Traqueostomía percutánea bajo control endoscópico en adolescentes / Percutaneous tracheostomy under endoscopic guidance in adolescents

La traqueostomía percutánea es una técnica bien establecida en pacientes adultos que precisan control a largo plazo de la vía aérea. La experiencia con este procedimiento en Pediatría es muy escasa; por ello comunicamos los resultados de la realización de traqueostomía percutánea mediante un método de dilatación progresiva y visualización endoscópica en tres adolescentes que presentaban traumatismos craneales graves. La traqueostomía se realizó con la técnica Ciaglia Blue Rhino guiada por fibrobroncoscopia, por parte del personal asistencial de la unidad de cuidados intensivos pediátricos (UCIP), a la cabecera de los pacientes. No se observaron datos de compromiso respiratorio o hemodinámico durante el procedimiento ni se detectaron complicaciones relacionadas con la técnica. Posteriormente, a dos de los pacientes se les pudo retirar la cánula de traqueotomía, sin incidencias. Los casos presentados indican que la traqueostomía percutánea puede ser realizada de forma segura, al menos en pacientes adolescentes

Percutaneous tracheostomy (PT) is a well-established procedure in adult patients who require long-term airway control. Because experience with this procedure is scarce in pediatrics, we report the results of PT by means of a progressive dilatational method with endoscopic guidance in three critically-ill adolescents with severe head injury. PT was performed by means of the Ciaglia Blue Rhino method at the bedside, guided by fiberoptic bronchoscopy by the pediatric intensive care unit staff. No hemodynamic or respiratory compromise was observed during the procedure. No complications were attributable to PT. Two patients were decannulated without incidents. The reported cases indicate that PT can be performed safely, at least in adolescents

[Percutaneous tracheostomy under endoscopic guidance in adolescents]. / Traqueostomía percutánea bajo control endoscópico en adolescentes.

Percutaneous tracheostomy (PT) is a well-established procedure in adult patients who require long-term airway control. Because experience with this procedure is scarce in pediatrics, we report the results of PT by means of a progressive dilatational method with endoscopic guidance in three critically-ill adolescents with severe head injury. PT was performed by means of the Ciaglia Blue Rhino method at the bedside, guided by fiberoptic bronchoscopy by the pediatric intensive care unit staff. No hemodynamic or respiratory compromise was observed during the procedure. No complications were attributable to PT. Two patients were decannulated without incidents. The reported cases indicate that PT can be performed safely, at least in adolescents.

[Noninvasive ventilation with heliox in an infant with acute respiratory distress syndrome]. / Ventilación no invasiva con heliox en un lactante con síndrome de dificultad respiratoria aguda.

Noninvasive ventilation (NIV) combined with heliox therapy (Hx) constitutes a therapeutic option in the management of adult patients with acute exacerbations of chronic obstructive pulmonary disease. Either NIV or Hx alone can also be effective in pediatric patients, but there are no published reports on their combined use. We describe the case of a 4-month-old infant with acute respiratory insufficiency due to severe acute respiratory distress syndrome secondary to respiratory syncytial virus infection, successfully treated with nasal continuous positive airway pressure and heliox (Hx-nCPAP). A commercially available nCPAP ventilator adapted for heliox use was employed for Hx-nCPAP application. This is the first report of the use of Hx-nCPAP in an infant.

Ventilación no invasiva con heliox en un lactante con síndrome de dificultad respiratoria aguda / Noninvasive ventilation with heliox in an infant with acute respiratory distress syndrome

La ventilación no invasiva (VNI) con heliox constituye una alternativa terapéutica en el tratamiento de los pacientes adultos con exacerbaciones agudas de su enfermedad respiratoria obstructiva crónica (EPOC). La aplicación de VNI o de heliox también puede ser eficaz en pacientes pediátricos, pero no existen referencias en la literatura médica de su uso combinado. Se presenta el caso de un lactante de 4 meses de edad con insuficiencia respiratoria aguda como consecuencia de un síndrome de dificultad respiratoria aguda (SDRA) grave secundario a una infección por virus respiratorio sincitial (VRS), y que respondió favorablemente al tratamiento con presión positiva continua en la vía aérea nasal y heliox (Hx-CPAPn). Para la realización de Hx-CPAPn se utilizó un dispositivo comercial de CPAPn adaptado para su utilización con heliox. Constituye el primer caso descrito de la aplicación de Hx-CPAPn en un lactante

Non invasive ventilation (NIV) combined with helioxtherapy (Hx) constitutes a therapeutic option in the managementof adult patients with acute exacerbations of chronic obstructive pulmonary disease. Either NIV or Hx alone can also be effective in pediatric patients, but there areno published reports on their combined use. We describe the case of a 4-month-old infant with acute respiratory insufficiency due to severe acute respiratory distress syndrome secondary to respiratory syncytial virus infection, successfully treated with nasal continuous positive air way pressure and heliox (Hx-nCPAP). A commercially availablen CPAP ventilator adapted for heliox use was employed for Hx-nCPAP application. This is the first report of the use of Hx-nCPAP in an infant