CPAP vs oxigenoterapia convencional en lactantes trasladados por insuficiencia respiratoria / CPAP vs oxygen therapy in infants being transported due to acute respiratory failure

OBJETIVOS: Evaluar la efectividad y la seguridad de la presión continua en la vía aérea (CPAP) en lactantes trasladados por insuficiencia respiratoria aguda (IRA) y comparar el curso clínico y la evolución en la unidad de cuidados intensivos pediátricos (UCIP) de los pacientes trasladados con dicha terapia vs la oxigenoterapia convencional. MATERIAL Y MÉTODOS: Estudio observacional y analítico de una cohorte retrospectiva. Se revisaron las historias de los lactantes de 0 a 12meses con IRA que precisaron traslado interhospitalario a la UCIP. RESULTADOS: Se incluyeron 110 pacientes: 71 trasladados con CPAP y 39 con oxigenoterapia. La causa principal de IRA fue la bronquiolitis (81,8%). La mediana del nivel de CPAP fue de 7cmH2O (rango intercuartílico, 6-7). Controlando en análisis multivariables específicos por los valores previos, se obtuvo que la CPAP durante el traslado produjo una disminución significativa en el score de Wood-Downes (beta=−1,08; IC95%: −1,76 a 0,40; p = 0,002) y en la frecuencia cardiaca (beta=−19,64, IC95%: −28,46 a −10,81; p < 0,001). Ningún paciente precisó intubación endotraqueal durante el transporte. En la UCIP, la tasa de intubación fue similar en el grupo CPAP (7%) y en el de oxigenoterapia (5,1%) (p = 0,689). El porcentaje de pacientes que precisaron ventilación no invasiva con dos niveles de presión en las primeras 6h de ingreso en la UCIP fue mayor en el grupo de oxigenoterapia: 100% (11/11) vs 69,2% (18/26), p = 0,04. CONCLUSIONES: La administración precoz de CPAP en lactantes es segura durante el traslado interhospitalario. Durante el transporte, la CPAP comparada con la oxigenoterapia disminuye el score de Wood-Downes y la frecuencia cardiaca

OBJECTIVE: The aims of our study are to evaluate the effectiveness and security of CPAP (continuous positive airway pressure) in infants transferred with acute respiratory failure (ARF) and to compare their evolution in PICU between CPAP vs oxygen therapy. MATERIALS AND METHODS: We conducted a retrospective observational and analytical study by reviewing the health records of infants with ARF aged 0 to 12months that required interhospital transfer to the PICU. RESULTS: We included 110 patients: 71 transported with CPAP and 39 with oxygen therapy. The main cause of ARF was acute bronchiolitis (81.8%). The median level of CPAP was 7cmH2O (interquartile range, 6-7). Controlling by the previous values in specific multivariable models, CPAP produced a significant decrease in the Wood-Downes score (beta = −1.08; 95% CI = −1.76 to −0.40; P = .002) and the heart rate (beta = −19.64, 95% CI = −28.46 to −10.81; P < .001). No patients required endotracheal intubation during transport. During the PICU stay, the intubation rate was similar in the CPAP group (7%) and the oxygen therapy group (5.1%) (P=.689). The proportion of patients that required bilevel positive airway pressure within 6hours of admission to the PICU was higher in the oxygen therapy group: 100% (11/11) vs 69.2% (18/26), P=.04. CONCLUSIONS: Early administration of CPAP to infants with ARF was a safe respiratory support intervention during interhospital transport. During patient transport, the use of CPAP achieved greater decreases in the Wood-Downes score and heart rate compared to oxygen therapy

[CPAP vs oxygen therapy in infants being transported due to acute respiratory failure]. / CPAP vs oxigenoterapia convencional en lactantes trasladados por insuficiencia respiratoria.

OBJECTIVE: The aims of our study are to evaluate the effectiveness and security of CPAP (continuous positive airway pressure) in infants transferred with acute respiratory failure (ARF) and to compare their evolution in PICU between CPAP vs oxygen therapy. MATERIALS AND METHODS: We conducted a retrospective observational and analytical study by reviewing the health records of infants with ARF aged 0 to 12months that required interhospital transfer to the PICU. RESULTS: We included 110 patients: 71 transported with CPAP and 39 with oxygen therapy. The main cause of ARF was acute bronchiolitis (81.8%). The median level of CPAP was 7cmH2O (interquartile range, 6-7). Controlling by the previous values in specific multivariable models, CPAP produced a significant decrease in the Wood-Downes score (beta = -1.08; 95% CI = -1.76 to -0.40; P = .002) and the heart rate (beta = -19.64, 95% CI = -28.46 to -10.81; P < .001). No patients required endotracheal intubation during transport. During the PICU stay, the intubation rate was similar in the CPAP group (7%) and the oxygen therapy group (5.1%) (P=.689). The proportion of patients that required bilevel positive airway pressure within 6hours of admission to the PICU was higher in the oxygen therapy group: 100% (11/11) vs 69.2% (18/26), P=.04. CONCLUSIONS: Early administration of CPAP to infants with ARF was a safe respiratory support intervention during interhospital transport. During patient transport, the use of CPAP achieved greater decreases in the Wood-Downes score and heart rate compared to oxygen therapy.

Agranulocitosis en niña de 6 años. ¿Qué hay detrás? / Agranulocytosis in a 6 year-old girl. What's behind it?

El síndrome de Kabuki (SK) es una rara enfermedad genética que cursa con importantes alteraciones cardiacas e inmunológicas. La mayoría de los pacientes son diagnosticados en los primeros años de vida pese a que la edad de inicio no está bien definida. Los pacientes afectos presentan infecciones de repetición debido a su inmunosupresión pudiendo llegar a un estado de agranulocitosis. Aunque su pronóstico es bastante favorable, su esperanza de vida viene condicionada por este tipo de complicaciones. Por ello, conocer sus características analíticas particulares resulta interesante desde el punto de vista del laboratorio de hematología para contribuir en su orientación diagnóstica y en el seguimiento de los mismos. Presentamos el caso de un paciente diagnosticado de SK

Kabuki syndrome (KS) is a rare genetic disease that usually involves significant cardiac and immunological disorders. Most patients are diagnosed in the first years of life, despite the fact that the age of onset is not well-defined. Affected patients have recurrent infections due to their immunosuppression, and may reach a state of agranulocytosis. Although their prognosis is quite favourable, their life expectancy is determined by these types of complications. Therefore, to understand its particular analytical characteristics is interesting from the point of view of the Haematology Laboratory to contribute to their diagnosis and follow-up. The case is presented of a patient diagnosed with KS