Evaluación de la perfusión tisular periférica mediante láser Doppler en niños en estado crítico / Use of laser Doppler to assess peripheral tissue perfusion in critically ill children

Objetivo: Analizar el flujo tisular cutáneo en diferentes localizaciones en niños en estado crítico. Pacientes y métodos: Se realizó un estudio prospectivo observacional en 41 niños críticamente enfermos, con una edad mediana de 12 meses y un peso de 8,2kg. Se midió el flujo tisular cutáneo mediante láser Doppler de forma consecutiva en la planta del pie, el antebrazo, el muslo y el hipocondrio, y se estudió su correlación con variables demográficas, hemodinámicas y lactato. Resultados: Se estudiaron 144 mediciones. El flujo tisular fue de 3,2±2,2ml/min/100g de tejido. Existió una correlación moderada del flujo tisular entre las localizaciones centrales; abdomen-brazo (r2: 0,574; p=0,001); abdomen-muslo (r2: 0,423; p=0,002) y muslo-brazo (r2: 0,703; p<0,000), pero no con la periférica (planta del pie). Los límites de concordancia entre los lugares de medición fueron amplios (rango de 6,1 a –2,5ml/min/100g). Existió una correlación leve-moderada del flujo tisular de la planta del pie con el peso (−0,355; p=0,039), la edad (−0,343; p=0,044), la temperatura periférica (0,503; p=0,017) y el índice de inotrópico (−0,443; p=0,008). Conclusiones: El flujo tisular en la planta del pie se correlaciona con el peso, la edad, la temperatura periférica y el índice inotrópico. Son necesarios estudios que analicen la utilidad del flujo tisular para valorar la perfusión periférica en situaciones de shock (AU)

Objective: To analyze skin tissue perfusion at different sites in critically ill children. Patients and methods: A prospective observational study was performed on 41 critically ill children with a median age of 12 months and weight of 8.2 kg. Skin tissue flow was measured in each patient using laser Doppler consecutively in the foot, forearm, thigh and hypochondrium, and its association with demographic and hemodynamic variables, as well as lactate and inotropic index, was analyzed. Results: A total of 144 tissue flow measurements were made, with a median flow of 3.2±2.2 ml/min/100 g tissue. There was a moderate correlation between the tissue flow measured in central locations, abdomen-arm (r2: 0.574, P=.001), abdomen-thigh (r2: 0.423, P=0.002) and thigh-arm (r2: 0.703, P<.000), but not with the peripheral measurements (sole of the foot). The limits of agreement, measured between the different locations, were wide (range 6.1 to−2.5 ml/min/100 g). There was a slight-moderate correlation between the flow in the sole of the foot with weight (−0.355, P=.039), age (−0.343, P=.044), peripheral temperature (0.503, P=.017) and inotropic index (−0.443, P=.008). Conclusions: Tissue flow in the foot correlates with weight, age, peripheral temperature and inotropic index. Further studies are needed to analyze its usefulness in assessing peripheral perfusion in situations of shock (AU)

[Use of laser Doppler to assess peripheral tissue perfusion in critically ill children]. / Evaluación de la perfusión tisular periférica mediante láser Doppler en niños en estado crítico.

OBJECTIVE: To analyze skin tissue perfusion at different sites in critically ill children. PATIENTS AND METHODS: A prospective observational study was performed on 41 critically ill children with a median age of 12 months and weight of 8.2 kg. Skin tissue flow was measured in each patient using laser Doppler consecutively in the foot, forearm, thigh and hypochondrium, and its association with demographic and hemodynamic variables, as well as lactate and inotropic index, was analyzed. RESULTS: A total of 144 tissue flow measurements were made, with a median flow of 3.2±2.2 ml/min/100 g tissue. There was a moderate correlation between the tissue flow measured in central locations, abdomen-arm (r(2): 0.574, P=.001), abdomen-thigh (r(2): 0.423, P=.002) and thigh-arm (r(2): 0.703, P<.000), but not with the peripheral measurements (sole of the foot). The limits of agreement, measured between the different locations, were wide (range 6.1 to -2.5 ml/min/100g). There was a slight-moderate correlation between the flow in the sole of the foot with weight (-0.355, P=.039), age (-0.343, P=.044), peripheral temperature (0.503, P=.017) and inotropic index (-0.443, P=.008). CONCLUSIONS: Tissue flow in the foot correlates with weight, age, peripheral temperature and inotropic index. Further studies are needed to analyze its usefulness in assessing peripheral perfusion in situations of shock.

