RESUMO
An adequate drug dosage at treatment initiation is particularly relevant for critically ill patients. An inadequate dosage may result in therapeutic failure, potentially severe adverse events, and unnecessary health expenditures. At present, due to the higher incidence of childhood obesity, primary care physicians are more commonly faced with this population, so they need to make appropriate therapeutic decisions. Knowledge of the resulting pharmacokinetic alterations caused by increased body fat is critical. The optimal drug dosage is not completely defined and the correct body descriptor should be used, although there is no consensus on which is the most adequate one. The objective of this update is to gain insight on pharmacokinetic alterations that affect dosage in the critically ill obese pediatric patient and, specifically, those related to the drugs most commonly used in this population during their stay in the pediatric intensive care unit.
La correcta dosificación de un medicamento al inicio de la terapia es de particular relevancia para el paciente críticamente enfermo. Una dosis inadecuada puede ocasionar falla terapéutica, eventos adversos potencialmente graves y gastos innecesarios en salud. Hoy, debido al incremento en la incidencia de obesidad infantil, el médico clínico, cada vez más, se enfrentará a esta población, por lo que es necesaria la adecuada toma de decisiones terapéuticas. El conocimiento de las alteraciones farmacocinéticas resultantes del incremento de grasa corporal es trascendental. La dosis óptima de fármacos no está totalmente definida y debe utilizarse un adecuado descriptor corporal (no existe consenso sobre cuál es el más apropiado). El objetivo de esta actualización es conocer las alteraciones farmacocinéticas que influyen en la dosificación en el paciente pediátrico obeso críticamente enfermo y, en forma particular, las referidas a los fármacos más empleados en esta población durante su estadía en Terapia Intensiva Pediátrica.
Assuntos
Unidades de Terapia Intensiva , Obesidade Infantil/complicações , Preparações Farmacêuticas/metabolismo , Criança , Estado Terminal , Relação Dose-Resposta a Droga , Humanos , Preparações Farmacêuticas/administração & dosagem , FarmacocinéticaRESUMO
Down syndrome is the most common chromosomal abnormality in newborns, with a high incidence in Chile. This condition presents unique physiological aspects that should be known, which can affect the child during their stay in an Intensive Care Unit, beyond the neonatal period This review is focused on the respiratory, cardiovascular, infectious and neurological disorders. Anesthetic management and postoperative analgesia considerations, weaning from mechanical ventilation, cervical spine instability and prognosis of the critically ill child with Down syndrome are also analyzed. The evaluation of these conditions should be performed when the patient is admitted to the intensive care unit. The purpose of this update is to update the knowledge of the diagnosis and treatment of potential complications of children with Down syndrome during their stay in the unit of critical patient.
Assuntos
Cuidados Críticos/métodos , Síndrome de Down/complicações , Criança , Estado Terminal , Síndrome de Down/fisiopatologia , Humanos , Unidades de Terapia Intensiva , Assistência Perioperatória/métodosRESUMO
El síndrome de Down es la alteración cromosómica más frecuente en los recién nacidos, con una alta incidencia en Chile. Esta condición presenta aspectos fisiológicos únicos, los cuales pueden afectar al niño durante su estadía en una Unidad de Cuidados Intensivos, posterior al período neonatal. En esta revisión abordamos aspectos actuales de la patología respiratoria, cardiovascular, infecciosa y neurológica, así como también consideraciones anestésicas y de analgesia postoperatoria, destete de la ventilación mecánica, inestabilidad columna cervical y pronóstico del niño críticamente enfermo portador de síndrome de Down. La evaluación de todas estas condiciones debe ser realizada cuando el paciente es ingresado a la Unidad de Cuidados Intensivos. El objetivo de la presente actualización es profundizar el conocimiento del diagnóstico y tratamiento de las potenciales complicaciones del niño con síndrome de Down durante su estadía en la unidad de paciente crítico.
Down syndrome is the most common chromosomal abnormality in newborns, with a high incidence in Chile. This condition presents unique physiological aspects that should be known, which can affect the child during their stay in an Intensive Care Unit, beyond the neonatal period This review is focused on the respiratory, cardiovascular, infectious and neurological disorders. Anesthetic management and postoperative analgesia considerations, weaning from mechanical ventilation, cervical spine instability and prognosis of the critically ill child with Down syndrome are also analyzed. The evaluation of these conditions should be performed when the patient is admitted to the intensive care unit. The purpose of this update is to update the knowledge of the diagnosis and treatment of potential complications of children with Down syndrome during their stay in the unit of critical patient.
