Estrés y ansiedad perioperatorios en padres de niños intervenidos de cardiopatías congénitas / Perioperative stress and anxiety in parents of children operated on for congenital heart disease

Introducción: Los niveles de estrés y la ansiedad que sufren los padres y madres de niños con cardiopatía congénita (PMNCC) durante el ingreso para cirugía cardíaca de sus hijos pueden ser más elevados que los que sufren otros padres y madres que pasan por la misma experiencia. Objetivo: El objetivo general de este estudio fue medir el estrés y la ansiedad que sufren los PMNCC y los padres de niños tratados mediante cirugía renal (PMNCR) en relación con la intervención de sus hijos. El objetivo específico del estudio cuantitativo fue comparar el estrés y ansiedad global con relación al sexo, el momento del periodo perioperatorio y la cohorte. El objetivo general del apartado cualitativo es explorar la vivencia que tienen los PMNCC y PMNCR durante su estancia hospitalaria e identificar los factores específicos que influyen en la génesis del estrés y la ansiedad. Método: Se realizó un estudio de cohortes en el que se incluyeron los PMNCC y los PMNCR. La parte cuantitativa se realizó comparando las puntuaciones de 3cuestionarios que miden los niveles de estrés (PSS-14), ansiedad estado (STAIE) y ansiedad rasgo (STAIR) a lo largo de 3momentos perioperatorios. Paralelamente se hizo un estudio cualitativo con entrevistas semiestructuradas y recogida de diarios sobre los que se realizó un análisis fenomenológico descriptivo, según Munhall. El análisis del texto se realizó según la propuesta de Colaizzi. Resultados: Los niveles de estrés y ansiedad fueron significativamente más altos en los PMNCC respecto a los PMNCR. Las madres de la cohorte cardíaca fueron las que presentaron las puntuaciones más altas en todas las escalas. En el estudio cualitativo emergieron 4temas: «estrés y ansiedad desde el momento del diagnóstico», «intervención quirúrgica como momento crítico», «dureza del postoperatorio en la Unidad de Cuidados Intensivos» y «alegría y agradecimiento versus dependencia y temor ante el futuro»...(AU)

Introduction: Levels of stress and anxiety suffered by parents of children with congenital heart disease (PCUCS) during their children's admission for cardiac surgery may be higher than those suffered by other parents who go through the same experience. Objective: General objective of this study was to measure the stress and anxiety suffered by PCUCS and parents of children undergoing renal surgery (PCURS) in relation to the intervention of their children. The specific objective of the quantitative study was to compare global stress and anxiety according to sex, time of the perioperative period, and cohort. The general objective of the qualitative section is to explore the experience that PCUCS and PCURS have during their hospital stay and to identify the specific factors that influence the genesis of stress and anxiety. Method: A cohort study was carried out in which PCURS and PCUCS were included. The quantitative part was performed by comparing the scores of 3questionnaires that measure stress levels (PSS-14), state anxiety (STAIE) and trait anxiety (STAIR) throughout 3perioperative moments. At the same time, a qualitative study was carried out with semi-structured interviews and collection of diaries on which a descriptive phenomenological analysis was carried out, according to Munhall. The analysis of the text was carried out according to Colaizzi. Results: Stress and anxiety levels were significantly higher in PCUCS compared to PCURS. Mothers in the cardiac cohort were those with the highest scores on all scales. In the qualitative study, 4themes emerged: “stress and anxiety from the moment of diagnosis”, “surgical intervention as a critical moment”, “harshness of the postoperative period in the Intensive Care Unit” and “joy and gratitude versus dependence and fear for the future”...(AU)

Perioperative stress and anxiety in parents of children operated on for congenital heart disease.

INTRODUCTION: Levels of stress and anxiety suffered by parents of children with congenital heart disease (PCUCS) during their children's admission for cardiac surgery may be higher than those suffered by other parents who go through the same experience. OBJECTIVE: General objective of this study was to measure the stress and anxiety suffered by PCUCS and parents of children undergoing renal surgery (PCURS) in relation to the intervention of their children. The specific objective of the quantitative study was to compare global stress and anxiety according to sex, time of the perioperative period, and cohort. The general objective of the qualitative section is to explore the experience that PCUCS and PCURS have during their hospital stay and to identify the specific factors that influence the genesis of stress and anxiety. METHOD: A cohort study was carried out in which PCURS and PCUCS were included. The quantitative part was performed by comparing the scores of three questionnaires that measure stress levels (PSS-14), state anxiety (STAIE) and trait anxiety (STAIR) throughout three perioperative moments. At the same time, a qualitative study was carried out with semi-structured interviews and collection of diaries on which a descriptive phenomenological analysis was carried out, according to Munhall. The analysis of the text was carried out according to Colaizzi. RESULTS: Stress and anxiety levels were significantly higher in PCUCS compared to PCURS. Mothers in the cardiac cohort were those with the highest scores on all scales. In the qualitative study, four themes emerged: "stress and anxiety from the moment of diagnosis", "surgical intervention as a critical moment", "harshness of the postoperative period in the Intensive Care Unit" and "joy and gratitude versus dependence and fear for the future". CONCLUSIONS: PCUCS suffer higher levels of stress and anxiety than PCURS, being the mothers of the cardiac cohort those who suffer these disorders with greater intensity. This study can constitute a starting point to develop strategies that cover these parental needs.

