Tiopental y falsa hipernatremia: compruebe su analizador / Thiopental and false hypernatremia: Check your analyzer

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Utilidad de etomidato en paciente con síndrome de Cushing con hipertensión arterial e hipopotasemia graves / Usefulness of ethomidate in patients with Cushing syndrome with severe arterial hypertension and hypopotassemia

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Monitorización no invasiva transcutánea de la concentración de hemoglobina en pacientes críticos pediátricos con riesgo de sangrado / Noninvasive hemoglobin monitoring in critically ill pediatric patients at risk of bleeding

OBJETIVO: Determinar la validez y precisión de un método de medición continua transcutánea de la concentración de hemoglobina (Hb) en pacientes críticos con riesgo de sangrado. DISEÑO: Estudio observacional prospectivo comparando el estándar de referencia con la determinación transcutánea de hemoglobina (SpHb). Ámbito: Unidad de cuidados intensivos pediátricos de un hospital universitario de tercer nivel. PACIENTES: Muestra consecutiva de pacientes con peso >3kg y riesgo de sangrado. INTERVENCIONES: Medición de SpHb mediante el cooxímetro de pulso Radical7 (Masimo Corp., Irvine, CA) en cada extracción sanguínea con determinación de Hb analizada con estándar de referencia (Siemens ADVIA 2120i). VARIABLES: Variables epidemiológicas, índice de perfusión (IP), índice de variabilidad pletismográfica, frecuencia cardiaca, SaO2, temperatura rectal, baja calidad de señal, así como otros factores que pueden afectar a la medición. RESULTADOS: Se realizaron 284 mediciones (80 pacientes). La media de Hb por el analizador central fue de 11,7±2,05g/dl. La media de SpHb fue de 12,32±2g/dl (Pearson 0,72, R2 0,52). El índice de correlación intraclase fue de 0,69 (IC95%: 0,55-0,78), p < 0,001. El diagrama de Bland-Altman mostró una diferencia media entre ambos métodos de 0,66±1,46g/dl. Un menor IP y una mayor temperatura rectal incrementaron de forma independiente el riesgo de baja calidad de la señal (OR 0,531 [IC95%: 0,32-0,88] y 0,529 [IC95%: 0,33-0,85], respectivamente). CONCLUSIONES: La SpHb presenta buena correlación con la obtenida por el analizador central, aunque los límites de concordancia son amplios. Su principal ventaja es la posibilidad de monitorización continua en pacientes con riesgo de sangrado. La fiabilidad de este método es limitada en casos de mala perfusión periférica

OBJECTIVE: To determine the accuracy and usefulness of noninvasive continuous hemoglobin (Hb) monitoring in critically ill patients at risk of bleeding. DESIGN: An observational prospective study was made, comparing core laboratory Hb measurement (LabHb) as the gold standard versus transcutaneous hemoglobin monitoring (SpHb). SETTING: Pediatric Intensive Care Unit of a tertiary University Hospital. PATIENTS: Patients weighing >3kg at risk of bleeding. INTERVENTIONS: SpHb was measured using the Radical7 pulse co-oximeter (Masimo Corp., Irvine, CA, USA) each time a blood sample was drawn for core laboratory analysis (Siemens ADVIA 2120i). VARIABLES: Sociodemographic characteristics, perfusion index (PI), pleth variability index, heart rate, SaO2, rectal temperature, low signal quality and other events that can interfere with measurement. RESULTS: A total of 284 measurements were made (80 patients). Mean LabHb was 11.7±2.05g/dl. Mean SpHb was 12.32±2g/dl (Pearson 0.72, R2 0.52). The intra-class correlation coefficient was 0.69 (95%CI 0.55-0.78)(p < 0.001). Bland-Altman analysis showed a mean difference of 0.07 ±1.46g/dl. A lower PI and higher temperature independently increased the risk of low signal quality (OR 0.531 [95%CI 0.32-0.88] and 0.529 [95%CI 0.33-0.85], respectively). CONCLUSIONS: SpHb shows a good overall correlation to LabHb, though with wide limits of agreement. Its main advantage is continuous monitoring of patients at risk of bleeding. The reliability of the method is limited in cases with poor peripheral perfusion

Noninvasive hemoglobin monitoring in critically ill pediatric patients at risk of bleeding. / Monitorización no invasiva transcutánea de la concentración de hemoglobina en pacientes críticos pediátricos con riesgo de sangrado.

