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Biomedical subjects

Angel Carrillo

Publications and source records attributed to Angel Carrillo.

At least 19 recordsLinked to original sources
PubMed2007

Early transpyloric enteral nutrition in critically ill children.

OBJECTIVE: We compared the tolerance of early (within the first 24 h after admission to the pediatric intensive care unit) and late transpyloric enteral nutrition in critically ill children. METHODS: We performed a prospective observational study including all critically ill children fed using transpyloric enteral nutrition. The clinical characteristics, energy intake, tolerance, and complications of nutritional delivery between the children with early (first 24 h) and late (after 24 h, range 1-43 d) transpyloric enteral nutrition were compared. RESULTS: Transpyloric nutrition was started within the first 24 h in 202 (38.5%) of the 526 children. There were no differences in the diagnoses, incidence of organ disturbances, doses of vasoactive drugs, or mortality between the two groups. There were no differences in the maximum number of calories delivered or in the duration of the nutrition between children with early and late transpyloric nutrition. The incidence of abdominal distention was lower in the children receiving early transpyloric nutrition (3.5%) than in those receiving nutrition at a later date (7.8%; P < 0.05). Moreover, 6.3% of patients presented diarrhea, with no difference being found between the two groups. CONCLUSION: Early transpyloric enteral nutrition is well tolerated in critically ill children and is not associated with an increase in incidence of complications.

Adolescent↗
PubMed2006

Effectiveness and long-term outcome of cardiopulmonary resuscitation in paediatric intensive care units in Spain.

OBJECTIVE: To analyse the immediate effectiveness of resuscitation and long-term outcome of children who suffered a cardiorespiratory arrest when admitted to paediatric intensive care units (PICU). DESIGN AND SETTING: Secondary analysis of data from an 18-month prospective, multicentre study analysing cardiorespiratory arrest in children in 16 paediatric intensive care units in Spain. PATIENTS AND METHODS: We studied 116 children between 7 days and 17 years of age. Data were recorded according to the Utstein style. Analysed outcome variables were sustained return of spontaneous circulation (ROSC), survival to hospital discharge and survival at 1 year. Neurological and general performance outcome was assessed by means of the Paediatric Cerebral Performance Category (PCPC) and the Paediatric Overall Performance Category (POPC) scales. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: In 80 patients (69%) ROSC was achieved and it was sustained > 20 min in 69 (59.5%). At one-year follow-up, 40 children (34.5%) were alive. Survival was not associated with sex, age or weight of patients. Mortality from cardiac arrest was higher than respiratory arrest (69.8% versus 40%, p = 0.01). Patients with sepsis had a higher mortality than other diagnostic groups. Mechanically ventilated children and those treated with vasoactive drugs had a higher mortality. Initial mortality was slightly higher in patients with slow ECG rhythms (35.7%) compared to those with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) (27.2%). Duration of resuscitation effort was correlated with mortality (p < 0.0001). Patients who required one or more doses of adrenaline had also a higher mortality (77.8% versus 20.7%, p < 0.0001) and survivors needed less doses of adrenaline (0.85 +/- 1.14 versus 4.4+/-2.9, p < 0.0001). At hospital discharge 86.8 and 84.6% of patients had scores 1 or 2 (normal or near-normal) in the PCPC and POPC scales. At 1-year follow-up these figures were 90.8 and 86.3%, respectively. CONCLUSION: One-third of children who suffer a cardiac or respiratory arrest when admitted to PICU survive, and most of them had a good long-term neurological and functional outcome. The duration of cardiopulmonary resuscitation attempts is the best indicator of mortality.

Adolescent↗
PubMed2006

Transpyloric enteral nutrition in the critically ill child with renal failure.

OBJECTIVE: To study the efficacy and tolerance of transpyloric enteral nutrition (TEN) in the critically ill child with acute renal failure (ARF). DESIGN: Prospective observational study. SETTING: Paediatric intensive care unit. PATIENTS: Critically ill children with ARF who received TEN were included in the study. They were compared with the remaining 473 critically ill children receiving TEN in this period. Tolerance of nutrition and gastrointestinal complications were assessed. INTERVENTION: Transpyloric enteral nutrition. MEASUREMENTS AND RESULTS: Fifty-three critically ill children with ARF aged between 3 days and 17 years received TEN. Children with ARF more frequently received parenteral nutrition before TEN (56.6%) than the other patients (17.5%). The incidence of shock, hepatic alterations and mortality was significantly higher in patients with ARF than in the remaining children. In children with ARF the mean duration of the TEN was 16.5-27.3 days and the maximum caloric intake was 77-26.7 kcal/kg/day. Thirteen patients (24.5%) presented gastrointestinal complications, 9 (17%) abdominal distension and/or excessive gastric residue, 5 (9.4%) diarrhoea, 1 necrotising enterocolitis and 1 duodenal perforation. The frequency of gastrointestinal complications was significantly higher in children with ARF. TEN was definitive suspended in five patients due to gastrointestinal complications. Four of these patients were treated with continuous renal replacement therapy. Thirty percent of patients died during TEN. In only one patient was the death related to complications of the nutrition. CONCLUSIONS: Critically ill children with ARF tolerate TEN, although the incidence of gastrointestinal complications is higher than in other critically ill children.

