[Cardiopulmonary resuscitation: discrepancy between the actual cardiopulmonary resuscitation and the documentation in the medical record] / Ressuscitação cardiopulmonar: discrepância entre o procedimento de ressuscitação e o registro no prontuário.

OBJECTIVES: To describe the characteristics of the patients not resuscitated in a university affiliated pediatric hospital. To characterize the data registered in the chart regarding the resuscitation and evaluate ethical and legal aspects of CPR (cardiopulmonary resuscitation). METHODS: Retrospective study of 176 deaths that occurred in a one year time period. The chart was reviewed and compared to information received directly from the physician that participated in the patientacute;s resuscitation. Ethical and legal aspects involved in resuscitation efforts were discussed. RESULTS: During the study period 176 deaths occurred. 47 (26.7%) patients did not receive CPR as reported directly by the physician in charge of the patient when the dead occurred. Two patients were excluded, because the chart could not be found. Prior to their death, 64.4% (29/45) received mechanical ventilatory support and 48.5% (33/45) received inotropic support. 60% (27/45) of the deaths occurred in the intensive care unit. The most common diagnoses at admission were sepsis in 28% (13/45) and pneumonia with respiratory failure in 27% (12/45). The most common underlying medical conditions were malignancies in 28.8% (13/45). Of these 45 patients, the medical record about CPR was available in 40 charts. It was documented that 11/40 (27.5%) were declared dead without resuscitation efforts and in 29/40 (72.5%) the medical record stated that CPR was performed without improvement in vital signs. CONCLUSION: There was a discrepancy between the actual cardiopulmonary resuscitation efforts and the documentation of cardiopulmonary resuscitation in the medical record. This behavior may be due to fear of possible legal consequences of not performing cardiopulmonary resuscitation. However, in patients with very poor prognosis it may be ethically justified to withhold CPR.

[Pediatric cardiopulmonar resuscitation] / Ressuscitação cardiopulmonar pediátrica.

OBJECTIVE: To present the main aspects of pediatric cardiopulmonary resuscitation.METHOD: The articles on pediatric cardiorespiratory arrest and cardiopulmonary resuscitation were revised, by Medline and Lilacs systems. Books and dissertations were also analyzed. Only the most important articles were included in this review.RESULTS: The relevant aspects related to diagnosis and epidemiology of pediatric cardiac arrest were described. The sequence of actions on cardiopulmonary resuscitation were emphasized. The basic and advanced life support techniques were described and the age differences were highlighted.CONCLUSION: The knowledge of the content of this review provides more effectiveness to cardiopulmonary resuscitation. The anoxic period of time of children in cardiac arrest can be reduced and a better prognosis can be thus achieved.

Adverse effects of vancomycin in children: a review of 22 cases.

Vancomycin has been frequently recommended for the treatment of multi-resistant infections. Twenty-two children undergoing vancomycin treatment were observed. Nine adverse effects were registered in 6 children: eosinophilia in 5 cases, skin rash in 2 cases, and an increase in plasma creatinine in 2 cases. All adverse effects remitted with withdrawal of the drug.

[Monitorization of blood levels of vancomycin in children with multi-resistant bacterial infections]. / Monitorização das concentrações séricas da vancomicina em crianças com infecções por bactérias multiresistentes.

Pharmacokinetics of vancomycin depends on many factors and one of them is the age of the patient. It is better known in adults and there are few studies in children. Therefore, we studied the serum concentrations in 22 children with multi-resistant bacteria infections that received vancomycin. The doses administered followed the recommended rules for its utilization. This study was made at the equilibrium phase and immunofluorescence was the method utilized. The peak serum concentrations varied from 23 to 99 mcg/ml and only in 8 children (36%) they varied from 30 to 40 mcg/ml. In 10 cases (45%) we found valley serum concentration between 5 to 10 mcg/ml. These observations confirm the imprevisibility of serum concentrations obtained from one single recommended dose. Therefore, due to the complexity of vancomycin pharmacokinetics, the monitoring of blood levels is recommended in order to obtain therapeutic success.