OBJECTIVE: To determine the accuracy and usefulness of noninvasive continuous hemoglobin (Hb) monitoring in critically ill patients at risk of bleeding. DESIGN: An observational prospective study was made, comparing core laboratory Hb measurement (LabHb) as the gold standard versus transcutaneous hemoglobin monitoring (SpHb). SETTING: Pediatric Intensive Care Unit of a tertiary University Hospital. PATIENTS: Patients weighing >3kg at risk of bleeding. INTERVENTIONS: SpHb was measured using the Radical7 pulse co-oximeter (Masimo Corp., Irvine, CA, USA) each time a blood sample was drawn for core laboratory analysis (Siemens ADVIA 2120i). VARIABLES: Sociodemographic characteristics, perfusion index (PI), pleth variability index, heart rate, SaO2, rectal temperature, low signal quality and other events that can interfere with measurement. RESULTS: A total of 284 measurements were made (80 patients). Mean LabHb was 11.7±2.05g/dl. Mean SpHb was 12.32±2g/dl (Pearson 0.72, R2 0.52). The intra-class correlation coefficient was 0.69 (95%CI 0.55-0.78)(p<0.001). Bland-Altman analysis showed a mean difference of 0.07 ±1.46g/dl. A lower PI and higher temperature independently increased the risk of low signal quality (OR 0.531 [95%CI 0.32-0.88] and 0.529 [95%CI 0.33-0.85], respectively). CONCLUSIONS: SpHb shows a good overall correlation to LabHb, though with wide limits of agreement. Its main advantage is continuous monitoring of patients at risk of bleeding. The reliability of the method is limited in cases with poor peripheral perfusion.

Test de apnea en muerte encefálica. ¿Es seguro realizarlo con CPAP en respiradores convencionales? / Apnea test in brain death. Is it safe to perform with CPAP using conventional respirators?

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Indicadores pronósticos clínicos en el posoperatorio de cirugía cardiovascular pediátrica y su relación con la cinética del estrés oxidativo / Prognostic indicators after cardiac surgery in children and their relationship with the oxidative stress response

Objetivos. Analizar la evolución de parámetros de estrés oxidativo en el posoperatorio de cirugía cardiovascular pediátrica y correlacionarlos con diferentes indicadores clínicos pronósticos. Material y métodos. Treinta niños, de entre un mes y 14 años, peso > 5 kg, sometidos a circulación extracorpórea. Se obtuvieron muestras preoperatoria, posoperatoria inmediata y tras 18-20 h. Se analizó la capacidad de peroxidación lipídica de las membranas celulares mediante la cuantificación de productos de reacción con el ácido tiobarbitúrico, cuyo principal representante es el malondialdehído; se cuantificó el contenido celular de glutatión total, oxidado y reducido (representantes de la respuesta antioxidante). Se analizaron las variables clínicas que permitieran establecer una puntuación para el síndrome de respuesta inflamatoria sistémica asociado a circulación extracorpórea. Resultados. Treinta pacientes con una mediana de edad de 4,1 años (rango intercuartílico [RIC]: 2,7; 8,0); el 62,1% eran niñas; mediana de desviaciones estándar de peso −0,39 (RIC: −0,76; 0,24), de talla −0,22 (RIC: −0,74; 0,27) y de IMC −0,43 (RIC: −1; 0,45). Mediana de tiempo quirúrgico 79 min (RIC: 52,5; 125,5), mediana de pinzamiento 38,5 min (RIC: 22; 59). Aumentó el malondialdehído y disminuyó el glutatión en ambos momentos posoperatorios, con clara correlación directa, estadísticamente significativa, del tiempo de circulación extracorpórea con el porcentaje de descenso de glutatión total entre preoperatorio y posoperatorio inmediato y entre el preoperatorio y el posoperatorio tardío. Hubo una correlación estadística entre los niveles de glutatión total tras 18-20 h posoperatorias y el tiempo de duración de la ventilación mecánica y la pertenencia al grupo de síndrome de respuesta inflamatoria sistémica. Conclusiones. La circulación extracorpórea activa mediadores inflamatorios, máximo tras el pinzamiento aórtico, mejorando tras 24 h, siendo dependiente de los tiempos quirúrgicos. El desarrollo de respuesta inflamatoria está asociado a una mayor duración de la ventilación mecánica, una estancia más prolongada en Cuidados Intensivos, puntuaciones mayores del Modelo de Aristóteles y tiempos más largos quirúrgicos. Los que no cumplen criterios de respuesta inflamatoria tienen más niveles de glutatión en el posoperatorio tardío (AU)

