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Resumen: Antecedentes: Los pacientes con circulación de Fontan (PCF) presentan limitación cardíaca durante el esfuerzo máximo lo que repercute en menor capacidad de ejercicio (VO2-peak). La rehabilitación cardiovascular (RC) revierte este desacondicionamiento, al aumentar el gasto cardíaco y diferencia arteriovenosa de oxígeno, aspectos evaluados con monitorización invasiva y gases exhalados. La valoración no invasiva de la saturación muscular de oxígeno (SmO2) es un método de reciente aplicación para evaluar la limitación muscular al ejercicio. En PCF esta limitación puede atribuirse a la mayor acción de músculos respiratorios (cambios ventilatorios) y/o locomotores (carga periférica). Objetivo: Evaluar el trabajo de músculos respiratorios y locomotores durante el ejercicio físico máximo e incremental mediante los cambios en la SmO2. Métodos: A seis PCF (5 hombres; 13.8±2.9 años; 158±9cm; 49.8±13.3 kg) se les valoró el VO2-peak (23.0±4.5mL·kg-1·min-1) mediante ciclo-ergoespirometría sincrónicamente con SmO2 en músculos respiratorios (SmO2-m.Intercostales) y locomotores (SmO2-m.Vastus-Laterallis) mediante espectroscopía cercana al rango infrarrojo durante el test cardiopulmonar. Resultados: SmO2-m.Intercostales disminuyó desde el 60% del VO2-peak (p<0.05), mientras que SmO2-m.Vastus-Laterallis no cambió. La ventilación pulmonar (VE) aumentó progresivamente, siendo significativo a partir del 60% VO2-peak (p<0.05). La mayor desoxigenación de SmO2-m.Intercostales (∆SmO2) se asoció con los máximos cambios en ventilación pulmonar (∆VE) en ejercicio (rho=0.80; p=0.05). Conclusiones: Durante un protocolo de esfuerzo, los pacientes con circulación de Fontan presentan mayor trabajo muscular respiratorio que locomotor. Los cambios en la ventilación pulmonar se asocian a mayor extracción de oxígeno en la musculatura respiratoria, reforzando la necesidad de incorporar el entrenamiento respiratorio en la rehabilitación cardiovascular.

Abstract: Background: During a maximum incremental exercise patients with Fontan circulation (PFC) show cardiac limitation reducing aerobic exercise capacity (VO2-peak). Cardiovascular rehabilitation (CR) reverses this deconditioning by increasing cardiac output and arteriovenous oxygen difference, aspects that can be evaluated by invasive methods and analyzing the exhaled gases. Non-invasive assessment of muscle oxygen saturation (SmO2) is a novel method for recording local oxygen levels. By this technology, it is possible to evaluate the muscle limitation to exercise. In PFC, that limitation could be attributed to higher contractions of respiratory (ventilatory changes) and/ or locomotor muscles (peripheral load). Objective: To evaluate in PFC the changes at SmO2 of respiratory and locomotor muscles during a maximum and incremental exercise protocol (cardiopulmonary test, VO2-peak). Methods: Six PFC (5 men; 13.8±2.9 years; 158±9 cm; 49.8±13.3 kg) were assessed during the VO2peak test (23.0±4.5mL·kg-1·min-1) by cyclo-ergospirometry synchronously with SmO2 at respiratory (SmO2-m.Intercostales) and locomotor (SmO2-m. Vastus-Laterallis) muscles by Near-Infrared Spectroscopy (NIRS). Results: SmO2-m.Intercostales decreased from 60% of VO2-peak (p<0.05), while SmO2-m.Vastus-Laterallis did not change. Minute ventilation (VE) increased progressively, showing changes to rest at 60% of VO2-peak (p<0.05). The higher deoxygenation of SmO2-m.Intercostales (∆SmO2) correlated to maximum changes of lung ventilation (∆VE) (rho=0.80; p=0.05). Conclusions: During an incremental and maximum exercise protocol, patients with Fontan circulation have more work at respiratory than locomotor muscles. Changes in VE are direct associated with greater extraction of oxygen at respiratory muscles, reinforcing the incorporation of respiratory muscle training in cardiovascular rehabilitation.

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OBJETIVO: Conocer el nivel de preparación de colegios y profesores de educación física en prevención de muerte súbita (MS) y soporte vital básico, incluyendo disponibilidad y uso del desfibrilador externo automático (DEA). MÉTODOS: Estudio descriptivo de corte transversal, en profesores de educación física de establecimientos educacionales de distintos tipos de sostenedores (municipales, subvencionados y particulares) de Santiago, Chile, a través de un cuestionario online. Se analizaron datos demográficos del profesor, antecedentes de preparación y disposición de reanimación cardiopulmonar (RCP), presencia y uso de DEA y preparación del establecimiento ante un caso de MS. RESULTADOS: De 97 profesores encuestados, 71,1% no se siente capacitado para realizar RCP a pesar que un 70% del total ha realizado un curso. La disposición para realizar reanimación en aquellos que han realizado un curso, es 99%, comparado con 83% en quienes no lo han realizado (p=0,003). Existe una marcada diferencia en disponibilidad de DEA según tipo de sostenedor (52,4% en particulares, 29,6% en municipales y 15% en subvencionados, p=0,001), pero transversalmente no saben cómo utilizarlo (42,9 %, 40,7% y 25%, p=0,43). La mayoría de los colegios no cuenta con un plan de acción ante MS. CONCLUSIONES: Los colegios y profesores de educación física tienen una preparación insuficiente y desactualizada en prevención de muerte súbita y soporte vital básico, con una distribución heterogénea de DEA en establecimiento según tipo de sostenedor.