Instituto Pediátrico del Corazón / Pediatric Health Institute

En el año 2001, se constituye el Instituto Pediátrico del Corazón (IPC) con el fin de integrar a cardiólogos pediátricos y cirujanos cardiacos en una unidad multidisciplinar dedicada a la atención integral del paciente con cardiopatía congénita. Esto incluye la atención a pacientes desde el periodo fetal hasta la edad adulta y requiere de una estrecha colaboración con intensivistas pediátricos, anestesiólogos, obstetras y cardiólogos de adultos. El crecimiento y la calidad de la actividad asistencial, investigadora y docente de esta unidad en los últimos años, la ha llevado a ser designada como unidad de referencia a nivel nacional (CSUR) para el tratamiento de neonatos y niños con cardiopatías congénitas así como para el tratamiento de la hipertensión pulmonar compleja (AU)

In the year 2001, the Pediatric Heart Institute (PHI) was formed in order to integrate pediatric cardiologists and heart surgeons into a multidisciplinary unit dedicated to the comprehensive care of the patient with congenital heart disease. This includes patient care from the fetal period up to the adult age and requires close collaboration by the pediatric intensive care physicians, anesthesiologists, adult cardiologist and obstetricians. The growth and quality of the care, investigator and teaching activity of this unit in recent years has led it to being designated as Reference Centers, Services and Units (CSUR by its acronym in Spanish) on the national level for the treatment of newborn and children with congenital heart disease and for the treatment of complex pulmonary hypertension (AU)

Síndrome de reperfusión pulmonar tras implante de stents pulmonares en un paciente con síndrome de tortuosidad vascular / Pulmonary reperfusion syndrome after pulmonary stent implants in a patient with vascular tortuosity syndrome

El síndrome de tortuosidad vascular es un infrecuente trastorno de origen genético que cursa con tortuosidad y estenosis de las circulaciones pulmonar, sistémica y/o coronaria. Como consecuencia del tratamiento de las estenosis pulmonares puede producirse un cuadro de edema pulmonar conocido como síndrome de reperfusión pulmonar. Presentamos el caso de un adolescente con un síndrome de tortuosidad vascular que presentó un síndrome de reperfusión pulmonar tras la colocación de varios stents en la arteria pulmonar izquierda. Tras el procedimiento, el paciente desarrolló de forma inmediata un cuadro de edema agudo de pulmón, con deterioro severo de su estado clínico, qué llegó a precisar asistencia con oxigenación por membrana extracorpórea para su recuperación

Vascular tortuosity syndrome is a rare genetic disorder that causes tortuosity and stenosis of the pulmonary, systemic and / or coronary circulations. As a result of treatment of pulmonary stenosis, symptoms of pulmonary edema, known as lung reperfusion syndrome, may occur. The case is presented of an adolescent patient with vascular tortuosity syndrome who presented with a pulmonary reperfusion syndrome after multiple stent implants in the left pulmonary artery. After the procedure, the patient immediately developed an acute pulmonary edema with severe clinical deterioration, which required assistance with extracorporeal membrane oxygenation for recovery

[Pulmonary reperfusion syndrome after pulmonary stent implants in a patient with vascular tortuosity syndrome]. / Síndrome de reperfusión pulmonar tras implante de stents pulmonares en un paciente con síndrome de tortuosidad vascular.

Vascular tortuosity syndrome is a rare genetic disorder that causes tortuosity and stenosis of the pulmonary, systemic and / or coronary circulations. As a result of treatment of pulmonary stenosis, symptoms of pulmonary edema, known as lung reperfusion syndrome, may occur. The case is presented of an adolescent patient with vascular tortuosity syndrome who presented with a pulmonary reperfusion syndrome after multiple stent implants in the left pulmonary artery. After the procedure, the patient immediately developed an acute pulmonary edema with severe clinical deterioration, which required assistance with extracorporeal membrane oxygenation for recovery.