Objectives. To analyse the trend in lipid peroxidation and antioxidant response as key markers of oxidative stress after paediatric cardiovascular surgery, and compare them with other internationally accepted clinical prognostic indicators. Patients and methods. A prospective study was conducted on 30 children aged one month to 14 years, weight > 5 kg, undergoing cardiopulmonary bypass surgery. Blood samples were taken just before the intervention, immediately after surgery, and after 18-20 h. Cell membrane lipid peroxidation was analysed by quantifying malondialdehyde, as well as measuring total glutathione (oxidized and reduced), as representatives of antioxidant response. An analysis was also performed on clinical variables for establishing a score for the systemic inflammatory response syndrome associated with cardiopulmonary bypass. Results. The study included 30 children with a mean age of 4.1 years old (interquartile range [IQR]: 2.7; 8.0). Of these, 62.1% were girls. The standard deviation of the median weight was −0.39 (IQR: −0.76; 0.24), the median height was −0.22 (IQR: −0.74; 0.27), and the median BMI was −0.43 (IQR: −1; 0.45). The final surgery times were divided into 2 parts: total time of extracorporeal circulation, with a mean of 79 min (IQR: 52.5; 125.5), and the clamping time, a measurement included in the previous figure with a mean value of 38.5 min (IQR: 22; 59). Malondialdehyde increased and glutathione decreased in postoperative time, with clear, statistically significant direct correlation between time of extracorporeal circulation and percentage decrease in total glutathione between preoperative and immediate postoperative time, and a decline between the preoperative and late postoperative. There was a statistical correlation between total glutathione levels at 18-20 h postoperatively and the duration of mechanical ventilation and inflammatory systemic response syndrome. Conclusions. Surgery with extracorporeal circulation performed in children activates inflammatory mediators, being maximum after aortic clamping, and improving after the first 24 h. The level of oxidative stress activation depends on surgical times. The development of systemic inflammatory response syndrome is associated with longer duration of mechanical ventilation, longer stay in intensive care, higher scores in the Aristotle model and longer surgical times. Those who do not meet criteria for inflammatory response have higher levels of glutathione in first 24 h (AU)

Prognostic indicators after cardiac surgery in children and their relationship with the oxidative stress response.

