Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Saúde Global , Unidades de Terapia Intensiva Pediátrica/organização & administração , Pandemias/estatística & dados numéricos , Pneumonia Viral/terapia , Síndrome Respiratória Aguda Grave/terapia , Adolescente , COVID-19 , Criança , Pré-Escolar , Chile , Estudos de Coortes , Colômbia , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Estado Terminal/mortalidade , Estado Terminal/terapia , Quimioterapia Combinada , Feminino , Mortalidade Hospitalar , Humanos , Internacionalidade , Itália , Masculino , Pediatria/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Respiração Artificial/métodos , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/mortalidade , Espanha , Estados UnidosRESUMO
OBJECTIVES: To analyze a training program in accident prevention and care and Pediatric Basic Cardiopulmonary Resuscitation taught by medical students. RESULTS: Medical students were trained as instructors. Four courses of were launched in Honduras, and the results were analyzed through a theoretical and practical evaluation and an anonymous survey. The volunteer experience for the students and the benefits to the population were positively valued. 37 students received the training. The score in the initial theoretical evaluation was 5.9 of 17 and in the final 10.5, p < 0.001. 89.1% and 91.9% of the students achieved adequate practical learning in basic Cardiopulmonary Resuscitation for children and infants respectively. The course was rated excellently by the students. We conclude that a training program in accident prevention and care and Pediatric Basic Cardiopulmonary Resuscitation taught by medical students could be useful in a cooperation health program.
Assuntos
Prevenção de Acidentes/métodos , Reanimação Cardiopulmonar/métodos , Educação/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Estudantes de Medicina/estatística & dados numéricos , Voluntários/estatística & dados numéricos , Criança , Comportamento Cooperativo , Honduras , Humanos , Lactente , Capacitação de Professores/métodos , Capacitação de Professores/normas , Capacitação de Professores/estatística & dados numéricosRESUMO
OBJECTIVE: To analyze the incidence and factors associated with constipation in critically ill children. STUDY DESIGN: We performed a prospective observational study that included children admitted to the pediatric intensive care unit for more than 3 days. Constipation was defined as more than 3 days without a bowel movement. Relationships between constipation and demographic data; clinical severity score; use of mechanical ventilation, use of vasoconstrictors, sedatives, and muscle relaxants; nutritional data; electrolyte disturbances; and clinical course were analyzed. RESULTS: Constipation developed in 46.7% of the 150 patients studied (mean age, 34.3 ± 7.1 months). It was most common in postoperative, older, and higher-body-weight patients, and in those with fecal continence (P < .01). Compared with patients without constipation, patients with constipation had higher severity scores and more frequently received midazolam, fentanyl, muscle relaxants, and inotropic support (P < .05). Patients with constipation also started nutrition later and with a lower volume of nutrition (P < .01). There were no between-group differences in mortality or length of pediatric intensive care unit stay. In multivariate analysis, independent factors associated with constipation were body weight (OR, 1.08; 95% CI, 1.03-1.13), Pediatric Index of Mortality 2 score (OR, 1.05; 95% CI, 1.02-1.09), admission after surgery (OR, 7.64; 95% CI, 2.56-22.81), and treatment with vasoconstrictors (OR, 10.28; 95% CI, 3.53-29.93). CONCLUSION: Constipation is common in critically ill children. Body weight, Pediatric Index of Mortality 2 clinical severity score, admission after surgery, and the need for vasoconstrictor therapy are major independent risk factors associated with constipation.
