Análisis de las traqueotomías en cuidados intensivos pediátricos durante el periodo 2003-2013 / Analysis of tracheostomies in a pediatric intensive care unit during the period 2003-2013

INTRODUCCIÓN: La traqueotomía es un procedimiento poco frecuente en la Unidad de cuidados intensivos pediátricos (UCIP). Analizamos las complicaciones derivadas de la técnica, la mortalidad atribuible a la misma y la mortalidad global de los pacientes traqueotomizados. PACIENTES Y MÉTODOS: Estudio retrospectivo descriptivo durante el periodo comprendido entre enero del 2003 y diciembre del 2013 de los pacientes ingresados en la UCIP a los que se realiza una traqueotomía a lo largo de su ingreso. RESULTADOS: Durante el periodo analizado se recoge a 25 pacientes. La media de edad es de 31,3 meses (rango 1-144, mediana 14 meses) y la media de estancia en UCIP es de 53 días (rango 1-338 días, mediana 37 días). En su mayoría (68%) son pacientes con comorbilidades previas a su ingreso, destacando en frecuencia las anomalías craneofaciales/síndromes polimalformativos (32%) y problemas asociados a la prematuridad (12%). Las patologías más frecuentes que motivaron la realización del procedimiento fueron la obstrucción congénita de la vía aérea y diversas causas de lesión medular, seguido de traqueobroncomalacia y estenosis subglótica. Se detectaron complicaciones en el 40% de los pacientes, siendo la más frecuente la decanulación accidental. Presentaron durante el curso evolutivo una decanulación accidental el 20% de los pacientes, principalmente en las primeras 24 h del postoperatorio, motivo por el que falleció uno de los pacientes. CONCLUSIONES: La realización de la traqueotomía es un procedimiento poco frecuente en la UCIP, aunque no exento de complicaciones, algunas de ellas de riesgo vital

INTRODUCTION: Tracheotomy in pediatric patients is a rare procedure. In this pediatric series, perioperative complications, mortality related to surgical procedure and overall mortality are analyzed. PATIENTS AND METHODS: This is a retrospective study conducted from January 2003 to December 2013. Data were retrieved from patients who were tracheotomized and admitted to our PICU in the postoperative period. RESULTS: Data were collected from 25 tracheotomized patients admitted during the study period. The mean age was 3.3 months (median 14 months, range 1-144 months), and PICU length of stay was 53 days (median 37 days, range 1-338 days). Most patients (68%) had comorbidities before their admission, with a higher prevalene of craniofacial anomalies/polymalformative syndromes (32%) and prematurity related disorders (12%) being obserevd. The most common etiologies related to the procedure were congenital airway obstruction (16%) and several types of spinal cord injury (16%), followed by tracheobronchomalacia (12%) and subglottic stenosis (12%). Some kind of complication was detected in 40% of patients, with accidental decannulation being the most frequent. Accidental or unexpected decannulation was present in a percentage as high as 20% of our patients, mainly in the first 24hours after surgery. One of the patients died as a result of this. CONCLUSIONS: The postoperative course of a tracheotomy is associated with a high rate of complications, some of them related to life-threatening events

[Analysis of tracheostomies in a pediatric intensive care unit during the period 2003-2013]. / Análisis de las traqueotomías en cuidados intensivos pediátricos durante el periodo 2003-2013.

INTRODUCTION: Tracheotomy in pediatric patients is a rare procedure. In this pediatric series, perioperative complications, mortality related to surgical procedure and overall mortality are analyzed. PATIENTS AND METHODS: This is a retrospective study conducted from January 2003 to December 2013. Data were retrieved from patients who were tracheotomized and admitted to our PICU in the postoperative period. RESULTS: Data were collected from 25 tracheotomized patients admitted during the study period. The mean age was 3.3 months (median 14 months, range 1-144 months), and PICU length of stay was 53 days (median 37 days, range 1-338 days). Most patients (68%) had comorbidities before their admission, with a higher prevalene of craniofacial anomalies/polymalformative syndromes (32%) and prematurity related disorders (12%) being obserevd. The most common etiologies related to the procedure were congenital airway obstruction (16%) and several types of spinal cord injury (16%), followed by tracheobronchomalacia (12%) and subglottic stenosis (12%). Some kind of complication was detected in 40% of patients, with accidental decannulation being the most frequent. Accidental or unexpected decannulation was present in a percentage as high as 20% of our patients, mainly in the first 24 hours after surgery. One of the patients died as a result of this. CONCLUSIONS: The postoperative course of a tracheotomy is associated with a high rate of complications, some of them related to life-threatening events.

