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Biomedical subjects

A Rodríguez Núñez

Publications and source records attributed to A Rodríguez Núñez.

At least 19 recordsLinked to original sources
PubMed2006

[Basic life support in pediatrics].

Basic life support (BLS) is the combination of maneuvers that identifies the child in cardiopulmonary arrest and initiates the substitution of respiratory and circulatory function, without the use of technical adjuncts, until the child can receive more advanced treatment. BLS includes a sequence of steps or maneuvers that should be performed sequentially: ensuring the safety of rescuer and child, assessing unconsciousness, calling for help, positioning the victim, opening the airway, assessing breathing, ventilating, assessing signs of circulation and/or central arterial pulse, performing chest compressions, activating the emergency medical service system, and checking the results of resuscitation. The most important changes in the new guidelines are the compression: ventilation ratio and the algorithm for relieving foreign body airway obstruction. A compression/ ventilation ratio of 30:2 will be recommended for lay rescuers of infants, children and adults. Health professionals will use a compression: ventilation ratio of 15:2 for infants and children. If the health professional is alone, he/she may also use a ratio of 30:2 to avoid fatigue. In the algorithm for relieving foreign body airway obstruction, when the child becomes unconscious, the maneuvers will be similar to the BLS sequence with chest compressions (functioning as a deobstruction procedure) and ventilation, with reassessment of the mouth every 2 min to check for a foreign body, and evaluation of breathing and the presence of vital signs. BLS maneuvers are easy to learn and can be performed by anyone with adequate training. Therefore, BLS should be taught to all citizens.

Algorithms↗
PubMed2006

[Automated external defibrillation in children].

Ventricular fibrillation is an infrequent arrhythmia in cardiac arrest occurring in the out-of-hospital setting in infants and small children. However, outcome is good provided early defibrillation is performed; consequently, this procedure is one of the main links in the chain of survival in children with a shockable rhythm. Automated external defibrillators are small devices that can analyze heart rhythm and deliver a dose of electric energy when considered timely by the operator. Automated external defibrillators are easy to use and can be operated, if necessary, by anyone. Therefore, all pediatricians should be aware of how these devices work and be able to use them safely and effectively, following the current defibrillation protocol.

Child↗
PubMed2006

[Ethical attitudes in Spanish pediatric critical care units].

OBJECTIVES: To assess physicians' awareness and experience of ethical problems that arise when dealing with critically ill children in pediatric intensive care units (PICUs). MATERIAL AND METHODS: Questionnaires containing 20 questions about ethical dilemmas and attitudes related to the care of children admitted to PICUs were mailed to 43 PICUs in Spain. RESULTS: Ninety-five responses corresponding to 24 residents and 71 attending physicians were received from 21 PICUs. The occurrence of ethical dilemmas in the PICU was recognized by 96.8 % of the respondents. The most frequent method of solving these problems was through medical consensus (80 %), while family participation in the decision making process was highly variable. A total of 95.8 % of respondents stated that decisions to limit therapy were made in their PICU, although only one third of these decisions were written in the medical record. The most frequent form of therapeutic limitation was the do not resuscitate order. One third (32.6 %) of participants considered there were ethical differences between withdrawal and withholding of treatment. Attending physicians had greater experience of therapeutic limitation than did residents, but their opinions on the subject were similar. CONCLUSIONS: Ethical dilemmas are common in the PICU. In this setting, decisions about limitation of therapy are frequent, although many physicians admit to not being clear on this issue or on other aspects of clinical ethics. Family members' participation in the decision making process is insufficient in Spanish PICUs.

Attitude of Health Personnel↗
PubMed2006

[Cardiorespiratory arrest in children with trauma].

OBJECTIVE: To analyze the characteristics and outcome of cardiorespiratory arrest secondary to trauma in children. PATIENTS AND METHODS: We performed a secondary analysis of data from a prospective, multicenter study of cardiorespiratory arrest in children. Data were recorded according to the Utstein style. Twenty-eight children (age range: 7 days to 16 years) with cardiorespiratory arrest secondary to trauma were evaluated. The outcome variables were return of spontaneous circulation, sustained (more than 20 minutes) return of spontaneous circulation (initial survival), and survival at hospital discharge (final survival) in relation to the characteristics of the cardiorespiratory arrest and cardiopulmonary resuscitation. Neurological and general performance outcome was assessed by means of the Pediatric Cerebral Performance Category scale and the Pediatric Overall Performance Category scale. RESULTS: Return of spontaneous circulation was obtained in 18 patients (64.2 %), initial survival was achieved in 14 (50 %) and final survival was achieved in three (10.7 %) (two without neurological sequelae and one with vegetative status). Final survival was significantly higher in patients with respiratory arrest (33.3 %) than in those with cardiac arrest (4.5 %), p = 0.04. Final survival was also higher in patients with a duration of cardiopulmonary resuscitation shorter than 20 minutes (27.2 %) than in the remaining patients (0 %), p =0.05. The two survivors without neurologic sequelae had respiratory arrest. CONCLUSIONS: Survival until hospital discharge in children with cardiorespiratory arrest secondary to trauma is lower than that in children with cardiorespiratory arrest. Patients with respiratory arrest when resuscitation is started and those with a duration of cardiopulmonary resuscitation of less than 20 minutes showed better survival than the remaining patients.