Assuntos
Constipação Intestinal/etiologia , Peso Corporal , Criança , Pré-Escolar , Estado Terminal , Eletrólitos , Feminino , Hospitalização , Humanos , Hipnóticos e Sedativos/efeitos adversos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Relaxantes Musculares Centrais/efeitos adversos , Estudos Prospectivos , Análise de Regressão , Respiração Artificial/efeitos adversos , Fatores de Risco , Vasoconstritores/efeitos adversosRESUMO
OBJECTIVE: To compare the effect of 2 doses of intravenous omeprazole on gastric pH, gastrointestinal bleeding, and adverse effects in critically ill children. STUDY DESIGN: We undertook a prospective randomized clinical trial in critically ill children at risk of gastrointestinal bleeding. The effect of 2 intravenous omeprazole regimens (0.5 or 1 mg/kg every 12 hours) on the gastric pH and incidence of gastrointestinal hemorrhage was compared. The efficacy criteria were a gastric pH >4 and the absence of clinically significant gastrointestinal bleeding. RESULTS: Forty patients, 20 in each treatment group, were studied. Overall, the gastric pH was greater than 4 for 57.8% of the time, with no difference between the doses (P = .66). The percentage of time with a gastric pH > 4 increased during the study (47.8% between 0 and 24 hours vs 76% between 24 and 48 hours, P = .001); the greater dose showed a greater increase in the percentage of time with a pH > 4: between hours 24 and 48 of the study, the gastric pH was greater than 4 for 84.5% of the time with the 1 mg/kg dose and for 65.5% of the time with the 0.5 mg/kg dose (P = .036). Plasma omeprazole levels were greater with 1 mg/kg dose, but no correlation was found between omeprazole plasma levels and gastric pH. No toxic adverse effects were detected, and there was no clinically significant bleeding. CONCLUSION: Neither of the 2 omeprazole regimens achieved adequate alkalinization of the gastric pH during the first 24 hours. Between 24 and 48 hours, the 1 mg/kg dose maintained the gastric pH greater than 4 for a greater percentage of the time.
Assuntos
Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/prevenção & controle , Infusões Intravenosas/métodos , Omeprazol/administração & dosagem , Antiulcerosos/administração & dosagem , Antiulcerosos/farmacocinética , Criança , Pré-Escolar , Estado Terminal , Feminino , Determinação da Acidez Gástrica , Humanos , Concentração de Íons de Hidrogênio , Lactente , Masculino , Omeprazol/farmacocinética , Estudos Prospectivos , Método Simples-Cego , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To compare a standard diet and a protein-enriched diet in critically ill children. STUDY DESIGN: In this prospective randomized controlled trial in critically ill children, all patients received enteral nutrition exclusively and were randomly assigned to a standard diet or a protein-enriched diet (1.1 g protein/100 mL of feeding formula). Blood and urine tests, nitrogen balance assessment, and energy expenditure testing by indirect calorimetry were performed before the beginning of the nutrition regimen and at 24 hours, 72 hours, and 5 days after initiation. Demographic data and pediatric mortality risk scores were recorded. RESULTS: Fifty-one children were randomized, and 41 completed the study. Of these, 21 patients received standard formula and 20 received a protein-enriched formula. There were no between-group differences in terms age, sex, diagnosis, or mortality risk scores. There was a greater positive trend in levels of prealbumin, transferrin, retinol-binding protein, and total protein in the protein-enriched diet group. These differences were significant only for retinol-binding protein. The positive nitrogen balance trend was also higher in the protein-enriched diet group; however, this difference did not reach statistical significance. No adverse effects or hyperproteinemia were detected in the protein-enriched diet group. CONCLUSIONS: The standard diet provides insufficient protein delivery to critically ill children. Enteral protein supplementation is safe and can improve some biochemical parameters of protein metabolism.
Assuntos
Estado Terminal/terapia , Proteínas Alimentares/administração & dosagem , Nutrição Enteral/métodos , Albuminas/metabolismo , Criança , Metabolismo Energético , Feminino , Alimentos Formulados , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Nitrogênio/metabolismo , Pré-Albumina/metabolismo , Estudos Prospectivos , Proteínas de Ligação ao Retinol/metabolismo , Transferrina/metabolismoRESUMO
OBJECTIVES: It is possible that the exportation of North American and European models has hindered the creation of a structured cardiopulmonary resuscitation (CPR) training programme in developing countries. The objective of this paper is to describe the design and present the results of a European paediatric and neonatal CPR training programme adapted to Honduras. MATERIALS AND METHODS: A paediatric CPR training project was set up in Honduras with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The programme was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. RESULTS: During the first phase, 24 Honduran doctors from paediatric intensive care, paediatric emergency and anaesthesiology departments attended the paediatric CPR course and 16 of them the course for preparation as instructors. The Honduran Paediatric and Neonatal CPR Group was formed. In the second phase, workshops were given by Honduran instructors and four of them attended a CPR course in Spain as trainee instructors. In the third phase, a CPR course was given in Honduras by the Honduran instructors, supervised by the Spanish team. In the final phase of independent teaching, eight courses were given, providing 177 students with training in CPR. CONCLUSIONS: The training of independent paediatric CPR groups with the collaboration and scientific assessment of an expert group could be a suitable model on which to base paediatric CPR training in Latin American developing countries.