PubMed Health⌕ Search

Biomedical subjects

A Bustinza

Publications and source records attributed to A Bustinza.

6 recordsLinked to original sources
PubMed2001

Hepatic dysfunction after cardiac surgery in children.

OBJECTIVE: The objective of this study was to analyze the incidence and significance of hepatic dysfunction after cardiac surgery in children. DESIGN: Prospective, observational study. SETTING: Pediatric intensive care unit of a university hospital. PATIENTS: The study consisted of 232 children ranging in age from newborn to 17 years with no history of liver disease. MEASUREMENTS AND MAIN RESULTS: Aspartate aminotransferase (AST), alanine aminotransferase (ALT), gammaglutamyltranspeptidase (GGT), alkaline phosphatase, total and conjugated bilirubin, blood glucose, urea, creatinine, and coagulation studies were determined at admission, at 24 and 48 hrs, and at 7 days. Hepatic dysfunction was taken as an ALT of > 100 IU/L or a moderate or high hepatic score. The statistical study included bivariate analysis and multivariate logistic regression to study the risk factors for hepatic dysfunction. Twenty-one patients (9%) showed an ALT > 100 IU/L, and 29.3% had a moderate or high hepatic score. A relationship was found between hepatic dysfunction and the type of cardiopathy (D-transposition of the great arteries and coarctation of the aorta), shock, the administration of dopamine or epinephrine, renal insufficiency, the presence of pulmonary changes (pulmonary edema, atelectasis, pulmonary hypertension, hypoxemia), hematologic disturbances (prothrombin time, kaolin-cephalin time, fibrinogen, and platelets), and the need for a greater number of transfusions of packed cells, plasma, and platelets. Compared with 7.6% of the rest of the patients (p <.001), 38% of patients with an ALT > 100 IU/L died. The hepatic score of those patients who died was 4.2 (2.3)-higher than that of the survivors at 1.5 (1.8), (p <.001). Shock and renal insufficiency were the factors most significantly related to the development of hepatic dysfunction. CONCLUSIONS: Hepatic dysfunction is an uncommon complication in children after cardiac surgery. This complication is related mainly to hemodynamic disturbances and renal insufficiency and is an indicator of poor prognosis.

Journal Article↗
PubMed1999

Surfactant treatment for acute respiratory distress syndrome.

OBJECTIVE: To determine prospectively the efficacy of surfactant in acute respiratory distress syndrome. STUDY DESIGN: Twenty patients, 1 month to 16 years of age, diagnosed with an acute pulmonary disease with severe hypoxaemia (PaO2/FiO2 < 100) (13 with systemic or pulmonary disease and seven with cardiac disease) were treated with one to six doses of 50-200 mg/kg of porcine surfactant administered directly into the trachea. The surfactant was considered to be effective when the PaO2/FiO2 improved by > 20%. RESULTS: After initial surfactant administration the PaO2/FiO2 increased significantly in patients with systemic or pulmonary disease from 68 to 111, and the oxygenation index (OI) diminished significantly from 36.9 to 27.1. The PaO2/FiO2 and OI did not improve in children with cardiac disease. The improvement of the patients who survived was greater than that of those who died. CONCLUSIONS: Surfactant moderately improves oxygenation in some children with severe acute respiratory distress syndrome secondary to pulmonary or systemic disease.

Adolescent↗
PubMed1998

Transpyloric enteral feeding in critically ill children.

BACKGROUND: Nutrition is important in childhood because the child has a lower energy reserve than the adult and a higher demand for calories because of ongoing growth. In this study, the utility of transpyloric enteral feeding (TEF) in critically ill children was evaluated. METHODS: A prospective, descriptive study was made in a pediatric intensive care unit of a tertiary pediatric center of 41 critically ill children, 30 after surgical procedures and 11 with nonsurgical illness, aged 8 days to 12 years, who received transpyloric enteral feeding with 8- or 10-Fr weighted feeding tubes. Analysis was made of tolerance and complications (vomiting, abdominal distension, excessive gastric residual, diarrhea, and pulmonary aspiration) of TEF. RESULTS: The mean duration of TEF was 19.5 +/- 26.8 days (range, 1-120 days). The administration of sedative agents or inotropic drugs did not alter toleration of TEF. Eight of 12 patients treated with continuous infusion of vecuronium tolerated TEF without complications. Eleven gastrointestinal complications occurred in 10 patients, abdominal distension and excessive gastric residual in 7 (17%), and diarrhea in 4 (9.7%). In 7 patients gastrointestinal complications improved, with decreasing use or transitory interruption of TEF, but in 4 patients (9.7%), TEF had to be withdrawn. Gastrointestinal complications were more frequent in postsurgical than in nonsurgical patients (p < 0.001). No patients suffered from pulmonary aspiration, and the incidence of pulmonary infection and hepatic dysfunction diminished during TEF. CONCLUSIONS: Transpyloric enteral feeding is a good method of nutritional support in critically ill children and can be used in patients treated with neuromuscular blocking agents. The frequency and severity of complications and the risks of pulmonary infection and hepatic dysfunction related to TEF are low.

Child↗
PubMed1996

Pediatric basic and advanced life support courses: first experience in Spain.

OBJECTIVE: to evaluate the efficiency of the first experience in pediatric basic and advanced life support courses in Spain. MATERIAL AND METHODS: we have given two pediatric basic life support (PBLS) courses of 8 h each to 52 school teachers and ambulance drivers, and 10 30-h pediatric advanced life support (PALS) courses to 276 health professionals, 62 nurses and 214 physicians (80 pediatricians, 57 pediatric, anesthesiology and intensive care medicine residents, 10 general physicians and 52 emergency physicians). We developed the courses according to the guidelines for pediatric life support from the European Resuscitation Council. We performed an initial and final theoretical written test, continuous practical evaluation and a written survey about the quality of the course. RESULTS: on PBLS courses, only 12% of practitioners answered at least 80% of the questions in the initial theory test correctly, compared with 77% in the final test (P < 0.001). All the students acquired skills in basic pediatric resuscitation. In the PALS courses, only 30% of practitioners answered at least 75% of the questions in the initial test correctly (35% of physicians and 12% of nurses, P < 0.01); this percentage increased to 95.6% in the final test (96% of physicians and 93.5% of nurses, P < 0.05). Of students, 95% acquired skills in advanced pediatric resuscitation. All students and teachers considered the theoretical and practical formation received adequate. CONCLUSIONS: basic and advanced pediatric life support courses are a useful educational method for the general population, health professionals, physicians and nurses in theoretical and practical pediatric resuscitation.

Cardiopulmonary Resuscitation↗
PubMed1995

Facial nerve paralysis following pediatric cardiac surgery.

A newborn female diagnosed with transposition of the great vessels with restrictive ventricular septal defect presented left facial peripheral nerve paralysis following anatomical surgery correction (arterial switch) by cardiopulmonary bypass. We have not found any causal factor either in the anesthesia or postoperative period. The electromyogram presented signs of peripheral nerve impairment, and the cerebral echography and electroencephalogram were normal. The facial nerve paralysis was almost recovered seven weeks after surgery. This is the first pediatric patient reported with peripheral facial nerve paralysis after cardiac surgery.

Facial Paralysis↗