Adolescent↗
PubMed2005

[Noninvasive ventilation with heliox in an infant with acute respiratory distress syndrome].

Noninvasive ventilation (NIV) combined with heliox therapy (Hx) constitutes a therapeutic option in the management of adult patients with acute exacerbations of chronic obstructive pulmonary disease. Either NIV or Hx alone can also be effective in pediatric patients, but there are no published reports on their combined use. We describe the case of a 4-month-old infant with acute respiratory insufficiency due to severe acute respiratory distress syndrome secondary to respiratory syncytial virus infection, successfully treated with nasal continuous positive airway pressure and heliox (Hx-nCPAP). A commercially available nCPAP ventilator adapted for heliox use was employed for Hx-nCPAP application. This is the first report of the use of Hx-nCPAP in an infant.

Equipment Design↗
PubMed2005

[Is high-dose epinephrine justified in cardiorespiratory arrest in children?].

OBJECTIVE: To evaluate the impact on survival of intravenous or intraosseous high-dose epinephrine compared with standard doses in children with cardiorespiratory arrest. MATERIAL AND METHODS: We performed a multicenter, prospective study. Cardiopulmonary resuscitation data from 283 children was collected following international guidelines (Utstein style) over 18 months. In a secondary analysis we studied survival in 92 children who were treated with intravenous or intraosseous epinephrine. RESULTS: One or more conventional doses of epinephrine (0.01 mg/kg) were administered in 12 patients and a first conventional dose followed by one or more high doses (0.1 mg/kg) were administered in 80 patients. The age and weight of children in the conventional-dose group were higher than those in the high-dose group (97.1 +/- 70.5 months vs 29.9 +/- 36.9 months, p = 0.03 and 24.7 +/- 20.8 kg vs 11.9 +/- 8.9 kg, p = 0.037, respectively). The number of doses administered in the conventional-dose group was lower than that in the high-dose group (4 +/- 4 vs 5.4 +/- 3.4, p = 0.01). No significant differences were observed between the two groups in type of arrest, site of arrest, initial electrocardiographic rhythm, response to resuscitation attempts with return of spontaneous circulation, total resuscitation time, neurological status at the end of the episode and survival to hospital discharge and at 1-year of follow-up. CONCLUSION: Although the present study has considerable limitations, the results suggest that high doses of epinephrine do not improve survival in cardiorespiratory arrest in children.

Adolescent↗
PubMed2005

[Burnout syndrome among health workers in pediatrics].

BACKGROUND: Burnout syndrome (BS) is a chronic adaptation disorder that provokes serious problems in occupational behavior. OBJECTIVE: In the present study we assessed the prevalence of burnout syndrome in pediatric healthcare workers. DESIGN: Cross-sectional, descriptive study. MATERIAL AND METHODS: In November 2002, the Maslach Burnout Inventory was given to 127 staff members (doctors, nurses and nurse assistants) working in a pediatrics department. The questionnaire includes 22 items that explore three aspects of BS: a) emotional exhaustion; b) depersonalization, and c) personal achievement. RESULTS: The questionnaire was completed by 93 staff members (73.2 % of the whole sample; 83 % women and 17 % men). The mean age was 38.6 +/- 10.2 years and the median number of years worked was 10 (range: 1-37 years). Twenty-nine percent were pediatricians, 50.5 % were nurses and 20.5 % were nurse assistants. A total of 20.8 % had a high level of BS, 19.8 % had a moderate level and 59.4 % showed a low level. When sub-scales were applied, the results showed that 67.7 % of respondents presented a low level of personal achievement, 14.5 % had high scores of emotional exhaustion and 23.9 % obtained high scores in the depersonalization scale. CONCLUSIONS: BS is present in a significant percentage of hospital workers attending pediatric patients. In our sample, the most notable component of BS was the lack of personal achievement. This finding alerted us to the eventual presence of negative attitudes toward self and professional activity, as well as to the loss of interest in pediatric care, low productivity and diminished self-esteem. We believe that specific strategies should be implemented to attenuate the factors influencing the development of BS in pediatric health staff.

Adult↗
PubMed2005

[Percutaneous tracheostomy under endoscopic guidance in adolescents].