OBJECTIVES: To analyse the trend in lipid peroxidation and antioxidant response as key markers of oxidative stress after paediatric cardiovascular surgery, and compare them with other internationally accepted clinical prognostic indicators. PATIENTS AND METHODS: A prospective study was conducted on 30 children aged one month to 14 years, weight>5 kg, undergoing cardiopulmonary bypass surgery. Blood samples were taken just before the intervention, immediately after surgery, and after 18-20 h. Cell membrane lipid peroxidation was analysed by quantifying malondialdehyde, as well as measuring total glutathione (oxidized and reduced), as representatives of antioxidant response. An analysis was also performed on clinical variables for establishing a score for the systemic inflammatory response syndrome associated with cardiopulmonary bypass. RESULTS: The study included 30 children with a mean age of 4.1 years old (interquartile range [IQR]: 2.7; 8.0). Of these, 62.1% were girls. The standard deviation of the median weight was -0.39 (IQR: -0.76; 0.24), the median height was -0.22 (IQR: -0.74; 0.27), and the median BMI was -0.43 (IQR: -1; 0.45). The final surgery times were divided into 2 parts: total time of extracorporeal circulation, with a mean of 79 min (IQR: 52.5; 125.5), and the clamping time, a measurement included in the previous figure with a mean value of 38.5 min (IQR: 22; 59). Malondialdehyde increased and glutathione decreased in postoperative time, with clear, statistically significant direct correlation between time of extracorporeal circulation and percentage decrease in total glutathione between preoperative and immediate postoperative time, and a decline between the preoperative and late postoperative. There was a statistical correlation between total glutathione levels at 18-20 h postoperatively and the duration of mechanical ventilation and inflammatory systemic response syndrome. CONCLUSIONS: Surgery with extracorporeal circulation performed in children activates inflammatory mediators, being maximum after aortic clamping, and improving after the first 24h. The level of oxidative stress activation depends on surgical times. The development of systemic inflammatory response syndrome is associated with longer duration of mechanical ventilation, longer stay in intensive care, higher scores in the Aristotle model and longer surgical times. Those who do not meet criteria for inflammatory response have higher levels of glutathione in first 24h.

La cinética de la citrulina y la arginina y su valor como factor pronóstico en pacientes pediátricos críticamente enfermos / Citrulline and arginine kinetics and its value as a prognostic factor in pediatric critically ill patients

INTRODUCCIÓN: Se han documentado bajas concentraciones de citrulina y arginina plasmáticas en niños en diversas condiciones patológicas. Hipótesis: La cinética de citrulina y arginina plasmáticas durante la enfermedad crítica pediátrica se correlaciona con parámetros evolutivos clínicos y bioquímicos. PACIENTES Y MÉTODOS: Estudio observacional unicéntrico prospectivo en pacientes de 7 días a 14 años ingresados en Unidad de Cuidados Intensivos Pediátricos (PICU). Los datos bioquímicos y clínicos fueron recogidos al ingreso, a las 12 h, a las 24 h, al 3.er y al 7.° día. RESULTADOS: Un total de 44 pacientes críticamente enfermos fueron incluidos y un grupo control de 51 niños sanos. La citrulina desciende de forma significativa (p < 0,05) a las 12 h de ingreso con niveles bajos mantenidos hasta el día 7, comenzando un aumento progresivo después. La arginina ya está descendida a las 6h, aunque tiene una subida más precoz (día 3). La disminución de citrulina al tercer día se correlaciona directamente con la arginina. Hay correlación entre la elevación de la citrulina al 7.° día con menor duración de ventilación mecánica, menor estancia en PICU y menos complicaciones. Los niveles de citrulina bajos al 7° día aún descendidos el día 7 se asocian con un mayor aumento de PCR y procalcitonina en primeras 24 h. La disminución de arginina en las primeras 12 h se correlaciona inversamente con estancia más larga, mayor número de complicaciones y aumento de reactantes de fase aguda en día 3. CONCLUSIONES: Hay disminución de arginina y citrulina en los primeros días de la enfermedad crítica, con recuperación al 3.er y 7.° día, respectivamente, y existe una relación entre mayor disminución y peor evolución

