[Continuous glucose monitoring system in the screening of glucose disorders in cystic fibrosis]. / Monitorización continua de glucosa para cribado de alteraciones hidrocarbonadas en fibrosis quística.

BACKGROUND: Diabetes mellitus (DM) is an increasing complication of cystic fibrosis (CF). It is associated with enhance morbidity. Continuous glucose monitoring system (CGMS) could detect glucose disorders earlier than other screening tests usually used. AIMS: To compare oral glucose tolerance test (OGTT), HbA(1c) and CGMS in patients with CF and recent disorders of glucose homeostasis and to analyse changes in nutritional status and/or pulmonary function. PATIENTS AND METHODS: Thirteen patients with CF (11-22 years, 7 males) were studied using OGTT, HbA(1c) and CGMS. All of them had newly diagnosed glucose disturbances. They were not receiving steroid therapy or had an underlying illness. In all subjects we compared: HbA(1c) levels (%), fasting and 2-hours glucose OGTT (mg/dl) and glucose CGMS values (overall, fasting, 2-hours post mean-meals and excursions >140mg/dl at any time). Furthermore, body mass index, forced expiratory volume in the first second (%) and forced vital capacity (%) were evaluated in the previous year and at the time of the study. We also analysed exocrine pancreatic function and CF-mutation. RESULTS: Mean age at diagnosis of glucose disturbance was 16.4 years. All patients had insufficient exocrine pancreatic function and 11/13 presented DeltaF508 CF-mutation. Only one patient was diagnosed with DM using OGGT and 7/13 (53.8%) with CGMS. A total 77% of patients had poor nutritional status and/or pulmonary function at time of diagnosing the glucose disorder. Only 4 patients had abnormal HbA(1c) levels. CONCLUSIONS: CGMS allows a better detection of glucose disorders than OGTT. Glucose homeostasis abnormalities are associated with a decrease in nutritional status and/or pulmonary function. HbA(1c) does not aid in the early diagnose of glucose disorders.

[Middle latency auditory evoked potentials in critical care children: preliminary study]. / Potenciales evocados auditivos de latencia media en el niño críticamente enfermo: estudio preliminar.

BACKGROUND: Middle latency auditory evoked potentials (MLAEP) reflect changes in electroencephalogram waves after an auditory signal and represent the earliest cortical response to acoustic stimulus. They are therefore used to measure variations in the level of consciousness. MLEAP have been used to measure the depth of anesthesia during surgical procedures, but experience in critical care patients is very limited. OBJECTIVE: To analyze the utility of MLAEP for monitoring the level of sedation in critically ill children. METHODS: Level of consciousness was monitored through MLAEP by placing special headphones and three sensors situated in the frontal and preauricular regions. Simultaneously, the level of sedation was measured using the COMFORT scale and the Bispectral Index (BIS) in distinct clinical situations. RESULTS: We studied six critically ill children in whom MLAEP helped us to evaluate the level of consciousness: light sedation, natural sleep, deep sedation, sedation in a paralyzed child, and brain death. MLAEP showed a good correlation with the COMFORT scale and BIS in light and deep sedation and were effective in the early detection of brain death in one patient. In the paralyzed patient, MLAEP was able to detect undersedation. In one patient, a pacemaker interfered with the MLAEP signal. CONCLUSIONS: MLAEP can be useful in evaluating the level of consciousness and sedation in critically ill children. Further studies with larger samples are required to analyze the limitations and reproducibility of this type of monitoring in children of different ages.

[Use of the Bispectral Index in monitoring critically-ill children]. / Aplicación del índice biespectral en la monitorización del niño enfermo crítico.