OBJECTIVE: To assess the competence of schools and physical education teachers in the prevention of sudden death (SD) and basic life support meassures, including availability and use of the automatic external defibrillator (AED). METHODS: A descriptive cross-sectional study included physical education teachers from different Schools (public, subsidized and private) in Santiago, Chile. An online questionnaire was applied including demographic data of the teacher, comentence and willingness to perform cardiopulmonary resuscitation (CPR), presence and use of AED and school preparation in case of a SD. RESULTS: From a total of 97 teachers surveyed do not feel capable of performing CPR, in spite of the fact that 70% of them completed a CPR course. Among those who took a course, their willingness to perform resuscitation was 99%, compared to 83% en those not having taken the course (p = 0.003). There was a marked difference in DEA availability according to class of school (private 52,4%, public 29,6 subsidized 15%, p=0,001), but the knowledge on how to use de DEA was uniformly insufficient (42,9 %, 40,7% and 25%, p=0,43) Most schools do not have a protocol to face SD. CONCLUSIONS: We observed that schools and physical education teachers have an insufficient and outdated preparation in sudden death prevention and basic life support. The availability of AED differed according to the class of establishment.

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Se realizó un estudio transversal en escolares con corazón univentricular en estadio pos-bypass total de ventrículo derecho con el objetivo de determinar la capacidad funcional basal mediante el test de marcha en 6 minutos e identificar posibles factores determinantes. Participaron 30 pacientes con una mediana de edad de 12 años. Dieciocho pacientes fueron de sexo masculino. La mediana de distancia recorrida fue de 551,3 metros, un 84 % de la distancia teórica para población pediátrica sana. Las variables talla, presión arterial sistólica pretest y saturación arterial de oxígeno de reposo se asociaron significativamente con la distancia recorrida en el modelo de regresión lineal múltiple. No hubo asociación significativa en los metros caminados respecto de las variables sexo, estado nutricional, dignóstico cardiológico inicial, número de cirugías previas y edad al momento del bypass total de ventrículo derecho

A cross-sectional study was done in students with univentricular heart after undergoing total cavopulmonary connection (Fontan procedure) to establish their baseline functional capacity based on the six-minute walk test and identify potential determining factors. Thirty patients were included; their median age was 12 years old. Eighteen patients were males. The median distance walked was 551.3 meters, 84 % of the theoretical distance for a healthy pediatric population. Height, pre-test systolic blood pressure, and resting arterial oxygen saturation showed a significant association with the distance walked in the multiple linear regression model. No significant association was observed in the meters walked in terms of the following outcome measures: sex, nutritional status, baseline cardiological diagnosis, number of prior surgeries, and age at the time of Fontan procedure

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A cross-sectional study was done in students with univentricular heart after undergoing total cavopulmonary connection (Fontan procedure) to establish their baseline functional capacity based on the six-minute walk test and identify potential determining factors. Thirty patients were included; their median age was 12 years old. Eighteen patients were males. The median distance walked was 551.3 meters, 84 % of the theoretical distance for a healthy pediatric population. Height, pre-test systolic blood pressure, and resting arterial oxygen saturation showed a significant association with the distance walked in the multiple linear regression model. No significant association was observed in the meters walked in terms of the following outcome measures: sex, nutritional status, baseline cardiological diagnosis, number of prior surgeries, and age at the time of Fontan procedure.

Se realizó un estudio transversal en escolares con corazón univentricular en estadio pos-bypass total de ventrículo derecho con el objetivo de determinar la capacidad funcional basal mediante el test de marcha en 6 minutos e identificar posibles factores determinantes. Participaron 30 pacientes con una mediana de edad de 12 años. Dieciocho pacientes fueron de sexo masculino. La mediana de distancia recorrida fue de 551,3 metros, un 84 % de la distancia teórica para población pediátrica sana. Las variables talla, presión arterial sistólica pretest y saturación arterial de oxígeno de reposo se asociaron significativamente con la distancia recorrida en el modelo de regresión lineal múltiple. No hubo asociación significativa en los metros caminados respecto de las variables sexo, estado nutricional, dignóstico cardiológico inicial, número de cirugías previas y edad al momento del bypass total de ventrículo derecho.

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INTRODUCTION: Intensive care units are known as high-stress environments for family members, this can be higher when the patient is a son or daughter and the parents must face the disease along with everything that the hospital environment implies. The Parental Stressor Scale Infant Hospitalization (PSSIH) instrument is a tool used to measure stressors in Pediatric Intensive Care Units (PICU), however, the scale is not validated in Chile. The objective of this study is to culturally validate and adapt the instrument "the modified Parental Stressor Scale Infant Hospitalization" in mothers/fathers of hospitalized children in the PICU of a University Hospital. METHOD: Instrumental validation study. After translating and counter-translating the English version of the instrument, a group of 10 expert professionals evaluated the Spanish adaptation. Then, 10 parents of hospitalized children in the PICU evaluated the understanding of the instrument. The psychometric properties of the instrument were evaluated using exploratory factorial analysis and Cronbach's alpha. RESULTS: The Chilean version of the "modified PSSIH" was applied to a sample of 221 parents, with minimal semantic modifications and the expert judges considered the instrument adequate, therefore, it was not necessary to delete any item. The 3-dimensional solution was chosen, which explained 48.89% of the total instrument variance. The Cronbach's alpha was 0.885, 0.902, and 0.703 respectively for each dimension. Con clusion: The modified PSSIH has proved to be a reliable and valid instrument in a sample of Chilean children hospitalized in a Pediatric Intensive Care Unit of a university hospital. The name in Spanish of the scale is "Escala de Evaluación de Estresores Parentales en niños hospitalizados en Unidades de Cuidados Intensivos Pediátricos" (EEEP - UCIP).

