntos
Criança , Humanos , Reanimação Cardiopulmonar/tendências , Parada Cardíaca/terapia , Suporte Vital Cardíaco Avançado/métodos , Protocolos ClínicosRESUMO
Fonament. La icterícia és un motiu habitual de consulta en els lactants. És important detectar les colestàtiques per establir precoçment el diagnòstic i millorar el pronòstic. Objectius. Analitzar les diferències clíniques i de les exploracions complementàries dels lactants amb colèstasi segons letiologia, per determinar quines haurien de guiar lespecialista per a un diagnòstic precoç. Material i mètodes. Estudi retrospectiu dels nadons ingressats per icterícia colestàtica entre gener de 1997 i desembre de 2001. Resultats. Es recullen setze casos, onze masculins, de disset dies a onze mesos dedat. Es diagnostiquen: sis hepatitis (H), cinc atrèsies de vies biliars (AVB), dos dèficits dalfa-1-antitripsina (Dα1AT), un ARC-I (síndrome caracteritzada per presentar artrogriposi, tubulopatia renal, colèstasi i ictiosi), una malaltia de Wolman (W) i una colèstasi extrahepàtica amb cirrosi micronodular (CM). Nou pacients presenten hipocòlia, set colúria, i tres estancament ponderal. Quatre nens amb baix pes en néixer tenen H. Es detecta hepatomegàlia en cinc pacients i esplenomegàlia només en el cas de W. La bilirubina (Br) total, directa i gammaglutamiltranspeptidasa (GGT) en les AVB són més elevades que en les H. Lecografia abdominal no objectiva bufeta biliar en quatre AVB, una H i a la CM. Es fa gammagrafia i és diagnòstica a les AVB, surt alterada en un Dα1AT i en la CM i és normal en una H. Comentaris. Lhepatitis idiopàtica es relaciona més freqüentment amb baix pes en néixer que lAVB. Una colèstasi amb Br total > 7 mg/dl i GGT > 300 UI/L suggereix AVB. Lecografia abdominal és la primera prova dimatge a fer davant una colèstasi; la gammagrafia es reserva per als casos amb alta sospita dAVB (AU)
Fundamento. La ictericia es motivo habitual de consulta en los lactantes. Es importante detectar las colestásicas para establecer precozmente el diagnóstico y mejorar el pronóstico. Objetivos. Analizar las diferencias clínicas y de las exploraciones complementarias de los lactantes con colestasis según la etiología, para determinar cuales tendrían que guiar al especialista para un diagnóstico precoz. Material y métodos. Estudio retrospectivo de los lactantes ingresados por ictericia colestásica entre enero de 1997 y diciembre de 2001. Resultados. Se recogen 16 casos, 11 masculinos, de 17 días a 11 meses de edad. Se diagnostican: 6 hepatitis (H), 5 atresias de vías biliares (AVB), 2 déficits de alfa-1-antitripsina, (Dα1AT), un ARC-I (síndrome caracterizado por artrogriposis, tubulopatía renal, colestasis e ictiosis), una enfermedad de Wolman (W) y una colestasis extrahepática con cirrosis micronodular (CM). Presentan hipocolia 9 pacientes, coluria 7 y estancamiento ponderal 3. Hay 4 niños con bajo peso al nacer tienen H. Se detecta hepatomegalia en 5 pacientes y esplenomegalia sólo en W. La bilirrubina (Br) total, directa y gamma-glutamiltranspeptidasa (GGT) en las AVB son más elevadas que en las H. La ecografía abdominal no objetiva vesícula biliar en 4 AVB, una H y en la CM. Se realiza gammagrafía y es diagnóstica en las AVB, está alterada en un Dα1AT y en la CM y es normal en una H. Comentarios. La hepatitis idiopática se relaciona más frecuentemente con bajo peso al nacer que la AVB. Una colestasis con Br total > 7 mg/dl y GGT > 300 UI/L sugiere AVB. La ecografía abdominal es la primera prueba de imagen a realizar ante una colestasis; la gammagrafía se reserva para los casos con alta sospecha de AVB (AU)
Background. Jaundice is a common reason for consultation in infants. Early detection of cholestatic jaundice may result in improved prognosis. Objectives. To analyze the distinct clinical features of the different types of cholestatic jaundice that can assist in an early diagnosis. Material and methods. Retrospective study of infants with cholestatic jaundice admitted between January 1997 and December 2001. Results. Sixteen infants (11 males), aged 17 days to 11 months, were included. Distribution by diagnosis was as follows: Hepatitis, 6 cases; Biliary atresia, 5 cases, alpha 1αantitrypsine deficiency, 2 cases; ARC-1 syndrome (arthrogryposis, renal tubulopathy, cholestasis and ichthyosis), 1 case; Wolman disease, 1 case; extrahepatic cholestasis with micronodular chirrosis, 1 case. Nine patients had hypocholia, 7 patients had choluria, and 3 patients had failure to thrive. The 4 patients with low birth weight had hepatitis. Five patients had hepatomegaly, and splenomegaly was only present in the case with Wolman syndrome. Total and direct bilirubin and gamma-glutamyltranspeptidase (GGT) were higher in biliary atresia than in hepatitis. Abdominal ultrasound failed to identify the gallbladder in 4 cases of biliary atresia, in one case of hepatitis, and in the case of micronodular chirrosis. A scintigraphy was diagnostic in the cases of biliary atresia, was abnormal in the cases of alpha-1-antitrypsine deficiency and micronodular chirrosis, and was normal in one case of hepatitis. Comments. Idiopatic hepatitis is more commonly associated with low birth weight than biliary atresia. A cholestasis with a total bilirrubin of > 7 mg/dl and GGT > 300 IU/L suggests biliary atresia. Abdominal ultrasound is the first imaging study that should be performed; the scintigraphy should be performed in those cases highly suspicious of biliary atresia (AU)