Asunto(s)
Insuficiencia Cardíaca , Trasplante de Células Madre Hematopoyéticas , Derrame Pleural , Insuficiencia Renal , Insuficiencia Respiratoria , Niño , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Masculino , Derrame Pleural/etiología , Insuficiencia Renal/etiología , Insuficiencia Renal/terapia , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapiaRESUMEN
We reviewed patients with Stevens-Johnson syndrome (SJS) evaluated at Children's Hospital Colorado and investigated the occurrence of bronchiolitis obliterans (BO). Approximately 9% of patients with SJS developed BO. Pediatricians should consider monitoring patients with SJS for BO, especially those with recurrent SJS and patients treated with mechanical ventilation.
Asunto(s)
Bronquiolitis Obliterante/complicaciones , Síndrome de Stevens-Johnson/complicaciones , Bronquiolitis Obliterante/diagnóstico por imagen , Niño , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Respiración Artificial , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To describe the clinical features of children who presented to Children's Hospital Colorado (CHCO) with high-altitude pulmonary edema (HAPE). STUDY DESIGN: We performed a retrospective chart review in children discharged from CHCO (an elevation of 1668 m) with a clinical diagnosis of HAPE and a chest radiograph consistent with noncardiogenic pulmonary edema. Descriptive statistics were used to describe the demographics, presentations, and treatment strategies. RESULTS: From 2004 to 2014, 50 children presented to CHCO who were found to have a clinical diagnosis of HAPE and a chest radiograph consistent with noncardiogenic pulmonary edema. Most (72%) patients were male, and most (60%) of the children in the study were diagnosed with classic HAPE, 38% with re-entry HAPE, and 2% with high altitude resident pulmonary edema. Elevation at symptom presentation ranged from 1840 to 3536 m. Patients were treated with a variety of medications, including diuretics, steroids, and antibiotics. Four patients were newly diagnosed with structural heart findings: 2 patients with patent foramen ovale and 2 with atrial septal defects. Eleven patients had findings consistent with pulmonary hypertension at the time of echocardiography. CONCLUSIONS: HAPE symptoms may develop below 2500 m, so providers should not rule out HAPE based on elevation alone. Structural heart findings and pulmonary hypertension are associated with HAPE susceptibility and their presence may inform treatment. Inappropriate use of antibiotics and diuretics in children with HAPE suggest that further education of providers is warranted.