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INTRODUCCIÓN: Las unidades de cuidados intensivos son conocidas como ambientes de alto estrés para los familiares, este puede ser mayor cuando el paciente es un hijo/hija y los padres deben enfrentar la enfermedad y el ambiente hospitalario. El instrumento "The Parental Stressor Scale Infant Hospitali zation (PSSIH), es una herramienta utilizada para medir estresores en Unidades de Cuidados Intensivos Pediátricos (UCIP), sin embargo, la escala no está validada en Chile. El objetivo de este estudio es validar y adaptar culturalmente el instrumento "The Parental Stressor Scale Infant Hospitalization modificado" en madres/padres de niños hospitalizados en la UCIP de un Hospital Universitario. MÉTODO: Estudio instrumental de validación. Luego de traducir y contratraducir la versión en inglés del instrumento, un grupo de 10 profesionales expertos evaluó la adaptación al español. Luego 10 padres/ madres de niños hospitalizados en la UCIP evaluaron la comprensión del instrumento. Las propiedades psicométricas del instrumento fueron evaluadas utilizando un análisis factorial exploratorio y alfa de Cronbach. RESULTADOS: Se aplicó en una muestra de 221 padres/madres la versión chilena del "PSSIH modificado", tuvo mínimas modificaciones semánticas y los jueces expertos consideraron adecuado el instrumento, por lo que no fue necesario borrar ningún ítem. Se eligió la solución de 3 dimensiones, que explicaron el 48,89% de la varianza total del instrumento. El alfa de Cronbach fue de 0,885, 0,902 y 0,703 respectivamente para cada dimensión. CONCLUSIÓN: El PSSIH modificado ha demostrado ser un instrumento confiable y valido en una muestra de niños chilenos hospitalizados en una Unidad de Cuidados Intensivos Pediátricos de un hospital universitario , cuyo nombre en español es "Escala de Evaluación de Estresores Parentales en niños hospitalizados en Unidades de Cuidados Intensivos Pediátricos" (EEEP - UCIP).

INTRODUCTION: Intensive care units are known as high-stress environments for family members, this can be higher when the patient is a son or daughter and the parents must face the disease along with everything that the hospital environment implies. The Parental Stressor Scale Infant Hospitalization (PSSIH) instrument is a tool used to measure stressors in Pediatric Intensive Care Units (PICU), however, the scale is not validated in Chile. The objective of this study is to culturally validate and adapt the instrument "the modified Parental Stressor Scale Infant Hospitalization" in mothers/fathers of hospitalized children in the PICU of a University Hospital. METHOD: Instrumental validation study. After translating and counter-translating the English version of the instrument, a group of 10 expert professionals evaluated the Spanish adaptation. Then, 10 parents of hospitalized children in the PICU evaluated the understanding of the instrument. The psychometric properties of the instrument were evaluated using exploratory factorial analysis and Cronbach's alpha. RESULTS: The Chilean version of the "modified PSSIH" was applied to a sample of 221 parents, with minimal semantic modifications and the expert judges considered the instrument adequate, therefore, it was not necessary to delete any item. The 3-dimensional solution was chosen, which explained 48.89% of the total instrument variance. The Cronbach's alpha was 0.885, 0.902, and 0.703 respectively for each dimension. CONCLUSION: The modified PSSIH has proved to be a reliable and valid instrument in a sample of Chilean children hospitalized in a Pediatric Intensive Care Unit of a university hospital. The name in Spanish of the scale is "Escala de Evaluación de Estresores Parentales en niños hospitalizados en Unidades de Cuidados Intensivos Pediátricos" (EEEP - UCIP).

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Introducción. Los niños con cardiopatías congénitas (CC) presentan malnutrición por déficit; una posible consecuencia a largo plazo es la talla baja. Objetivo. Describir la presencia de talla baja en niños con CC al momento de su cardiocirugía. Población y métodos. Estudio retrospectivo. Se incluyeron niños sometidos a cardiocirugía con circulación extracorpórea en 2009-2013. Se excluyeron prematuros, con síndromes genéticos u otra enfermedad con compromiso nutricional. Se estudiaron variables demográficas, diagnóstico cardiológico, cirugía de ingreso y evaluación antropométrica según estándares de la Organización Mundial de la Salud; se definió talla baja como ZT/E < -2 desvíos estándar, según sexo. Resultados. Se estudiaron 640niños; 361 varones (el 56,4 %); mediana de edad: 8 meses (RIC: 1,9; 34,6); 66 niños tuvieron > 1 cirugía; 27 de ellos (el 40,9 %), con hipoplasia del ventrículo izquierdo. Fueron CC cianóticas 358 (el 55,9 %), con fisiología univentricular 196 (el 30,6 %). La mediana de ZT/E fue -0,9 (RIC: -1,9; -0,1); presentaron talla baja 135 (el 21,1 %), el 11 % en neonatos y el 24,1 % en mayores de un mes. Se encontró mayor frecuencia de talla baja en reparación completa de canal atrioventricular en 4/6 niños, reparación de tetralogía de Fallot en 15/39, Glenn en hipoplasia del ventrículo izquierdo en 8/25, cierre de comunicación interventricular en 34/103. No se encontró asociación ni diferencia con significación estadística entre talla baja y cianosis ni según fisiología univentricular. Conclusiones. Existe una alta frecuencia de talla baja en niños con CC, con diferencias según el diagnóstico cardiológico y la cardiocirugía realizada.