The Bispectral Index (BIS) is a single numeric value that indicates the depth of hypnosis by estimating the level of electrical activity in the brain through analysis of the frequency bands in the electroencephalogram. The BIS was primarily developed to monitor the level of hypnosis during surgery and has recently begun to be used in critically-ill patients. Currently, there is little experience of the BIS in critically-ill children. We present 6 cases that illustrate the utility of BIS monitoring in the PICU. We assessed sedation and analgesia during mechanical ventilation with and without neuromuscular block in two patients, and the effect of anesthetic agents during a surgical procedure in the PICU. The BIS was also useful in the continuous monitoring of the level of consciousness in a patient with encephalitis and in the early detection of brain death. Pacer-induced artefacts in the BIS value are also described. We conclude that BIS monitoring may be a useful, noninvasive method for assessing the level of hypnosis in critically-ill children.

[Domiciliary mechanical ventilation in children: a Spanish multicentre study]. / Ventilación mecánica domiciliaria en niños: estudio multicéntrico español.

INTRODUCTION: Domiciliary mechanical ventilation (DMV) use is increasing in children. Few studies have analysed the characteristics of patients using this technique. MATERIALS AND METHODS: An observational, descriptive, transversal, multicentre study was conducted on patients between 1 month and 16 years of age dependent on domiciliary mechanical ventilation. RESULTS: A total of 163 patients with a median age of 7.6 years from 17 Spanish hospitals were studied. The main reasons for DMV were neuromuscular disorders. The median age at beginning of DMV was 4.6 years. Almost three-quarters (71.3%) received non-invasive ventilation. Patients depending on invasive ventilation were younger, started DMV at an earlier age, and had more hours of mechanical ventilation per day. The large majority (80.9%) used DMV during sleep time only, and 11.7% during the whole day. Only 3.4% of patients had external health assistance. Just under half (48.2%) were being followed up in specific DMV or multidisciplinary clinics. Almost three-quarters (72.1%) of patients attended school (42.3% with adapted schooling). Only 47.8% of school patients had specific caregivers in their schools. CONCLUSIONS: DMV in children is used in a very heterogeneous group of patients, and in an important number of patients it is started before the third year of life. Despite there being a significant proportion of patients with a high dependency on DMV, few families receive specific support at home or at school, and health care surveillance is variable and poorly coordinated.

[Abnormal glucose tolerance in prepubertal patients with cystic fibrosis]. / Alteraciones hidrocarbonadas en pacientes impúberes con fibrosis quística.

INTRODUCTION: Annual screening for abnormal glucose tolerance (AGT) with oral glucose test should begin by age 10 years in cystic fibrosis (CF) patients (Consensus-2010). AIMS: To examine the frequency of AGT and its outcome in prepubertal CF patients and the changes in glycemic and nutritional status and lung function over the preceding year. PATIENTS AND METHODS: Retrospective study of 19 prepubertal CF patients (68% males). All subjects underwent an oral glucose tolerance test (OGTT). Results were classified as: normal glucose tolerance (NGT) or AGT (impaired glucose tolerance [IGT], CF related diabetes [CFRD] or indeterminate glucose tolerance [INDET]). We analyzed: OGTT (glucose and insulin levels), nutritional status (BMI-SD) and lung function (forced spirometry). Statistical analysis was performed with SPSS program-version-15.0, non parametric tests. RESULTS: Mean age at first OGGT: 8.5 years (5.8-9.8). Mean follow-up: 2 years (2-3). Initially, 47% patients had AGT and 53% NGT. In follow-up: 4/10 NGT patients developed AGT (3 IGT, 1 CFRD). Among initial AGT patients, of 4 INDET: 2 developed IGT, 1 CFRD. Mean age of AGT onset: 8.6 years (6.4-11.1). In 69% AGT patients a declining BMI-DS and/or lung function was found in the preceding year. In OGTTs performed, fasting and 2h AUC insulin levels were comparable between NGT and AGT; however, insulinogenic index was lower in AGT patients (p=.006). Insulin secretion was delayed in all patients. CONCLUSIONS: The high frequency of AGT in prepubertal CF patients and their negative clinical impact supports the usefulness of an earlier glycemic screening.