INTRODUCTION: Low concentrations of plasma citrulline and arginine have been reported in children under various pathological conditions. Hypothesis: Plasma citrulline and arginine levels undergo different kinetics during the early days of critical illness in children according to the severity of symptoms and can be correlated with other clinical and laboratory parameters associated with the SIR. PATIENTS AND METHODS: A single-center prospective observational study in patients 7 days to 14 years admitted to pediatric intensive care unit (PICU). Citrulline and arginine blood levels (blood in dry paper, analysis by mass spectrometry in tandem), acute phase reactants and clinical data were collected on admission, at 12 h, 24 h, 3 and 7 days. RESULTS: A total of 44 critically ill patients were included and control group was formed by 42 healthy children. The citrulline and arginine kinetic analysis showed: 1) Citrulline falls significantly (P<.05) at 12 h of admission; levels remain low until day 7 and begin progressive increase again. 2) Arginine is already lowered at 6h, although an earlier rise occurs (3rd day). 3. The decrease of citrulline in the first 3 days of admission positively correlates with arginine kinetics. Bivariate analysis showed: 1) Correlation of elevated citrulline on the 7th day with shorter duration of mechanical ventilation, lower PICU stay and lower occurrence of complications. The levels of citrulline still descended at day 7 are associated with increased CRP/procalcitonin elevation at first 24 h. 2) The greatest decrease of arginine in the first 12 h is associated with a longer PICU stay and greater number of complications and increase of acute phase reactants at 3 days. CONCLUSIONS: There are decreased levels of arginine and citrulline in the first days at PICU, with recovery at the 3rd and 7th day respectively, and a relationship between a greater decrease and a worse outcome and between a longer income and a higher serum CRP/procalcitonin

Errores innatos del metabolism en un hospital pediátrico. Diferencias sustanciales entre la era pre y postcribado neonatal ampliado / Innate errors of metabolism in a pediatric hospital. Substantial differences between the extended neonatal pre- and post screening era

Introducción. Las aminoacidopatías son enfermedades metabólicas hereditarias (EMH) que sin diagnóstico ni tratamiento precoz pueden producir consecuencias graves, llegando incluso a la muerte. La introducción del programa de cribado neonatal mediante espectrometría de masas en tándem (MS/MS) pretende mejorar el pronóstico. El objetivo del estudio es comparar la evolución clínica de pacientes diagnosticados de aminoacidopatías en fase clínica frente a los resultantes del cribado neonatal. Material y métodos. Estudio descriptivo retrospectivo de pacientes diagnosticados de metabolopatías entre Enero de 2002 y Junio de 2015. El cribado ampliado de EIM mediante MS/MS se está empleando en nuestro centro desde abril de 2010. Resultados. Han sido diagnosticados en nuestra unidad en estos 13 años 245 casos de EMH. Agrupándolos por patologías: 152 trastornos del metabolismo de las proteínas, 27 trastornos del metabolismo de los carbohidratos, 33 trastornos del metabolismo lipídico, 12 enfermedades lisosomales, 2 enfermedades peroxisomales, 4 defectos congénitos de glicosilación de proteínas, 10 casos de enfermedad de Wilson y 5 de deficiencia de alfa-1 antitripsina. Del total de la serie, 19 pacientes son de origen magrebí (7,7%) y un 52 % de sexo femenino. De los casos que debutaron en cuidados intensivos pediátricos la mayoría de los pacientes requirieron apoyo agresivo, incluyendo ventilación mecánica y terapia de eliminación extracorpórea (7 diálisis peritoneal, 6 hemofiltración veno-venosa continua), así como fármacos vasoactivos. De todos los pacientes, sufrieron datos de shock 15 niños, fallo multiorgánico 6, grave insulto neurológico 8, coagulopatía 3 y fallo hepático agudo 3. Discusión. La descompensación aguda de una metabolopatía, como en otros EIM, es una emergencia metabólica que debemos diagnosticar y tratar precozmente, por su elevada morbimortalidad. La instauración del cribado ampliado ha logrado el tratamiento en fase presintomática y la identificación precoz de las descompensaciones agudas, lo cual ha contribuido al descenso de las mismas y a una clara reducción de mortalidad. Hay niños ya diagnosticados por cribado que pueden necesitar ingreso por descompensación y otros sin posibilidad de cribado que pueden requerir ingreso por debut (AU)

