Pleurodesis con sangre autóloga. Un nuevo concento en el tratamiento del neumotórax de repetición en el SDRA / No disponible

Objetivo: El neumotórax se encuentra presente como complicación frecuente en el síndrome de distres respiratorio agudo (SDRA). La fuga aérea persistente (FAP) prolonga la resolución del neumotórax en una 2% de los casos de SDRA, aumentando la tasa de mortalidad en un 26%. La Pleurodesis con Sangre Autóloga (PSA) en un método efectivo en los casos de cirugía oncológica pulmonar con amplias resecciones. El objetivo de este estudio es comparar la PSA con el drenaje convencional con sello de agua exclusivamente en el manejo del al FAP en el SDRA, en pacientes con neumotórax. Diseño: Caso-control, prospectivo, no randomizado, comparando dos grupos sometidos a matching artificial apareados 1:1. Lugar: Universidad de Granada, Departamento de Medicina y Unidad de Cuidados Intensivos de Almería. Pacientes: Dos grupos de 27 pacientes, todos con SDRA, neumotórax y FAP. Intervención: Un grupo ha recibido tratamiento convencional mientras que el otro se ha sometido a PSA. Resultados principales: La gravedad de los pacientes en ambos grupos es homogénea, mostrada mediante sexo, edad, escalas de Murria, Marshall y Apache II, así como las etiologías del SRDA. Los pacientes en el grupo de PSA tienen una menor estancia en UCI, menor tiempo de weaning y una menor tasa de mortalidad. Las diferencias medias entre ambos grupos fueron 11 días menos en el tiempo de weaning (odds ratioajustada de 0,1) y 9 menos días de tiempo de estancia en UCI (odds ratio ajustada de 0.24). Las tasas de mortalidad en el grupo de PSA y el grupo control fueron 3,7% frente a un 29,6% respectivamente (odds ratioajustada de 0.6). Conclusiones: El uso de PSA hace posible una disminución en los tiempos de ventilación mecánica así como una menor estancia en UCI junto a una optimización de la recuperación funcional y un decremento de la mortalidad (AU)

Pleurodesis with autologous blood

Objective: Pneumothorax is present as a frequent complication in Acute Respiratory Distress Syndrome (ARDS). Persistent air leak (PAL) prolongs pneumothorax in 2% of cases of ARDS, increasing the rate of mortality by 26%. Pleurodesis using autologous blood (PAB) is an effective method in cases of oncological pulmonary surgery. The goal of this study is to compare PAB with the conventional drain and water seal in the management of PAL in ARDS patients with pneumothorax. Design: Case-control, prospective, non-randomised study, comparing two groups subjected to artificial pairing 1:1. Setting: University of Granada, Department of Medicine and Intensive Care Unit, Almeria. Patients: Two groups of 27 patients, all with ARDS, pneumothorax and PAL. Interventions: One group which had received conventional treatment while the other received PAB. Main results: The server of the conditions of both groups is homogeneous, shown by sex, age, Murray, Marshall and Apache II scores, and aetiology of ARDS The patients in the PAB group had a shorter stay in ICU, shorter weaning time and lower death rate. The average difference between the groups is 11 day less waning time (adjusted odds ratio 0.1), and 9 days less on average spent in the Intensive Care Unit (ICU) (adjusted odds ratio 0,24). The death rates in the PAB group and the control group were 3,7% versus 29,6% respectively (adjusted odds ratio 0.6). Conclusions: The use of PAB makes possible a decrease in the ventilator weaning time and shorter stay in ICU with a resulting increase in functional recuperation and decrease in patient mortality (AU)

[Ventilation in special situations. Neonatal mechanical ventilation]. / Ventilación en situaciones especiales. Ventilación mecánica neonatal.

Severe respiratory failure is a common problem in premature neonates. We review the various ventilation modes available in the neonatal intensive care unit, as well as their indications, settings, and complications.

[Genetic maternal-child identification with DNA]. / Identificación genética materno-infantil mediante ADN.