Ingreso prolongado en la unidad de cuidados intensivos pediátricos: mortalidad y consumo de recursos asistenciales / Prolonged stay in pediatric intensive care units: mortality and health care resource

Objetivo: Analizar la mortalidad y el consumo de recursos de los niños con ingreso prolongado en unidades de cuidados intensivos pediátricos (UCIP).Diseño: Estudio descriptivo retrospectivo de una serie de casos.Ámbito: UCIP médico-quirúrgica de un hospital de tercer nivel.Pacientes: Se recogieron los datos de los pacientes ingresados durante 28 o más días en la UCIPentre 2006 y 2010. De los 2.118 pacientes ingresados entre 2006 y 2010, 83 (3,9%) requirieron ingreso prolongado.Variables de interés: Se analizaron la morbimortalidad y el consumo de recursos por los pacientescon ingreso prolongado.Resultados: La mortalidad de los pacientes con ingreso prolongado fue mayor (22,9%) que la del resto de los pacientes (2%) (p < 0,001). En un 52,6% de estos pacientes el fallecimiento se produjo tras la limitación del esfuerzo terapéutico o por no iniciar medidas de reanimación. Los pacientes con ingreso prolongado presentaron una elevada incidencia de infección nosocomial (96,3%) y un elevado consumo de los recursos asistenciales (el 97,6% precisó ventilación mecánica;el 90,2%, transfusión de hemoderivados; el 86,7% fármacos vasoactivos intravenosos, y el22,9%, oxigenación por membrana extracorpórea (ECMO).Conclusiones: Los niños en estado crítico con ingreso prolongado en la UCIP tienen una elevada morbimortalidad y requieren un elevado consumo de recursos asistenciales. Son necesarias medidas específicas que permitan identificar precozmente a los pacientes susceptibles de presentar ingreso prolongado para adecuar las medidas terapéuticas y los recursos disponibles y mejorar la eficiencia del tratamiento (AU)

Objective: To analyze mortality and resource consumption in patients with long stays in pediatric intensive care units (PICUs).Design: A retrospective, descriptive case series study.Scope: Medical-surgical PICU in a third level hospital.Patients: Data were collected from patients with a stay of 28 days or more in PICU between 2006 and 2010. Of the 2118 patients assisted in this period, 83 (3.9%) required prolonged stay.Study variables: Morbidity-mortality and resource consumption among patients with prolonged stay in the PICU. Results: Mortality was higher in patients with a long stay (22.9%) than in the rest of patients (2%)(p < 0.001). In 52.6% of these patients, death occurred after with drawal of treatment or after not starting resuscitation measures. Patients with prolonged stay showed a high incidence of nosocomial infection (96.3%) and an important consumption of healthcare resources (97.6% required conventional mechanical ventilation, 90.2% required transfusion of blood products, 86.7% required intravenous vasoactive drugs and 22.9% required extracorporeal membrane oxygenation[ECMO]).Conclusions: Critical children with prolonged stay in the PICU show important morbidity and mortality, and an important consumption of healthcare resources. The adoption of specific measures permitting early identification of patients at risk of prolonged stay is needed in order to adapt therapeutic measures and available resources, and to improve treatment efficiency (AU)

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)

[Prolonged stay in pediatric intensive care units: mortality and healthcare resource consumption]. / Ingreso prolongado en la unidad de cuidados intensivos pediátricos: mortalidad y consumo de recursos asistenciales.