Introduction. Amino acid disorders are hereditary metabolic diseases (HMD) that may cause serious consequences, even death, without diagnosis or early treatment. The introduction of the neonatal screening program using tandem mass spectrometry (MS/MS) aims to improve the prognosis. This study has aimed to compare the clinical course of patients diagnosed of amino acid disorders in the clinical phase versus the results of neonatal screening. Material and methods. Retrospective descriptive study of patients diagnosed of metabolic disorders between January 2002 and June 2015. The extended screening of EIM by MS/ MS has been used in our center since April 2010. Results. A total of 245 cases of HMD has been diagnosed in our unit during these 13 years. Grouped by conditions: 152 protein metabolism disorders, 27 carbohydrate metabolism disorders, 33 lipid metabolism disorders, 12 lysosomal diseases, 2 peroxisomal diseases, 4 protein glycosylation congenital defects, 10 cases of Wilson disease and 5 alpha-1 antitrypsin deficiency. Nineteen out of the entire series were of origin Maghreb (7.7%) and 52% were women. Of the cases initiating in pediatric intensive care, most of the patients required aggressive support, including mechanical ventilation and extracorporeal elimination therapy (7 peritoneal dialysis, 6 continuous venovenous hemofiltration) and vasoactive drugs. Fifteen of all the patients suffered shock data, 6 multiorgan failure, 8 severe neurological insult, 3 coagulopathy, and 3 severe liver failure. Discussion. Acute decompensation of a metabolic disorder, as in other EIM is a metabolic emergency that should be diagnosed and treated early, due to its elevated morbidity- mortality. Initiation of extended screening has achieved treatment in the presymptomatic phase and early identification of acute decompensations, which has contributed to their decrease and to a clear reduction of mortality. There are children who have already been diagnosed by screening that may need hospitalization due to decompensations and others without possibility of screening that may require admission due to debut (AU)

Taponamiento cardiaco atípico por reservorio venoso central. ¿Podemos prevenirlo? / Atypical cardiac tamponade due to central venous catheter. Can we prevent it?

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[Citrulline and arginine kinetics and its value as a prognostic factor in pediatric critically ill patients]. / La cinética de la citrulina y la arginina y su valor como factor pronóstico en pacientes pediátricos críticamente enfermos.

INTRODUCTION: Low concentrations of plasma citrulline and arginine have been reported in children under various pathological conditions. HYPOTHESIS: Plasma citrulline and arginine levels undergo different kinetics during the early days of critical illness in children according to the severity of symptoms and can be correlated with other clinical and laboratory parameters associated with the SIR. PATIENTS AND METHODS: A single-center prospective observational study in patients 7 days to 14 years admitted to pediatric intensive care unit (PICU). Citrulline and arginine blood levels (blood in dry paper, analysis by mass spectrometry in tandem), acute phase reactants and clinical data were collected on admission, at 12 h, 24 h, 3 and 7 days. RESULTS: A total of 44 critically ill patients were included and control group was formed by 42 healthy children. The citrulline and arginine kinetic analysis showed: 1) Citrulline falls significantly (P<.05) at 12 h of admission; levels remain low until day 7 and begin progressive increase again. 2) Arginine is already lowered at 6h, although an earlier rise occurs (3rd day). 3. The decrease of citrulline in the first 3 days of admission positively correlates with arginine kinetics. Bivariate analysis showed: 1) Correlation of elevated citrulline on the 7th day with shorter duration of mechanical ventilation, lower PICU stay and lower occurrence of complications. The levels of citrulline still descended at day 7 are associated with increased CRP/procalcitonin elevation at first 24 h. 2) The greatest decrease of arginine in the first 12 h is associated with a longer PICU stay and greater number of complications and increase of acute phase reactants at 3 days. CONCLUSIONS: There are decreased levels of arginine and citrulline in the first days at PICU, with recovery at the 3rd and 7th day respectively, and a relationship between a greater decrease and a worse outcome and between a longer income and a higher serum CRP/procalcitonin.