Introduction. Children with congenital heart diseases (CHDs) suffer from malnutrition because of nutritional deficiencies, being short stature the possible long-term consequence. Objective. To describe the presence of short stature among children undergoing cardiac surgery for CHDs. Population and methods. Retrospective study. Children undergoing cardiac surgery with cardiopulmonary bypass pump between 2009 and 2013 were included. Preterm infants, carriers of genetic syndromes or other disease with nutritional compromise were excluded. Demographic data, type of CHD, admission surgery and anthropometric assessment using the WHO standards were studied. Short stature was defined as lenght/height for age Z score < -2 standard deviations, by sex. Results. A total of 640 children were studied; 361 (56.4 %) were boys; median age: 8 months (IQR: 1.9; 34.6); 66 children underwent > 1 surgery; 27 of them (40.9 %) had hypoplasia of the left ventricle. There were 358 (55.9 %) infants with cyanotic CHDs, 196 (30.6 %) with univentricular physiology. The median HAZ was -0.9 (IQR: -1.9; -0.1); 135 (21.1 %) had a short stature, 11 % of newborn infants and 24.1 % of older than one month old. A higher frequency of short stature was observed in 4 out of 6 children who underwent complete repair of the atrioventricular canal, in 15 out of 39 infants with repair of tetralogy of Fallot, in 8 out of 25 infants with hypoplasia of the left ventricle subjected to Glenn procedure, and in 34 out of 103 with closure of the ventricular septal defect. No association or statistically significant difference was found between short stature and cyanosis or univentricular physiology. Conclusions. There is a high frequency of short stature among children with CHDs, with differences according to the type of CHD and cardiac surgery performed.

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Introduction: Children with congenital heart diseases (CHDs) suffer from malnutrition because of nutritional deficiencies, being short stature the possible long-term consequence. Objective: To describe the presence of short stature among children undergoing cardiac surgery for CHDs. Population and methods: Retrospective study. Children undergoing cardiac surgery with cardiopulmonary bypass pump between 2009 and 2013 were included. Preterm infants, carriers of genetic syndromes or other disease with nutritional compromise were excluded. Demographic data, type of CHD, admission surgery and anthropometric assessment using the WHO standards were studied. Short stature was defined as lenght/height for age Z score < -2 standard deviations, by sex. Results: A total of 640 children were studied; 361 (56.4 %) were boys; median age: 8 months (IQR: 1.9; 34.6); 66 children underwent > 1 surgery; 27 of them (40.9 %) had hypoplasia of the left ventricle. There were 358 (55.9 %) infants with cyanotic CHDs, 196 (30.6 %) with univentricular physiology. The median HAZ was -0.9 (IQR: -1.9; -0.1); 135 (21.1 %) had a short stature, 11 % of newborn infants and 24.1 % of older than one month old. A higher frequency of short stature was observed in 4 out of 6 children who underwent complete repair of the atrioventricular canal, in 15 out of 39 infants with repair of tetralogy of Fallot, in 8 out of 25 infants with hypoplasia of the left ventricle subjected to Glenn procedure, and in 34 out of 103 with closure of the ventricular septal defect. No association or statistically significant difference was found between short stature and cyanosis or univentricular physiology. Conclusions: There is a high frequency of short stature among children with CHDs, with differences according to the type of CHD and cardiac surgery performed.

Introducción. Los niños con cardiopatías congénitas (CC) presentan malnutrición por déficit; una posible consecuencia a largo plazo es la talla baja. Objetivo. Describir la presencia de talla baja en niños con CC al momento de su cardiocirugía. Población y métodos. Estudio retrospectivo. Se incluyeron niños sometidos a cardiocirugía con circulación extracorpórea en 2009-2013. Se excluyeron prematuros, con síndromes genéticos u otra enfermedad con compromiso nutricional. Se estudiaron variables demográficas, diagnóstico cardiológico, cirugía de ingreso y evaluación antropométrica según estándares de la Organización Mundial de la Salud; se definió talla baja como ZT/E < -2 desvíos estándar, según sexo. Resultados. Se estudiaron 640niños; 361 varones (el 56,4 %); mediana de edad: 8 meses (RIC: 1,9; 34,6); 66 niños tuvieron > 1 cirugía; 27 de ellos (el 40,9 %), con hipoplasia del ventrículo izquierdo. Fueron CC cianóticas 358 (el 55,9 %), con fisiología univentricular 196 (el 30,6 %). La mediana de ZT/E fue -0,9 (RIC: -1,9; -0,1); presentaron talla baja 135 (el 21,1 %), el 11 % en neonatos y el 24,1 % en mayores de un mes. Se encontró mayor frecuencia de talla baja en reparación completa de canal atrioventricular en 4/6 niños, reparación de tetralogía de Fallot en 15/39, Glenn en hipoplasia del ventrículo izquierdo en 8/25, cierre de comunicación interventricular en 34/103. No se encontró asociación ni diferencia con significación estadística entre talla baja y cianosis ni según fisiología univentricular. Conclusiones. Existe una alta frecuencia de talla baja en niños con CC, con diferencias según el diagnóstico cardiológico y la cardiocirugía realizada.