Inicio, dosificación y balance de líquidos en las técnicas de depuración extrarrenal / Initiation, dosage and fluid balance in the extrarenal depuration techniques

No disponible

Manejo inicial del politraumatismo pediátrico (III). Transporte del paciente politraumatizado / Monographic series: initial treatment of pediatric polytraumatism (III). Transportation of the polytraumatized patient

No disponible

Neumonía aspirativa tras administración de polietilenglicol / Aspiration pneumonia after administration of a polyethylene glycol solution

No disponible

Síndrome de disfunción autonómica secundario a meningitis tuberculosa / Autonomic dysfunction syndrome secondary to tuberculous meningitis

No disponible

[Unilateral agenesis of the pulmonary branch. Its diagnosis by color echo-Doppler and nuclear magnetic resonance]. / Agenesia unilateral de rama pulmonar. Diagnóstico con eco-Doppler color y resonancia nuclear magnética.

We present two symptomatic patients of five and six months old with unilateral agenesis of main pulmonary branch (right and left) without associated anomalies. The diagnostic was made with magnetic resonance imaging and two-dimensional echocardiographic with Doppler color flow. We think that the magnetic resonance, must be used with priority in this pathology for being a non invasive diagnostic method, that is able to diagnostic the basic cardiopathy and the intracardiac and extracardiac associated anomalies. His association with the Doppler-echocardiography allow to ignore the arteriography upon to get a accurate diagnostic.

[Univentricular heart with left morphology with permeable atrio-ventricular valves. Study of the bulbo-ventricular foramen with color echo-Doppler. Importance for the surgical repair]. / Corazón univentricular de morfología izquierda con válvulas aurículo-ventriculares permeables. Estudio del foramen bulbo-ventricular con eco-Doppler color. Importancia para la corrección quirúrgica.

INTRODUCTION AND OBJECTIVES: Bidimensional and color-coded Doppler echocardiography were used to study 19 patients with univentricular heart, permeable atrioventricular valves, muscular bulbo-ventricular foramen and an anterior rudimentary chamber. We evaluated the influence of the foramen upon the size of the great vessels, and in consequence the most appropriated surgical techniques. MATERIAL AND METHODS: The foramen was measured in two projections at the end of the systolic period, and its area was calculated, according to the body surface, with the formula S = pi (D1/2 x D2/2). Indexes lower than 2 cm2/m2 were considered as restrictive. We studied 19 patients that presented a mean age of 11 +/- 12 years (range 1 day-39 years). The patients were classified in two groups. Group A: patients who had transposition of the great vessels (13 cases). Group B: patients who had normal connection of the great vessels (6 cases). Each group was classified in two subgroups: subgroup 1, patients who presented a restrictive foramen, and subgroup 2, patients who presented a normal foramen. In this study, we evaluated the associated cardiac anomalies. RESULTS: Group A. Thirteen cases. The index value for the whole group was 2.47 +/- 1.18 cm2/m2. The first subgroup included 6 cases with a restrictive foramen, 2 patients presented pathology of the arch. Four patients had a pressure gradient between the ventricle and the rudimentary chamber beyond 20 mmHg. The index of this subgroup was 1.68 +/- 0.39 cm2/m2, the median was 1.7. Seven cases, with a normal foramen, were included in the second subgroup, six of them had pulmonary valve stenosis, and the other one had undergone a pulmonary artery bandage 2 months before. Only one patient had a gradient pressure at the foramen beyond 20 mmHg. The index for this second subgroup was 3.34 +/- 0.83 cm2/m2. GROUP B: Six patients with normal connection of the great vessels were included. The index was 1.56 +/- 1.17 cm2/m2. The first subgroup included 3 cases with a restrictive foramen. The index was 0.72 +/- 0.29 cm2/m2 (range 0.41-1) and the median was 0.75. Pressure gradient between the ventricle and the rudimentary chamber was greater than 20 mmHg. Three patients with a normal foramen were in the second subgroup and here, the index was under normal limits 2.4 +/- 0.52 cm2/m2 (range 2.1-3), the median was 2.1. One patient underwent a pulmonary artery bandage two months before. CONCLUSIONS: Bulbo-ventricular foramen size/body surface index may exert an influence on the size of the vessel connected to the rudimentary chamber. The index vary in a negative way with the evolution time, or in those cases with transposition of the great vessels after a pulmonary artery bandage. Whenever the foramen is restrictive, the pulmonary artery or the aorta have a smaller diameter and the pressure gradient between the ventricle and the rudimentary chamber rises.