Seguridad en la prescripción en Cuidados Intensivos Pediátricos / Safety in the prescription in Pediatric Intensive Cares

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Síndrome de abstinencia en Cuidados Intensivos Pediátricos. Incidencia y factores de riesgo / Withdrawal syndrome in the pediatric intensive care unit. incidence and risk factors

Objetivo Conocer la incidencia de síndrome de abstinencia tras perfusión prolongada de fentanilo y midazolam en niños, y los factores de riesgo asociados. Diseño Estudio de cohorte histórica o retrospectiva. Ámbito UCI pediátrica de seis camas de un hospital universitario. Pacientes Se incluyen 48 pacientes pediátricos que recibieron sedoanalgesia en perfusión continua con midazolam y fentanilo exclusivamente, durante al menos 48 horas. Intervenciones Ninguna. Variables de interés principales Se recogen datos clínicos y demográficos, dosis y duración de sedoanalgesia recibida, aparición de síndrome de abstinencia, gravedad y tratamiento del mismo. Resultados El 50% desarrolló síndrome de abstinencia. Hubo diferencias significativas entre los que lo desarrollaron y los que no en cuanto a duración del tratamiento previo y dosis acumulada de ambos fármacos. Una dosis acumulada de fentanilo de 0,48mg/kg o de midazolam de 40mg/kg, y una duración de la perfusión de ambos de 5,75 días fueron factores de riesgo para el desarrollo de abstinencia. La mayoría presentó un cuadro leve o moderado, que comenzó a las 12-36 horas de suspender la perfusión. El fármaco más utilizado en el tratamiento fue la metadona. Conclusiones La incidencia de síndrome de abstinencia en niños tras perfusión prolongada de midazolam y fentanilo es elevada. El desarrollo del síndrome se relaciona con tiempos de perfusión prolongados y con dosis acumuladas elevadas de ambos fármacos (AU)

Objective To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. Design Historic or retrospective cohort study. Setting Pediatric Intensive Care Unit in an academic center. Patients Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48hours.InterventionsNone.Main variables of interest Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. Results Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48mg/kg, a cumulative midazolam dose of 40mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36hours after weaning from infusion. Methadone was used in most cases for treating with drawal. Conclusions There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome (AU)

Withdrawal syndrome in the pediatric intensive care unit. Incidence and risk factors.

OBJECTIVE: To determine the incidence of withdrawal syndrome after prolonged infusion of fentanyl and midazolam in children, and the associated risk factors. DESIGN: Historic or retrospective cohort study. SETTING: Pediatric Intensive Care Unit in an academic center. PATIENTS: Forty-eight pediatric patients who received sedation and analgesia only with fentanyl and midazolam through continuous infusion for at least 48 hours. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Collected data included demographic and clinical parameters, dose and duration of sedation received, and incidence, severity and treatment of withdrawal syndrome. RESULTS: Fifty percent of the patients developed withdrawal syndrome. There were significant differences between the patients who developed withdrawal syndrome and those who did not, in terms of the duration of infusion and the cumulative doses of both drugs. A cumulative fentanyl dose of 0.48 mg/kg, a cumulative midazolam dose of 40 mg/kg, and a duration of infusion of both drugs of 5.75 days were risk factors for the development of withdrawal syndrome. Most children developed mild or moderate disease, beginning about 12-36 hours after weaning from infusion. Methadone was used in most cases for treating withdrawal. CONCLUSIONS: There is a high incidence of withdrawal syndrome in children following the continuous infusion of midazolam and fentanyl. The duration of infusion of both drugs and higher cumulative doses are associated with the development of withdrawal syndrome.

Monitorización de la sedación en cuidados intensivos pediátricos / Monitoring of sedation in pediatric intensive cares

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El absceso retrofaríngeo en la edad infantil / Childhood retropharyngeal abscess

Introducción: Las infecciones del espacio retrofaríngeo tienen una baja incidencia. Suceden entre los 2 y los 5 años de edad normalmente. Son infecciones polimicrobianas, aunque dominan los estreptococos, estafilococos y gérmenes anaerobios. Producen dolor faríngeo, fiebre y disfagia, asociada a rigidez cervical. En la exploración se observa un abombamiento de la pared posterior faríngea. Caso clínico: Presentamos el caso de un niño de 2 años que presentó un absceso de 11 cm3 de volumen, y otro de una niña de 4 años con un absceso de 8 cm3, por lo que se procede a la incisión y el drenaje del absceso por vía transoral de entrada. Discusión: La tomografía computarizada (TC) cervical es la prueba diagnóstica de elección; permite realizar el diagnóstico en estadio temprano, así como la diferenciación entre celulitis y absceso. El absceso retrofaríngeo rara vez se resuelve espontáneamente, por lo que es necesario administrar antibioterapia intravenosa y, si es mayor de 3 mL, un drenaje quirúrgico por vía transoral o externa mediante cervicotomía lateral. Conclusión: La prueba estándar es la TC. Las complicaciones pueden ser muy graves(AU)

Introduction: The incidence of retropharyngeal infection is low. The usually occur in children between the ages of 2 and 5 years. They are often polymicrobial infections, although Streptococcus, Staphylococcus, and anaerobic organisms are especially predominant. The clinical symptoms are sore throat, fever, dysphagia and stiff neck. Physical exploration reveals a bulging of the posterior pharyngeal wall. Case report: We report the cases of a two-year-old boy with and abscess of 11 cm3 and a four-year-old girl with an abscess of 8 cm3 that required transoral surgical drainage. Discussion: Computed tomography of the neck is the diagnostic technique of choice as it enables the early detection of abscesses and makes it possible to distinguish between and abscess and cellulitis. Retropharyngeal abscesses rarely resolve spontaneously and, thus, require intravenous antibiotic therapy and, when the volume is greater thar 3 cc., transoral surgical drainage or external drainage via lateral neck incision. Conclusion: Computed tomography is the gold standard for the diagnosis of this entity. Very severe complications can develop(AU)