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INTRODUCTION: The hospitalization of a child is a situation that produces a high level of stress on parents, especially at the Pediatric Intensive Care Unit (PICU). OBJECTIVE: To determine which are the main stressors perceived by the parents of children hospitalized at PICU and the associated variables. PATIENTS AND METHOD: A quantitative, cross-sectional and correlational study, which considers the secondary analysis of data from the IDA project # 201403 of UC School of Nursing: Validation of "The parental stressor scale infant hospitalization in Spanish" (PSSIH modified). Sampling was non probabilistic by convenience, with 217 parents of children at the PICU of a University hospital, who answered a demographic questionnaire and the modified PSSIH instrument to measure stressors in the PICU environment. RESULTS: Three dimensions of stressors were identified: Clinical, Emotional and Communication with the professional team. The clinical dimension was the most stressful, with the factors images or sounds, procedures and interventions and the aspect of the child, dimensions related to behavior and communication with the team were less stressful. In addition, it is associated with a greater perception of stress in the different dimensions, when having: previous experiences in PICU, programmed admission, admission due tocardiac pathology, single child, higher educational level and no partner. CONCLUSIONS: The modified PSSIH instrument made it possible to determine the main stressors perceived by the parents of children in the PICU, the Clinical dimension being the major stressor. These results are useful for developing local intervention programs according to the particular characteristics of the PICU.

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INTRODUCCIÓN: La hospitalización de un hijo es una situación que produce un alto nivel de estrés en padres/madres, especialmente en Unidades de Cuidados Intensivos Pediátricos (UCIP). OBJETIVO: Determinar cuáles son los principales estresores percibidos por los padres/madres de niños/as en UCIP y qué variables se asocian. PACIENTES Y MÉTODO: Estudio cuantitativo, trasversal y correlacional, contempla el análisis secundario de datos del proyecto de Investigación Docente Asistencial # 201403 de Escuela de Enfermería UC: Validación de "The Parental Stressor Scale Infant Hospitalization al español" (PSSIH modificado). El muestreo fue no probabilístico por conveniencia, con 217 padres de niños/as en la UCIP de un hospital universitario, quienes contestaron un cuestionario demográfico y el instrumento PSSIH modificado para medir estresores en el ambiente de la UCIP. RESULTADOS: Se identificaron 3 dimensiones de estresores: Clínica, Emocional y Comunicación con el equipo profesional. La dimensión clínica fue la más estresante, con los factores imágenes o sonidos, procedimientos e intervenciones y el aspecto del hijo, las dimensiones relacionadas con la conducta y la comunicación con el equipo resultaron menos estresantes. Además, se asocian a una mayor percepción de estrés para las distintas dimensiones, tener: experiencias previas en UCIP, ingreso programado, ingreso por patología cardiaca, hijo único, mayor nivel educacional y no tener pareja. CONCLUSIONES: El instrumento PSSIH modificado permitió determinar principales estresores percibidos por los padres/ madres de niños/as en UCIP, siendo la dimensión Clínica, el mayor estresor. Estos resultados son útiles para desarrollar programas de intervención local según características particulares de las UCIP.

INTRODUCTION: The hospitalization of a child is a situation that produces a high level of stress on parents, especially at the Pediatric Intensive Care Unit (PICU). OBJECTIVE: To determine which are the main stressors perceived by the parents of children hospitalized at PICU and the associated variables. PATIENTS AND METHOD: A quantitative, cross-sectional and correlational study, which considers the secondary analysis of data from the IDA project # 201403 of UC School of Nursing: Validation of "The parental stressor scale infant hospitalization in Spanish" (PSSIH modified). Sampling was non probabilistic by convenience, with 217 parents of children at the PICU of a University hospital, who answered a demographic questionnaire and the modified PSSIH instrument to measure stressors in the PICU environment. RESULTS: Three dimensions of stressors were identified: Clinical, Emotional and Communication with the professional team. The clinical dimension was the most stressful, with the factors images or sounds, procedures and interventions and the aspect of the child, dimensions related to behavior and communication with the team were less stressful. In addition, it is associated with a greater perception of stress in the different dimensions, when having: previous experiences in PICU, programmed admission, admission due tocardiac pathology, single child, higher educational level and no partner. CONCLUSIONS: The modified PSSIH instrument made it possible to determine the main stressors perceived by the parents of children in the PICU, the Clinical dimension being the major stressor. These results are useful for developing local intervention programs according to the particular characteristics of the PICU.

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Introduction: Surgical site infections (SSI) are an important cause of morbidity in pediatric cardiac surgery. Risk factors in patients requiring delayed sternal closure (DSC) are unknown. Aim: To report the rate of SSI in children undergoing cardiac surgery with DSC and determine the risk factors. Methodology: A retrospective case-control study, in patients younger than 15 years old undergoing cardiac surgery with DSC in our center between 2009 and 2010. SSI was diagnosed according to the criteria of the nosocomial infections committee of our institution, based on international recommendations. Univariate and multivariate analysis of variables was performed. A p < 0.05 was considered significant. Results: 58 patients were included; the average age was 9.5 days. The most frequent diagnosis were transposition of the great arteries (36%) and hypoplastic left heart syndrome (27%). 13 patients had SSI (22%); 11 incisional and 2 mediastinitis. It was independently associated to SSI by-pass (BP) time longer than 200 min (OR adjusted = 9,53; IC 95% 1,37-66,35) and mechanical ventilation (MV) more than 5 days (OR adjusted = 8,98; IC 95% 1,16-69,40). Conclusion: The duration of BP and MV are risk factors of SSI in children undergoing cardiac surgery with DSC.