Assessing pulmonary hypertensive vascular disease in childhood. Data from the Spanish registry.

RATIONALE: There is a lack of knowledge regarding the epidemiology, clinical characterization, and survival in pediatric pulmonary hypertension. OBJECTIVES: To describe the epidemiology, outcomes, and risk factors for mortality in pediatric pulmonary hypertension in Spain. METHODS: We analyzed data from the Spanish Registry for Pediatric Pulmonary Hypertension. From January 2009 to June 2012, a total of 225 patients diagnosed with pulmonary hypertension in 1998 or after were collected from 21 referral and nonreferral centers. We included all Nice etiologies, estimated incidence and prevalence of pulmonary hypertension in the Spanish pediatric population, and analyzed risk factors for mortality (Nice etiologic group, clinical and hemodynamic variables). Patients were classified as follows: group I, pulmonary arterial hypertension (n = 142; 61%); group II, left heart disease (n = 31; 14%); group III, respiratory disease (n = 41; 18%); group IV, thromboembolic pulmonary hypertension (n = 2; 1%); or group V, mostly inherited metabolic diseases (n = 10; 4.5%). Of the patients studied, 31% had multifactorial pulmonary hypertension. MEASUREMENTS AND MAIN RESULTS: Mean age at diagnosis was 4.3 ± 4.9 years (50% < 2 yr). Survival rates at 1 and 3 years were 80 and 74% for the whole cohort, and 89 and 85% for patients with pulmonary arterial hypertension. Independent risk factors for mortality included an etiologic group other than pulmonary arterial hypertension (P < 0.001), age at diagnosis younger than 2 years old (P < 0.001), advanced functional class at diagnosis (P < 0.001), and high right atrial pressure at diagnosis (P = 0.002). CONCLUSIONS: In moderate to severe pediatric pulmonary hypertension, the prognosis is better in pulmonary arterial hypertension than in other Nice categories. In pediatric pulmonary hypertension age at diagnosis younger than 2 years is a risk factor for mortality, in addition to the previously established risk factors.

Hemorragia digestiva masiva por fistulización al esófago de una colateral aortopulmonar / Massive digestive system haemorrhage due to the formation of oesophageal fistulas of the aortopulmonary collateral arter

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[Plastic bronchitis. A case report and review of the literature]. / Bronquitis plástica. A propósito de un caso y revisión de los casos asociados a cirugía de Fontan.

Plastic bronchitis is a rare complication in which bronchial casts of lymphatic origin develop in the tracheobronchial tree and cause airway obstruction. The main feature is expectoration of bronchial casts. This condition usually occurs in the postoperative period after the Fontan operation for congenital heart disease. Treatment modalities include mucolytics and chest physiotherapy, and in the most severe cases bronchoscopy to remove the casts and aerosolized urokinase or r-TPA. We describe a 12-year-old boy with pulmonary atresia with intact ventricular septum and severely hypoplastic right ventricle who underwent a modified Fontan operation at the age of 7 years. At the age of 12 years the patient started to present frequent episodes of coughing, dyspnea, and desaturation followed by difficult emission of white bronchial casts. An extracardiac Fontan conversion was performed to improve hemodynamics and symptoms. During the postoperative period frequent episodes of airway obstruction required bronchoscopy and finally improved with administration of aerosolized urokinase.

Bronquitis plástica. A propósito de un caso y revisión de los casos asociados a cirugía de Fontan / Plastic bronchitis. A case report and review of the literature

La bronquitis plástica es una rara manifestación consistente en la formación y expectoración de moldes bronquiales de origen linfático que provocan obstrucción de la vía respiratoria. Se asocia sobre todo al postoperatorio de cardiopatías congénitas corregidas con la operación de Fontan. Como tratamiento de base se han utilizado mucolíticos y fisioterapia respiratoria y en los casos más graves la extracción de los moldes por broncoscopia así como la nebulización de urocinasa o activador tisular del plasminógeno recombinante (rt-PA). Se presenta el caso de un varón con atresia pulmonar con tabique íntegro y ventrículo derecho hipoplásico operado a los 7 años con una intervención de Fontan, que a los 12 años presentó episodios frecuentes de tos, disnea y desaturación en los cuales el paciente expectoraba moldes bronquiales de aspecto blanquecino. Se realizó una conversión a Fontan extracardíaca para mejorar la clínica y hemodinámica, presentando en el postoperatorio frecuentes episodios de obstrucción respiratoria por moldes bronquiales que requirieron extracción mediante broncoscopia y mejoraron con la administración de urocinasa nebulizada