BACKGROUND: Classical methods for newborn identification cannot establish a true biological nexus between mother and newborn, and hence they have been widely criticized. Therefore, a pilot study on a mother-infant genetic identification program (PROIGMI) has been started in order to ensure the determination of a biological relationship between mother and newborn in cases of vaginal delivery, caesarean birth or fetal autopsies. MATERIAL AND METHOD: In the delivery room and after informed consent, a total of 100 blood samples from mother/newborn couples were taken and deposited on clean and sterile paper supports. DNA from a total of 20 mother/newborn couples was studied by PCR techniques, being able to unequivocally establish the biological relationship in all cases, even when using minimal amounts of DNA. RESULTS: Blood samples collection does not show differences regarding the kind of birth (delivery, cesarean). The protocol used is easy and fast, and does not employ materials not known for health care professionals. Minimal amounts of blood yield enough DNA to obtain conclusive inclusion probabilities. CONCLUSIONS: The use of DNA allows to stablish the so called biological truth in cases of doubt or where necessary; with the use of medical protocols these studies can be completed in 6 to 8 hours using small amounts of DNA (5 microliters).

[Hypoxic-ischemic coma in children. Factors related to the prognosis]. / Coma hipóxico-isquémico en niños. Factores relacionados con su pronóstico.

OBJECTIVE: The purpose of this study was to analyze the etiology, evolution and predictive value of clinical variables and complementary explorations in children admitted to a PICU with hypoxic-ischemic coma. PATIENTS AND METHODS: A retrospective review (1991-1996) of 24 children with hypoxic-ischemic coma admitted to the pediatric ICU of a reference hospital was performed. Clinical data on admission and results of complementary explorations (EEG and neuroimaging techniques) were collected and the findings compared according to the evolution and underlying pathophysiological mechanism. RESULTS: Non-reactive and dilated pupils, existence of neurohypophyseal disorders and isoelectric EEGs were exclusively found in dead patients. A score of 3-4 on the Glasgow Coma Score was obtained more frequently in groups with the worse evolution (exitus and surviving with sequelae), as well as positive findings with neuroimaging techniques and the appearance of seizures, though without meaningful differences. More significant was the existence of associated problems, which was more frequent in groups with a negative evolution. The differences among the pathophysiological groups were not meaningful. Global mortality in the series studied was 41.6%, with 29.2% of the survivors having neurological sequelae and 29.2% being healthy. CONCLUSIONS: Hypoxic-ischemic coma in children has a high mortality and morbility. The prognosis for each patient is based on the clinical facts and complementary explorations. No isolated data allows the establishment of the final outcome with certainty.

[Parent's perception of vaccination]. / Percepción de la vacunación por parte de los padres.

OBJECTIVE: The purpose of this study was to analyze the attitude and grade of knowledge of the parents of children concerning the vaccination of their children, as well as to know their opinion about a program destine to diminish their anxiety. PATIENTS AND METHODS: The subjects of the study were parents of children of our county that began their immunizations in 1994. The method utilized was realization of a survey with closed questions. The statistical analysis was carried out by means of the R-SIGMA program. RESULTS: There were 115 surveys registered. Of these 71% has adequate knowledge of the illness against which their child had been vaccinated. Anxiety and fear was seen in 60% before beginning the vaccination process, descending to 30% once the process of immunization began. Only 54.5% perceived the vaccination as inoffensive and 66% considered that the illness against which their child was being protected were very grave. The principal secondary effect seen in the children was fever (70.4%). Forty-one percent of those surveyed considered that the illness of the vaccination program were typical of a low socioeconomic class. Only 7% gave an opinion that the vaccine should be voluntary and in 100% of the cases was it considered that it was an advance in medicine. Only 25% of the population surveyed had access to previous information and their attitude was reinforced positively. The data most valued by those surveyed, referring to the vaccination program, was the informative interview previous to the program and the presence of the pediatrician. CONCLUSIONS: The vaccine is considered as something dangerous, but necessary. Better education of the parents, on the part of the sanitary authorities and those responsible of ordering and administering vaccines, would result in a modification in the attitude of the population in regards to vaccinations.