Introducción: Las infecciones del sitio quirúrgico (ISQ) son importante causa de morbilidad en cirugía cardíaca pediátrica. Los factores de riesgo en pacientes que requieren cierre esternal diferido (CED) se desconocen. Objetivos: Reportar la tasa de ISQ en niños sometidos a cirugía cardíaca con CED y determinar factores de riesgo de ISQ. Metodología: Estudio retrospectivo de casos y controles en pacientes bajo 15 años de edad, sometidos a cirugía cardíaca con CED, en los años 2009 y 2010. Se consideró casos aquellos con ISQ diagnosticada según criterios del comité de IAAS local. Se realizó análisis uni y multivariado de las variables. Se consideró significativo un p < 0,05. Resultados: Se incluyeron 58 pacientes; la mediana de edad fue 9,5 días. Diagnósticos más frecuentes fueron transposición de grandes arterias (36%) e hipoplasia de ventrículo izquierdo (27%). Trece pacientes presentaron ISQ (22%); 11 incisionales y 2 me-diastinitis. Se asociaron de manera independiente a ISQ: circulación extracorpórea (CEC) mayor a 200 min (OR ajustado = 9,53; IC 95% 1,37-66,35) y ventilación mecánica invasora (VMI) más de 5 días (OR ajustado = 8,98; IC 95% 1,16-69,40). Conclusión: La duración de CEC y VMI son factores de riesgo de ISQ en niños sometidos a cirugía cardíaca con CED.

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Resumen El síndrome de hipoplasia de corazón izquierdo (SHCI) es una cardiopatía congénita con letalidad superior al 95%. La etapificación quirúrgica es la principal vía de tratamiento, y se inicia con la operación de Norwood; la sobrevida a largo plazo de los pacientes tratados es desconocida en nuestro medio. Objetivos 1) Revisar nuestra experiencia en el manejo de todos los pacientes con SHCI evaluados entre enero 2000 y junio 2010. 2) Identificar factores de riesgo de mortalidad quirúrgica. Pacientes y método Estudio retrospectivo de una única institución con una cohorte de pacientes con SHCI. Se revisan antecedentes clínicos, quirúrgicos, y registros de seguimiento. Resultados Se evaluaron 76 pacientes con SHCI; 9/76 tenían comunicación interauricular (CIA) restrictiva, y 8/76, aorta ascendente de < 2 mm; 65/76 fueron tratados: 77% tuvieron operación de Norwood con conducto entre ventrículo derecho y ramas pulmonares como fuente de flujo pulmonar, 17% Norwood con shunt de Blalock-Taussig, y 6% otra cirugía. La mortalidad en la primera etapa quirúrgica fue del 23%, y en operación de Norwood, del 21,3%. En el período 2000-2005 la mortalidad en la primera etapa quirúrgica fue del 36%, y entre 2005-2010, del 15% (p = 0,05). La sobrevida global fue del 64% a un año y del 57% a 5 años. Por análisis multivariado fueron factores de riesgo para mortalidad la presencia de aorta ascendente diminuta y CIA restrictiva. Conclusiones Nuestros resultados inmediatos y a largo plazo en la etapificación quirúrgica de SHCI son similares a la experiencia de grandes centros. Hay una mejoría en mortalidad operatoria en la segunda mitad de la serie. Se identifican factores de riesgo de mortalidad.

Abstract Hypoplastic left heart syndrome (HLHS) is a lethal congenital heart disease in 95% of non-treated patients. Surgical staging is the main form of treatment, consisting of a 3-stage approach, beginning with the Norwood operation. Long term survival of treated patients is unknown in our country. Objectives 1) To review our experience in the management of all patients seen with HLHS between January 2000 and June 2012. 2) Identify risk factors for mortality. Patients and method Retrospective analysis of a single institution experience with a cohort of patients with HLHS. Clinical, surgical, and follow-up records were reviewed. Results Of the 76 patients with HLHS, 9 had a restrictive atrial septal defect (ASD), and 8 had an ascending aorta ≤ 2 mm. Of the 65 out of 76 patients that were treated, 77% had a Norwood operation with pulmonary blood flow supplied by a right ventricle to pulmonary artery conduit, 17% had a Norwood with a Blalock-Taussig shunt, and 6% other surgical procedure. Surgical mortality at the first stage was 23%, and for Norwood operation 21.3%. For the period between 2000-2005, surgical mortality at the first stage was 36%, and between 2005-2010, 15% (P = .05). Actuarial survival was 64% at one year, and 57% at 5 years. Using a multivariate analysis, a restrictive ASD and a diminutive aorta were high risk factors for mortality. Conclusions Our immediate and long term outcome for staged surgical management of HLHS is similar to that reported by large centres. There is an improvement in surgical mortality in the second half of our experience. Risk factors for mortality are also identified.