Plastic bronchitis is a rare complication in which bronchial casts of lymphatic origin develop in the tracheobronchial tree and cause airway obstruction. The main feature is expectoration of bronchial casts. This condition usually occurs in the postoperative period after the Fontan operation for congenital heart disease. Treatment modalities include mucolytics and chest physiotherapy, and in the most severe cases bronchoscopy to remove the casts and aerosolized urokinase or r-TPA. We describe a 12-year-old boy with pulmonary atresia with intact ventricular septum and severely hypoplastic right ventricle who underwent a modified Fontan operation at the age of 7 years. At the age of 12 years the patient started to present frequent episodes of coughing, dyspnea, and desaturation followed by difficult emission of white bronchial casts. An extracardiac Fontan conversion was performed to improve hemodynamics and symptoms. During the postoperative period frequent episodes of airway obstruction required bronchoscopy and finally improved with administration of aerosolized urokinase

[Recurrent respiratory papillomatosis: a cause of progressive respiratory distress]. / Papilomatosis respiratoria recurrente: una causa de dificultad respiratoria progresiva.

A 5-year-old girl was brought to the emergency department because of respiratory distress of 3 months' evolution that had worsened over the previous 3 weeks. Cervical radiograph and cervical computerized axial tomography showed an endolaryngeal mass almost completely occluding the airway. Urgent laryngoscopy revealed an endolaryngeal fleshy mass, which was excised during the procedure. Histological diagnosis was laryngeal papilloma. Although infrequent in children, laryngeal papilloma is the most common laryngeal tumor in pediatrics. It is currently named juvenile onset recurrent respiratory papillomatosis. The human papilloma virus (HPV) causes the disease by vertical transmission from a mother with active or latent vulvar HPV infection.

Papilomatosis respiratoria recurrente: una causa de dificultad respiratoria progresiva / Recurrent respitatory papillomatosis: a cause of progressive respiratory distress

Se trataba de una niña de 5 años que acudió a urgencias por un cuadro de dificultad respiratoria de 3 meses de evolución que se había agravado durante las últimas 3 semanas. Se realizaron radiografía lateral de cuello y tomografía computarizada (TC) cervical que mostraron una gran masa endolaríngea. Se realizó laringoscopia urgente, en la que se visualizó una masa endolaríngea que fue extirpada en el mismo procedimiento. El diagnóstico anatomopatológico fue de papiloma laríngeo. Aunque el papiloma laríngeo es un proceso poco frecuente en pediatría, constituye la neoplasia laríngea más frecuente en niños. Actualmente la entidad se denomina papilomatosis respiratoria recurrente de inicio juvenil. Está causada por el papilomavirus humano que se transmite por vía vertical de una madre con infección anogenital activa o latente (AU)

[Perineal bag versus urethral catheterization of suprapubic aspiration for the diagnosis of urinary tract infections in infants in emergency units]. / Bolsa perineal versus sondaje uretral o punción suprapúbica para el diagnóstico de infección urinaria en el lactante en las unidades de urgencias.

OBJECTIVE: Our objective was to determine the utility of urine cultures collected by sterile perineal bags as a method of diagnosis of urinary tract infection in infants. PATIENTS AND METHODS: Forty-two patients, aged 0 to 27 months, were diagnosed with urinary tract infections based on the growth of more than 100,000 colonies/ml in two urine cultures collected by sterile bags. Confirmation of the infection was done by urine cultures obtained by suprapubic aspiration or urethral catheterization. A urinalysis was simultaneously performed. RESULTS: Urinary tract infection was confirmed in only 6 out of 42 patients. The positive predictive value of the sterile bag was 14%, increasing to 42% combined with an abnormal urinalysis. CONCLUSIONS: The sterile perineal bag is not an accurate method to collect urine for diagnosis of urinary tract infections in febrile infants or those who need prompt diagnosis and treatment.

[Transcutaneous bilirubin measurement in neonates]. / Bilirrubina transcutánea en neonatos.

A study was performed to determine, in our population, the relationship between transcutaneous, visual and serum bilirubin values. This was done in attempts to reduce the number of serum bilirubin determinations to be performed in the future. We did a correlation coefficient between serum bilirubin and five measurements of transcutaneous bilirubin levels in a group of 60 term newborns and 60 preterm newborns, obtaining a value of 0.84 in both groups. The results were also considered from an analytical point of view where the ability of the test to predict an alteration in serum bilirubin levels, for example > or = 12 mg/dl in preterm and > or = 13 mg/dl in term newborns, was assessed. For values of 18 in preterm and 17 in term infants, the transcutaneous method was found to be both sensitive and specific. If Kramer's test is also evaluated the results improve.