Percutaneous tracheostomy (PT) is a well-established procedure in adult patients who require long-term airway control. Because experience with this procedure is scarce in pediatrics, we report the results of PT by means of a progressive dilatational method with endoscopic guidance in three critically-ill adolescents with severe head injury. PT was performed by means of the Ciaglia Blue Rhino method at the bedside, guided by fiberoptic bronchoscopy by the pediatric intensive care unit staff. No hemodynamic or respiratory compromise was observed during the procedure. No complications were attributable to PT. Two patients were decannulated without incidents. The reported cases indicate that PT can be performed safely, at least in adolescents.

Adolescent↗
PubMed2005

[Bacterial tracheitis: an infectious cause of upper airway obstruction to be considered in children].

INTRODUCTION: Bacterial tracheitis is a cause of severe upper respiratory airway obstruction. It has been considered a rare entity whose clinical and epidemiological features are not well known. PATIENTS AND METHODS: The medical records of children diagnosed with bacterial tracheitis and admitted to our pediatric intensive care unit (PICU) from June 1992 to May 2004 (12 years) were analyzed. The following variables were recorded: age, sex, personal history, need for endotracheal intubation, duration of intubation, isolated bacteria, antibiotic treatment, steroid administration, and length of stay in the PICU. RESULTS: Twelve patients (six girls and six boys) were included in this study. Age ranged from 1 month to 13 years (median 24 months). Four children had a history of acute laryngotracheitis, one had Down syndrome and another had interauricular communication. All patients needed orotracheal intubation for 2 to 72 hours (median 48 hours). All patients received empirical antibiotic therapy: cephalosporins in 11 children (91 %) (in association with vancomycin or teicoplanin in four of them) and erythromycin in one (9 %). Corticosteroids were administered in nine patients (75 %). Bacterial pathogens were isolated from tracheal secretion culture in seven children (58 %) and the most common was Staphylococcus aureus (42 %). Three children (25 %) developed lobar pneumonia and one developed congestive cardiac insufficiency as a complication of bacterial tracheitis. In all patients, clinical outcome was satisfactory. CONCLUSIONS: Although the absolute frequency of bacterial tracheitis is low, in our environment this entity represents a considerable cause of severe upper respiratory airway obstruction secondary to an infectious process. Therefore, it should be considered in patients who present with stridor and fever. If the correct treatment is provided, the prognosis is generally good.

Adolescent↗
PubMed2005

[Syncope in adolescents. Diagnostic and therapeutic approach].

Syncopal episodes are frequent in adolescence. Syncope is usually a benign, self-limiting condition but it may be a warning sign of serious disease that must be diagnosed and appropriately treated. The present article provides a review of the basic principles of the differential diagnosis of syncope in the adolescent patient and treatment recommendations.

Adolescent↗
PubMed2004

[Semiautomatic defibrillation in children].

The main survival factor in cardiac arrest secondary to ventricular fibrillation (VF) is the interval between collapse and defibrillation; consequently, this treatment constitutes one of the most important links in the survival chain in adults. Although VF is a rare cause of out-of-hospital cardiac arrest in children, its detection and treatment is essential because in the pediatric cardiac arrest scenario, VF is the dysrhythmia with the best prognosis. Automated external defibrillators (AED) are simple devices that allow cardiac rhythm to be analyzed; they can also determine whether it is shockable or not with high sensitivity and specificity in adults and children. Currently available evidence has prompted the recommendation of AED use in children older than 1 year without signs of circulation, mainly in the pre-hospital setting and ideally with a dose-limiting device.

Adolescent↗
PubMed2004

[Information and quality of care in a pediatric intensive care unit. Parents' opinion].

OBJECTIVE: To identify parents' opinion of the quality of medical information and the quality of care in a pediatric intensive care unit (PICU). MATERIAL Y METHOD: We designed a structured survey to gather data on the characteristics of information given to parents, parents' dealings with the unit's staff and resources for parents. This survey was carried out by means of personal direct interviews with the parents of 61 children admitted to our PICU from November 2003 to March 2003. RESULTS: Most of the parents (90.2 %) reported that the information they received was of good quality, whereas 3 % did not receive any information at all and 8 % only once. A total of 83.6 % were satisfied with the unit's staff, whereas 50.8 % pointed out at least one deficiency in the PICU resources available for families. Eighty-seven percent of the parents wanted more time to be with their child in the PICU. Eighty-four percent of parents reported that they had been particularly worried in one or more occasion during their child's stay in the PICU and 47 % would occasions liked to have received some type of psychological help. CONCLUSIONS: In our PICU the parents of admitted children were satisfied with the quality of information and the unit's medical staff. Nevertheless, we identified some features that could be improved such as the information provided in the first few hours of admission, visiting time schedules, psychological support and the unit's infrastructure.

Adult↗