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INTRODUCTION: Surgical site infections (SSI) are an important cause of morbidity in pediatric cardiac surgery. Risk factors in patients requiring delayed sternal closure (DSC) are unknown. AIM: To report the rate of SSI in children undergoing cardiac surgery with DSC and determine the risk factors. METHODOLOGY: A retrospective case-control study, in patients younger than 15 years old undergoing cardiac surgery with DSC in our center between 2009 and 2010. SSI was diagnosed according to the criteria of the nosocomial infections committee of our institution, based on international recommendations. Univariate and multivariate analysis of variables was performed. A p < 0.05 was considered significant. RESULTS: 58 patients were included; the average age was 9.5 days. The most frequent diagnosis were transposition of the great arteries (36%) and hypoplastic left heart syndrome (27%). 13 patients had SSI (22%); 11 incisional and 2 mediastinitis. It was independently associated to SSI by-pass (BP) time longer than 200 min (OR adjusted = 9,53; IC 95% 1,37-66,35) and mechanical ventilation (MV) more than 5 days (OR adjusted = 8,98; IC 95% 1,16-69,40). CONCLUSION: The duration of BP and MV are risk factors of SSI in children undergoing cardiac surgery with DSC.

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UNLABELLED: Hypoplastic left heart syndrome (HLHS) is a lethal congenital heart disease in 95% of non-treated patients. Surgical staging is the main form of treatment, consisting of a 3-stage approach, beginning with the Norwood operation. Long term survival of treated patients is unknown in our country. OBJECTIVES: 1) To review our experience in the management of all patients seen with HLHS between January 2000 and June 2012. 2) Identify risk factors for mortality. PATIENTS AND METHOD: Retrospective analysis of a single institution experience with a cohort of patients with HLHS. Clinical, surgical, and follow-up records were reviewed. RESULTS: Of the 76 patients with HLHS, 9 had a restrictive atrial septal defect (ASD), and 8 had an ascending aorta ≤2mm. Of the 65 out of 76 patients that were treated, 77% had a Norwood operation with pulmonary blood flow supplied by a right ventricle to pulmonary artery conduit, 17% had a Norwood with a Blalock-Taussig shunt, and 6% other surgical procedure. Surgical mortality at the first stage was 23%, and for Norwood operation 21.3%. For the period between 2000-2005, surgical mortality at the first stage was 36%, and between 2005-2010, 15% (P=.05). Actuarial survival was 64% at one year, and 57% at 5years. Using a multivariate analysis, a restrictive ASD and a diminutive aorta were high risk factors for mortality. CONCLUSIONS: Our immediate and long term outcome for staged surgical management of HLHS is similar to that reported by large centres. There is an improvement in surgical mortality in the second half of our experience. Risk factors for mortality are also identified.

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Debido a los avances en las técnicas diagnósticas y resultados operatorios, los niños con cardiopatías congénitas (CC) tienen hoy mayor expectativa de vida. Nuestro hospital - un Centro de Referencia Nacional para la tratamiento de las CC en menores de 15 años -, ha reportado una disminución significativa de la mortalidad operatoria desde un 8,1% a un 4,7% entre 2000 y 2010, pero ello no se ha acompañado de mejoría importante de la calidad de vida. La falta de programas de actividad física y participación social, puede ser un factor importante en la limitación de la calidad de vida. La evidencia existente describe que la medida referida produce mejorías en el consumo de oxígeno peak (VO2peak), tolerancia al esfuerzo físico y menores tasas de re hospitalización. En el presente artículo se revisan los métodos de evaluación de la condición física en la edad pediátrica, la evidencia actual de los programas de rehabilitación cardiovascular pediátrica y recomendaciones de actividad física en niños portadores de CC.

Due to advances in diagnostic procedures and surgi-cal results life expectancy of children with congenital heart disease (CHD) has increased significantly. In our hospital- a national reference center- operative mortality has decreased from 8.1% in 2000 to 4.7% in 2010. However, quality of life of these children has not improved accordingly. A significant factor which may account for this effect is the absence of physical activity and rehabilitation programs. Existing evidence points out to an increase in peak oxygen consumption, tolerance to physical exertion and a lower rate of re-hospitalizations. Herein we review methods to evaluate physical condition in children, the current evidence supporting rehabilitation programs and the recommen-dations for physical activity in children with CHD.

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INTRODUCTION: Nosocomial infections generate high morbidity and mortality in children undergoing cardiac surgery. OBJECTIVE: To determine risk factors for nosocomial infections in children after congenital heart surgery. METHODS: A retrospective case-control study, in patients younger than 15 years undergoing surgery for congenital heart disease from January 2007 to December 2011 admitted to the Pediatric Critical Patient Unit (UPC-P) in a university hospital. For cases, the information was analyzed from the first episode of infection. RESULTS: 39 patients who develop infections and 39 controls who did not develop infection were enrolled. The median age of cases was 2 months. We identified a number of factors associated with the occurrence of infections, highlighting in univariate analysis: age, weight, univentricular heart physiology, complexity of the surgical procedure according to RACHS-1 and cardiopulmonary bypass (CPB) time ≥ 200 minutes. Multivariate analysis identified CPB time ≥ 200 minutes as the major risk factor, with an OR of 11.57 (CI: 1.04 to 128.5). CONCLUSION: CPB time ≥ 200 minutes was the mayor risk factor associated with the development of nosocomial infections.

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Introduction: Nosocomial infections generate high morbidity and mortality in children undergoing cardiac surgery. Objective: To determine risk factors for nosocomial infections in children after congenital heart surgery. Methods: A retrospective case-control study, in patients younger than 15 years undergoing surgery for congenital heart disease from January 2007 to December 2011 admitted to the Pediatric Critical Patient Unit (UPC-P) in a university hospital. For cases, the information was analyzed from the first episode of infection. Results: 39 patients who develop infections and 39 controls who did not develop infection were enrolled. The median age of cases was 2 months. We identified a number of factors associated with the occurrence of infections, highlighting in univariate analysis: age, weight, univentricular heart physiology, complexity of the surgical procedure according to RACHS-1 and cardiopulmonary bypass (CPB) time ≥ 200 minutes. Multivariate analysis identified CPB time ≥ 200 minutes as the major risk factor, with an OR of 11.57 (CI: 1.04 to 128.5). Conclusion: CPB time ≥ 200 minutes was the mayor risk factor associated with the development of nosocomial infections.

