RESUMEN
Extracorporeal membrane oxygenation (ECMO) is a therapy that ensures adequate tissue oxygen delivery in patients suffering cardiac and/or respiratory failure that are unresponsive to conventional therapy. During ECMO, it is common to see a decrease in urine output that may be associated with acute renal failure. In this context, continuous renal replacement therapy (CRRT) should be considered. Our aim is to evaluate a pioneer experience in Latin America, related to the use of CRRT in a group of neonatal-pediatric patients during ECMO. We conducted a retrospective review of patients treated with ECMO at our institution between May 2003 and May 2005. Twelve infants were treated with ECMO, six of them also underwent CRRT. The main reasons for CRRT initiation were fluid overload and progressive azotemia. Observed complications were clots in the filter and excessive ultrafiltration. CRRT was successful in fluid management and solute clearance in all patients. Discharge survival rate was 83%, all of them with normal renal function. Concurrent CRRT with ECMO is technically feasible and efficacious in the management of fluid overload and solute clearance. We report the first experience with these therapies in a Latin American neonatal-pediatric ECMO program associated with the Extracorporeal Life Support Organization.
Asunto(s)
Lesión Renal Aguda/terapia , Oxigenación por Membrana Extracorpórea , Hemodiafiltración , Lesión Renal Aguda/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Pruebas de Función Renal , Masculino , Trastornos Respiratorios/complicaciones , Trastornos Respiratorios/terapia , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Anaplasmosis/prevención & control , Antiinfecciosos/uso terapéutico , Profilaxis Antibiótica , Fluoroquinolonas , Quinolonas/uso terapéutico , Anaplasma/inmunología , Animales , Anticuerpos Antibacterianos/sangre , Bovinos , Enrofloxacina , Eritrocitos/microbiología , Masculino , OrquiectomíaRESUMEN
The National Disaster Medical System was designed to respond to a catastrophic disaster by creating a group of specially trained civilian disaster medical assistance teams. The teams would be transported to the periphery of the event to triage, stabilize, and then prepare victims for evacuation to facilities elsewhere in the United States that have agreed in advance to accept such patients. Hurricane Hugo's devastation in St Croix offered the first opportunity to test the system. The event was an example of a type of medical disaster that resulted in a sudden reduction in medical resources without a great increase in casualties. Background information and operation of the New Mexico disaster medical assistance team are presented with a clinical profile of the patients seen during the disaster. We describe the first actual deployment of a disaster medical assistance team and the issues that must be addressed before future deployments.
Asunto(s)
Planificación en Desastres , Desastres , Servicios Médicos de Urgencia , Sistemas de Comunicación entre Servicios de Urgencia/organización & administración , Servicios Médicos de Urgencia/estadística & datos numéricos , Humanos , Grupo de Atención al Paciente , Sistemas de Socorro , Estados Unidos , Islas Virgenes de los Estados UnidosRESUMEN
In September 1983, we selected 30 villages in four rural counties of northern Haiti for a partial census and malaria prevalence survey. A cohort of 1,577 persons was enumerated in this census. Survey teams revisited the same houses in these villages in September 1984 and updated the previous census, inquiring about all listed family members. We administered an additional questionnaire to each household concerning the occurrence over the past year of deaths, births, pregnancies, and migration. Among the 1,218 persons who had been followed for one year, there were 21 deaths (crude mortality rate: 17 per 1,000 population; 95% confidence interval [95% CI]: 12 per 1,000, 25 per 1,000) and 35 births (birth rate: 29 per 1,000 population year; 95% CI: 19 per 1,000, 38 per 1,000). The infant mortality rate was 171 per 1,000 live births (95% CI: 81 per 1,000, 315 per 1,000), and the mortality rate for children less than 5 years old was 36 per 1,000 (95% CI: 24 per 1,000, 56 per 1,000). Although small sample surveys are subject to limitations of precision dependent on sample size, they can be a simple method by which researchers may estimate vital statistics for rural areas of less-developed countries.