RESUMEN
WHAT IS KNOWN AND OBJECTIVE: Dexmedetomidine (DEX) has been reported to be safe in paediatric patients. CASE DESCRIPTION: We present the case of a girl without heart disease admitted at our PICU due to an influenza A acute respiratory distress syndrome, who suffered a paroxysmal supraventricular tachycardia (PSVT) twelve hours after DEX progressive withdrawal was completed. WHAT IS NEW AND CONCLUSION: This is the first report of PSVT as an adverse reaction to DEX in a paediatric patient without heart disease.
Asunto(s)
Agonistas de Receptores Adrenérgicos alfa 2/efectos adversos , Dexmedetomidina/efectos adversos , Taquicardia Paroxística/etiología , Taquicardia Supraventricular/etiología , Agonistas de Receptores Adrenérgicos alfa 2/administración & dosificación , Preescolar , Dexmedetomidina/administración & dosificación , Femenino , Humanos , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Unidades de Cuidado Intensivo Pediátrico , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/virología , Síndrome de Abstinencia a Sustancias/fisiopatologíaAsunto(s)
Arritmias Cardíacas/inducido químicamente , Disnea/inducido químicamente , Intento de Suicidio , Tiroxina/envenenamiento , Adolescente , Arritmias Cardíacas/tratamiento farmacológico , Disnea/tratamiento farmacológico , Electrocardiografía , Humanos , Masculino , Propranolol/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Epilepsy is one of the most common symptoms in Tuberous Sclerosis Complex (TSC), appearing mainly in the first year of life and often resistant to therapy. Several studies have demonstrated the effectiveness of everolimus but its safety in children has not yet been well reported. We present two cases of severe pneumonia caused by Mycoplasma in two children receiving everolimus for epilepsy secondary to TSC. STUDY CASES: Both patients were admitted to the PICU for severe pneumonia with pleural effusion. One of them needed support with high concentration of oxygen and broad spectrum antibiotics and the other developed a septic shock with acute respiratory distress needing mechanical ventilation, vasoactive drugs, pleural drainage and broad-spectrum antibiotics. Everolimus was discontinued and in both patients Mycoplasma pneumoniae was identified by PCR. Both patients were discharged without sequelae. CONCLUSION: Everolimus therapy for epilepsy in the context of TCS could be associated, as in these two cases, with severe bacterial infection by Mycoplasma.
Asunto(s)
Everolimus/efectos adversos , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Infecciones por Mycoplasma/etiología , Neumonía/inmunología , Esclerosis Tuberosa/tratamiento farmacológico , Niño , Preescolar , Epilepsia/tratamiento farmacológico , Epilepsia/etiología , Femenino , Humanos , Lactante , Masculino , Neumonía/microbiología , Esclerosis Tuberosa/complicacionesRESUMEN
BACKGROUND AND AIMS: There is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline. PATIENTS AND METHODS: We performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours. The primary outcome measure was the length of hospital stay. RESULTS: A total of 185 infants were analyzed: 94 in the epinephrine plus 3% hypertonic saline group and 91 in the placebo plus 3% hypertonic saline group. Baseline demographic and clinical characteristics were similar in both groups. Length of hospital stay was significantly reduced in the epinephrine group as compared with the placebo group (3.94 ±1.88 days vs. 4.82 ±2.30 days, P = 0.011). Disease severity also decreased significantly earlier in the epinephrine group (P = 0.029 and P = 0.036 on days 3 and 5, respectively). CONCLUSIONS: In our setting, nebulized epinephrine in 3% hypertonic saline significantly shortens hospital stay in hospitalized infants with acute moderate bronchiolitis compared to 3% hypertonic saline alone, and improves the clinical scores of severity from the third day of treatment, but not before. TRIAL REGISTRATION: EudraCT 2009-016042-57.