OBJECTIVE: To analyze mortality and resource consumption in patients with long stays in pediatric intensive care units (PICUs). DESIGN: A retrospective, descriptive case series study. SCOPE: Medical-surgical PICU in a third level hospital. PATIENTS: Data were collected from patients with a stay of 28 days or more in PICU between 2006 and 2010. Of the 2118 patients assisted in this period, 83 (3.9%) required prolonged stay. STUDY VARIABLES: Morbidity-mortality and resource consumption among patients with prolonged stay in the PICU. RESULTS: Mortality was higher in patients with a long stay (22.9%) than in the rest of patients (2%) (p<0.001). In 52.6% of these patients, death occurred after withdrawal of treatment or after not starting resuscitation measures. Patients with prolonged stay showed a high incidence of nosocomial infection (96.3%) and an important consumption of healthcare resources (97.6% required conventional mechanical ventilation, 90.2% required transfusion of blood products, 86.7% required intravenous vasoactive drugs and 22.9% required extracorporeal membrane oxygenation [ECMO]). CONCLUSIONS: Critical children with prolonged stay in the PICU show important morbidity and mortality, and an important consumption of healthcare resources. The adoption of specific measures permitting early identification of patients at risk of prolonged stay is needed in order to adapt therapeutic measures and available resources, and to improve treatment efficiency.

[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.

Lesión foruncular producida por Cordylobia anthropophaga / Furuncular lesions produced by Cordylobia anthropophaga

El aumento reciente de la inmigración, así como los viajes hacia países subsaharianos e iberoamericanos, ha producido un incremento de ciertas infestaciones, como son las miasis. Es importante conocer el ciclo biológico del artrópodo, así como las características clínicas de su infestación para incluirlo dentro del diagnóstico diferencial de un forúnculo de mala evolución. Las sencillas medidas de prevención y de tratamiento eficaz nos obligan a realizar recomendaciones básicas ante un viaje a zonas endémicas(AU)

The recent increase in immigration, as well as in travel to sub-Saharan and Latin American countries, has resulted in an increase in certain infestations such as myiasis. It is important to know the life cycle of arthropods, as well as the clinical characteristics of their infestation, so they can be included in the differential diagnosis of a furuncle with a complicated course. We provide recommendations concerning simple preventive measures for those who plan to travel to endemic zones and an effective treatment(AU)

Adenitis cervical por «Mycobacterium bovis» / Cervical lymphadenitis due to Mycobacterium bovis

Mycobacterium bovis es un microrganismo que origina fundamentalmente tuberculosis en el ganado. Pertenece a la familia del complejo Mycobacterium tuberculosis y es responsable de un porcentaje escaso de todas las tuberculosis en humanos. La incidencia es mayor en países en vías de desarrollo donde no hay un control sociosanitario de la tuberculosis del ganado. La vía de contagio suele ser digestiva por la ingesta de leche infectada no pasteurizada, por lo que las manifestaciones más frecuentes son extrapulmonares, entre las que destacan la linfadenitis cervical y la tuberculosis digestiva. El tratamiento debe hacerse con fármacos tuberculostáticos de primera línea, teniendo en cuenta que este microrganismo posee una resistencia intrínseca a la pirazinamida. En nuestro medio debemos sospechar esta etiología ante un caso de tuberculosis en un paciente procedente de una zona donde la tuberculosis en el ganado no esté controlada. Presentamos el caso de una niña de 11 años de origen marroquí, con tuberculosis ganglionar cervical debida a M. bovis

Mycobacterium bovis is a common microorganism in cattle, and is responsible for bovine tuberculosis. M. bovis belongs to the M. tuberculosis complex. The incidence of M. bovis infection in humans is very low, but is higher in countries where the health of livestock is not monitored. M. bovis is usually transmitted through the ingestion of unpasteurized milk. Thus, the most common clinical presentations in infected individuals are extrapulmonary tuberculosis, cervical lymphadenitis and abdominal tuberculosis. Treatment should consist of antituberculous chemotherapy, taking into consideration the fact that M. bovis is resistant to pyrazinamide. The differential diagnosis should include M. bovis in any patient from an endemic area in which livestock are not monitored for bovine tuberculosis. We describe a case of cervical lymphadenitis due to M. bovis in an 11-year-old girl from Morocco