Introducción: Las infecciones asociadas a la atención en salud (IAAS) generan elevada morbilidad y mortalidad en niños sometidos a cirugía cardíaca. Objetivo: Determinar factores de riesgo que inciden en la ocurrencia de IAAS en niños operados de cardiopatías congénitas. Métodos: Estudio retrospectivo de casos y controles, en pacientes menores de 15 años sometidos a cirugía por cardiopatías congénitas desde enero 2007 a diciembre 2011 admitidos en la Unidad de Paciente Crítico Pediátrico (UPC-P) de un hospital universitario. Para los casos, se analizó la información del primer episodio de infección. Resultados: Se enrolaron 39 pacientes con IAAS y 39 controles operados que no desarrollaron infección. La mediana de edad de los casos fue 2 meses. Se identificó una serie de factores asociados a la ocurrencia de IAAS, destacando en el análisis univariado: edad, peso, fisiología cardíaca tipo univentricular, complejidad del procedimiento quirúrgico según RACHS-1 y tiempo de circulación extracorpórea (CEC) ≥ 200 min. El análisis multivariado identificó al tiempo de CEC ≥ 200 min como el principal factor de riesgo, con un OR de 11,57 (IC: 1,04-128,5). Conclusión: El tiempo de CEC ≥ 200 min fue el factor de riesgo más asociado al desarrollo de IAAS en niños operados de cardiopatías congénitas.

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Introducción: La mortalidad operatoria en cirugía cardíaca de cardiopatías congênitas es utilizada como indicador de calidad, pero no incorpora la complejidad del procedimiento. La puntuación de riesgo "Risk Adjustment in Congenital Heart Surgery-1" agrupa las cirugías según riesgo de mortalidad. Objetivos: Determinar nuestra mortalidad operatoria de cirugía cardíaca en pacientes pediátricos con cardio-patías congénitas, analizar nuestros resultados aplicando esta puntuación de riesgo, determinar la evolución de la mortalidad y comparar nuestros resultados con los publicados. Métodos: Estudio de cohorte no concurrente (enero 2000-julio 2010). Las cirugías fueron estratificadas según puntuación de riesgo. La tendencia de mortalidad operatoria se evaluó dividiendo el período estudiado en tres subperíodos. Comparamos nuestros resultados con los publicados por las Sociedades de Cirujanos de Cardiopatías Congênitas y la de Cirujanos de Tórax. Resultados: Se realizaron 1658 cirugías con mortalidad operatoria de 5,9 por ciento. Mortalidad según categoría de riesgo fue: Categorías 1 y 2: 2,1 por ciento; Categoría 3: 6,2 por ciento; Categoría 4: 24,3 por ciento y Categoría 6: 20,7 por ciento (RT = 9,87 ; P<0,001). La mortalidad disminuyó a lo largo de los tres períodos (8,1 por ciento a 4,7 por ciento; RT = 1,72; P=0,031). La mortalidad operatoria global fue similar a la reportada por la Sociedad de Cirujanos de Tórax (4,7 por ciento vs. 3.9 por ciento), pero mayor a la Sociedad de Cirujanos de Cardiopatías Con-génitas (4,7 por ciento vs. 2,9 por ciento; RT = 1,65; P=0,013). Conclusión: Nuestra mortalidad operatoria de cirugía cardíaca es 5.9 por ciento, disminuye a lo largo del estudio y es comparable a la publicada por Sociedades Internacionales.

Background: Surgical mortality in congenital heart surgery has been commonly used to assess quality of care, but it doesn't take into account the complexity of the procedure performed. The risk score "Risk Adjustment in Congenital Heart Surgery-1" was developed to address this case mix. Objectives: To determine our institution surgical mortality in congenital heart surgery, assess mortality risk using the RACHS-1 score, evaluate our trend in surgical mortality and to compare our results with published data. Methods: Retrospective study of all congenital heart surgeries performed between January 2000 and July 2010. Heart surgeries were stratified according to the RACHS-1 score. The trend in surgical mortality was assessed across 3 consecutive periods. Our results were compared with published data from the Congenital Heart Surgeons' Society and the Society of Thoracic Surgeons. Results: 1658 congenital heart surgeries were performed with 5,9 percent surgical mortality . Stratified by RACHS-1 score surgical mortality was: Risk category 1 and 2: 2,1 percent; Risk category 3: 6,2 percent; Risk category 4: 24,3 percent and Risk category 6: 20,7 percent (RR = 9,87; P<0,001). Mortality decreased during the study period from 8,1 percent to 4,7 percent (RR = 1,72; P=0,031). Our surgical mortality was similar to that reported by the Congenital Heart Surgeons' Society (4,7 percent vs. 3.9 percent. respectively), but higher than that reported by the Society of Thoracic Surgeons (4,7 percent vs. 2,9 percent, respectively; RR = 1,65; P=0,013). Conclusions: Our surgical mortality of congenital heart surgery is 5.9 percent, it decreases along the study period and is comparable to the results of large international surgical databases.

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