Estado actual y utilidad de la autopsia clínica en una unidad de cuidados intensivos pediátricos / Current situation and usefulness of autopsy in a paediatric intensive care unit

Introducción: La autopsia clínica (AC) es una herramienta de confrontación diagnóstica que se encuentra en descenso en las últimas décadas. Nuestro objetivo es describir la tasa de autopsias, la correlación de los diagnósticos clínicos y hallazgos postmortem para valorar su utilidad global en nuestro medio. Pacientes y método: Revisión de las AC en una unidad de cuidados intensivos pediátricos de un hospital terciario en un periodo de 6 años (2004-2009). Resultados: De los 154 fallecidos, se realizaron 23 AC (tasa 14,9%). Hemos asistido a un descenso en el número de autopsias practicadas, del 26 al 11%, desde el 2004 hasta el 2009. El examen postmortem mostró concordancia completa (clase V) en 7/23 casos (30,4%). En 4 casos se realizó un diagnóstico que pudo eventualmente haber afectado al pronóstico a medio-largo plazo (clase IV). En 5 casos se identificaron patologías que pudieron haberse relacionado con la enfermedad principal y pudieron contribuir a la causa de muerte (clase III). Hubo 4 casos de discrepancia de clase II. En 3 pacientes (13%) el diagnóstico postmortem, de haber sido detectado en vida, pudiera haber aumentado la supervivencia (clase IA). En 3 casos (13%) la AC permitió el consejo genético. Conclusiones: La tasa de AC en nuestro medio es baja en comparación con otros países desarrollados. El hecho de que en el 69,6% de los casos la AC arrojara nueva información acerca de la enfermedad que condujo, contribuyera o se relacionara con la muerte indica que las razones que justifican la realización de la autopsia continúan estando vigentes(AU)

Backgrounds: The autopsy is a diagnostic tool in decline over the last few decades. Our purpose is to describe the autopsy rates, the relationship between clinical and post-mortem diagnosis to evaluate the current overall usefulness of the autopsy. Patients and methods: Retrospective review of all cases in which clinical autopsy was performed between January 2004 and December 2009 in a paediatric intensive care unit (PICU) of a tertiary care hospital. Results: Of 154 deaths in the PICU during the study period, 23 autopsies were performed (rate 14.9%). Autopsy rates decreased over the study period; from 26% in 2004 to 11% in 2009. There was a complete correlation (class V) in seven patients (29.1%). Some missed minor diagnosis (class IV) were found in four patients. Five patients had class III discrepancies, and four had class II discrepancies. Major diagnoses were missed in three (17.4%) patients, with a potencial adverse impact on survival and that could have changed management in life (Class IA). In three cases (13%) the autopsy results led to parents having genetic counselling. Conclusions: The autopsy rate in our country is low when compared to other developed countries. The fact that in 69.6% of cases the autopsy revealed new findings related with the illness that caused or contributed to death shows that the reasons for performing the autopsy are still valid(AU)

[Current situation and usefulness of autopsy in a paediatric intensive care unit]. / Estado actual y utilidad de la autopsia clínica en una unidad de cuidados intensivos pediátricos.

BACKGROUNDS: The autopsy is a diagnostic tool in decline over the last few decades. Our purpose is to describe the autopsy rates, the relationship between clinical and post-mortem diagnosis to evaluate the current overall usefulness of the autopsy. PATIENTS AND METHODS: Retrospective review of all cases in which clinical autopsy was performed between January 2004 and December 2009 in a paediatric intensive care unit (PICU) of a tertiary care hospital. RESULTS: Of 154 deaths in the PICU during the study period, 23 autopsies were performed (rate 14.9%). Autopsy rates decreased over the study period; from 26% in 2004 to 11% in 2009. There was a complete correlation (class V) in seven patients (29.1%). Some missed minor diagnosis (class IV) were found in four patients. Five patients had class III discrepancies, and four had class II discrepancies. Major diagnoses were missed in three (17.4%) patients, with a potential adverse impact on survival and that could have changed management in life (Class IA). In three cases (13%) the autopsy results led to parents having genetic counselling. CONCLUSIONS: The autopsy rate in our country is low when compared to other developed countries. The fact that in 69.6% of cases the autopsy revealed new findings related with the illness that caused or contributed to death shows that the reasons for performing the autopsy are still valid.

Lengua vellosa negra en lactante / Black hairy tongue in an infant

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