[Psoas muscular abscess in children]. / Abscesso de músculo psoas em crianças.

Symptoms of psoas muscular abscess in children are nonspecific and differential diagnosis is made among diseases included in childrens acute hip pain syndrome, imaging tests being necessary for diagnostic confirmation. During the first semester of 1995, 48,550 children were examined in Pronto Socorro do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, four of them diagnosed as having psoas muscular abscess (2 females and 2 males, ages varying from 1 to 12 years). All of them had nonspecific clinical features and diagnosis was confirmed by abdominal ultrasound and/or computerized tomography. Staphylococcus aureus was isolated as the etiologic agent in 3 children, findings similar to the ones in literature.

Septicemia por Staphylococcus aureus em crianças: tolerância bacteriana à vancomicina e poder bactericida do soro / Staphylococcus aureus septicemia in children: bacterial tolerance to vancomycin and serum bactericidal test

OBJETIVO. Analisar a sensibilidade e tolerância das cepas de Staphylococcus aureus isoladas de crianças com septicemia e avaliar o poder bactericida sérico na monitorizaçäo terapêutica desses casos. MÉTODOS. Foram estudados 17 casos de crianças com septicemia por Staphylococcus aureus internadas na Enfermaria de cuidados semi-Intensivos do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo. Foram realizados testes de sensibilidade antimicrobiana pelo método de difusäo em disco e diluiçäo em tubo. Foram realizados 29 testes no pico e 23 no vale dos antibióticos utilizados, determinando o poder bactericida do soro. RESULTADOS. As cepas de Staphylococcus aureus de origem hospitalar mostraram resistência a quase todos os antibióticos, exceto vancomicina e pefloxacina. Observou-se fenômeno de tolerância em cinco (50 por cento) das cepas testadas para vancomicina, sendo que quatro apresentaram má evoluçäo clínica. Os testes para determinaçäo do poder bactericida sérico revelaram títulos no pico ò1/8 em 55,5 por cento das observaç 8es; neste grupo a evoluçäo clínica foi melhor. CONCLUSäO. As cepas de Staphylococcus aureus de origem hospitalar estudadas säo multirresistentes. O fenômeno de tolerância antimicrobiana, assim como o poder bactericida do soro em níveis baixos, pode estar associado a má resposta terapêutica. A valorizaçäo do PBS como critério de avaliaçäo terapêutica em infecçöes graves e o papel da tolerância do Staphylococcus aureus à vancomicina merecem maiores estudos

[Staphylococcus aureus septicemia in children: bacterial tolerance to vancomycin and serum bactericidal activity]. / Septicemia por Staphylococcus aureus em criança: tolerância bacteriana à vancomicina e poder bactericida do soro.

PURPOSE: To evaluate the susceptibility and of strains of Staphylococcus aureus isolated from children with septicemia, and to evaluate the importance of the serum bactericidal test. METHODS: Seventeen children with Staphylococcus aureus septicemia admitted to the Semi Intensive Care Unit of the Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo were studied. Twenty nine tests in the pico and 23 in the nadir of the antibiotics were made. RESULTS: Strains of Staphylococcus aureus from hospital origin were resistant to all the antibiotics but vancomycin and pefloxacin. The phenomenon of tolerance was seen in 5 (50%) of the strains that were tested for vancomycin, and 4 of the children had a bad evolution. The serum bactericidal tests showed titles in the pico > or = 1/8 in 55.5% of the observations; in this group the evolution was better. CONCLUSION: Strain of Staphylococcus aureus from hospital origin are multiresistant. The phenomenon of antimicrobial tolerance, as well as the serum bactericidal test may be related to a bad therapeutic evolution. The increasing value of the serum bactericidal test as a way to evaluate the therapeutic evolution in severe infections, and the role of the tolerance of the Staphylococcus aureus to vancomycin more studies.