RESUMEN
The aim of this study was to assess the feasibility of using serial bronchoalveolar lavage fluids (BALFs) to characterize the course of cell damage and inflammation in the airways of pediatric patients with acute burn or inhalation injury. This was a prospective, longitudinal, descriptive pilot study conducted at the Burn and Pediatric Intensive Care Units in a tertiary care medical center. Six consecutively intubated and mechanically ventilated pediatric patients with acute inhalational injuries were studied. Serial BALF specimens from clinically indicated bronchoscopies were used to measure DNA and cytokine levels. BALF DNA levels for the six pediatric burn subjects were the highest within the first 72 hours after burn injury and declined thereafter. At the early stages after injury, BALF DNA levels (median [min, max] 3789 [1170, 11,917] ng/ml) were similar to those in adult burn patients and pediatric cystic fibrosis or bronchiectasis patients and was higher than those in pediatric recurrent pneumonia patients. BALF DNA levels in children and adults with inhalation injury correlated significantly with BALF interleukin-6, interleukin-8, and transforming growth factor-ß1 levels. The patient with the most severe early visible airway mucosal damage and soot pattern at bronchoscopy, as well as the most extensive burns, also had the highest average early BALF DNA level (11,917 ng/ml) and the longest ventilator course and hospital stay. Procedures were well tolerated. In children with acute burn and inhalational injury, airway cellular damage and inflammation (reflected in high BALF DNA levels) appear to peak during the first 72 hours after burn or inhalation injury followed by a slow decline. Serial analysis of factors in airway secretions is feasible and has the potential to reveal important pathophyisiologic pathways and therapeutic targets for the treatment of acute inhalational injuries.
Asunto(s)
Líquido del Lavado Bronquioalveolar/química , Quemaduras por Inhalación/patología , ADN/análisis , Mediadores de Inflamación/análisis , Adolescente , Análisis de Varianza , Broncoscopía , Niño , Preescolar , Citocinas/análisis , Femenino , Humanos , Unidades de Cuidado Intensivo Pediátrico , Intubación Intratraqueal , Tiempo de Internación/estadística & datos numéricos , Modelos Lineales , Estudios Longitudinales , Masculino , Proyectos Piloto , Estudios Prospectivos , Respiración Artificial , Índice de Severidad de la EnfermedadRESUMEN
Efforts to reduce infections acquired during a hospital stay through improvements in the quality of care have had measurable results in many hospital settings. In pediatric intensive care units, the right quality interventions can save lives and money. We found that improving practices of hand hygiene, oral care, and central-line catheter care reduced hospital-acquired infections and improved mortality rates among children admitted to a large pediatric intensive care unit in 2007-09. In addition, on average patients admitted after the quality interventions were fully implemented spent 2.3 fewer days in the hospital, their hospitalization cost $12,136 less, and mortality was 2.3 percentage points lower, compared to patients admitted before the interventions. The projected annual cost savings for the single pediatric intensive care unit studied was approximately $12 million. Given the modest expenses incurred for these improvements-which mainly consisted of posters for an educational campaign, a training "fair," roughly $21 per day for oral care kits, about $0.60 per day for chlorhexidine antiseptic patches, and hand sanitizers attached to the walls outside patients' rooms-this represents a significant return on investment. Used on a larger scale, these quality improvements could save lives and reduce costs for patients, hospitals, and payers around the country, provided that sustained efforts ensure compliance with new protocols and achieve long-lasting changes.
Asunto(s)
Desinfección de las Manos , Mortalidad Hospitalaria/tendencias , Higiene/economía , Unidades de Cuidado Intensivo Pediátrico/economía , Tiempo de Internación/tendencias , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Control de Costos , Femenino , Adhesión a Directriz , Humanos , Lactante , Masculino , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the efficacy of probiotics in reducing the rates of nosocomial infection in pediatric intensive care. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: A 16-bed pediatric intensive care unit in a university-affiliated children's hospital. PATIENTS: Sixty-one pediatric patients were enrolled from April 2004 until December 2004. Screening of all patients admitted occurred on a daily basis. Patients were excluded if they had the following: evidence/suspicion of intestinal perforation, evidence/suspicion of mechanical gastrointestinal obstruction, absolute neutrophil count Asunto(s)
Enfermedad Crítica/terapia
, Infección Hospitalaria/prevención & control
, Lacticaseibacillus rhamnosus
, Probióticos/uso terapéutico
, Preescolar
, Enfermedad Crítica/mortalidad
, Infección Hospitalaria/epidemiología
, Método Doble Ciego
, Humanos
, Incidencia
, Lactante
, Recién Nacido
, Unidades de Cuidado Intensivo Pediátrico
, Riesgo
Asunto(s)
Presentación de Antígeno/efectos de los fármacos , Biomarcadores/análisis , Inmunidad Innata/efectos de los fármacos , Monocitos/efectos de los fármacos , Ozono/toxicidad , Adulto , Presentación de Antígeno/inmunología , Antígeno B7-2/efectos de los fármacos , Antígeno B7-2/metabolismo , Antígeno CD11b/efectos de los fármacos , Antígeno CD11b/metabolismo , Método Doble Ciego , Femenino , Citometría de Flujo , Antígenos HLA-DR/efectos de los fármacos , Antígenos HLA-DR/metabolismo , Humanos , Receptores de Lipopolisacáridos/efectos de los fármacos , Receptores de Lipopolisacáridos/metabolismo , Pulmón/citología , Pulmón/inmunología , Macrófagos/efectos de los fármacos , Macrófagos/metabolismo , Masculino , Monocitos/inmunología , Monocitos/metabolismo , Neutrófilos/efectos de los fármacos , Neutrófilos/metabolismo , Receptores de IgG/efectos de los fármacos , Receptores de IgG/metabolismo , Pruebas de Función Respiratoria , Esputo/citología , Esputo/inmunologíaRESUMEN
OBJECTIVES: To describe four adolescents with hyperglycemic hyperosmolar syndrome, an uncommon presentation of type 2 diabetes in pediatric patients. DESIGN: Case report. SETTING: Two tertiary pediatric intensive care units in university teaching hospitals. PATIENTS: Four obese adolescents with hyperglycemic hyperosmolar syndrome associated with type 2 diabetes mellitus. INTERVENTIONS: Isotonic fluid resuscitation and insulin. MEASUREMENTS AND MAIN RESULTS: Two of the four patients died. The first patient died within the first 24 hrs of hyperglycemic hyperosmolar syndrome presumably due to hypovolemic shock. The second patient, who died, developed rhabdomyolysis and multiple-system organ failure after a prolonged intensive care unit stay. The third and fourth patients were discharged from the hospital in good health. None of the patients had cerebral edema on head computed tomography, despite differences in fluid and insulin management. CONCLUSIONS: Pediatric patients with hyperglycemic hyperosmolar syndrome have a high mortality rate and may experience multiple complications such as rhabdomyolysis and hypovolemic shock. Treatment strategies to reduce mortality are unclear and warrant further investigation.