Acute Kidney Injury↗
PubMed2006

Transpyloric enteral feeding in the postoperative of cardiac surgery in children.

PURPOSE: The aim of this study is to assess the utility of transpyloric enteral nutrition in the postoperative period of cardiac surgery in children. METHODS: A prospective, observational study was performed on children receiving transpyloric enteral nutrition in the postoperative period of cardiac surgery. The type of nutrition, duration, tolerance, and complications were studied. RESULTS: Children (212) between the ages of 3 days and 17 years received transpyloric enteral nutrition in the postoperative period of cardiac surgery. The duration of the transpyloric feeding was 16 +/- 23.8 days, and the maximum calorie delivery was 85.1 +/- 25.7 kcal/kg/d. Tolerance to nutrition was good and was not affected by the infusion of vasoactive drugs, sedatives, or muscle relaxants. Of the study population, 14.6% presented with gastrointestinal complications, 9.4% with abdominal distension and/or excessive gastric residue, and 7.5% with diarrhea. Nutrition was withdrawn in 2.4% of the patients because of gastrointestinal complications. Mortality was not related to any characteristic of the nutrition or to gastrointestinal complications. CONCLUSIONS: Transpyloric enteral nutrition is useful and is a simple feeding method that enables a high calorie delivery to be provided with few complications in the postoperative period of cardiac surgery in children, including those receiving high doses of sedatives and muscle relaxants.

Adolescent↗
PubMed2006

Duodenal perforation caused by a transpyloric tube in a critically ill infant.

OBJECTIVE: We describe the case of a 2-mo-old infant who weighed 3.5 kg, had alveolar interstitial pneumopathy on mechanical ventilation, and developed a duodenal perforation due to a 6-Fr polyurethane transpyloric tube. METHODS AND RESULTS: Abdominal ultrasound showed the tube to be within the intestinal lumen. Due to this diagnostic error, nutrition was administered through the tube and the patient developed severe peritonitis. Laparotomy showed a perforation due to the transpyloric tube at the level of the union of the second and third portions of the duodenum. The perforation was sutured but the patient developed new intestinal perforations with severe progressive intestinal damage, leading to multiorgan failure and death. CONCLUSIONS: If there is a clinical suspicion of intestinal perforation secondary to insertion of a transpyloric tube, the position of the tube must be confirmed by radiographic and echographic techniques. In case of doubt, the tube should be withdrawn and endoscopic or contrast radiographic evaluation must be performed.

Critical Illness↗
PubMed2006

[Analysis of the Spanish National Registry of Laparoscopic Pancreatic Surgery].

INTRODUCTION: The reported experience with laparoscopic pancreatic surgery remains limited to case reports or small series of patients. A recent European multicenter study has allowed the limits and results of this technique to be known. This article presents an analysis of the results of the Spanish National Registry of Laparoscopic Pancreatic Surgery. MATERIAL AND METHODS: A total of 132 patients with lesions in the left pancreas were included in this series. The final diagnosis included 42 neuroendocrine tumors, 40 cystic neoplasms, 24 cysts and pseudocysts, 8 inflammatory tumors, 8 ductal carcinomas, 7 intraductal papillary mucinous tumors, 1 acinar carcinoma and 2 solid pseudopapillary tumors. RESULTS: The conversion rate was 9.7%. Tumor enucleation was performed only in patients with insulinomas. The most frequent technique was spleen-preserving distal pancreatectomy. There were no postoperative deaths. The overall rate of postoperative pancreatic-related complications was 16%. CONCLUSIONS: Although only a few Spanish hospitals participated in the registry, a greater number of hospitals are expected to enroll patients in the very near future.

Female↗
PubMed2006

Severe ischemia of the lower limb and of the intestine associated with systemic vasoconstrictor therapy and femoral arterial catheterization.

OBJECTIVE: To report a case of peripheral and intestinal ischemia associated with arterial catheterization and terlipressin treatment in a child. DESIGN: Case report. SETTING: Pediatric intensive care unit of a university hospital. PATIENT: The patient was a 2-month-old female infant with shock refractory to treatment with catecholamines, who received treatment with terlipressin (20 microg/kg/4 hrs). In order to monitor her cardiac output, the right femoral artery was catheterized with a 4-Fr PiCCO catheter. At 60 hrs, the patient presented progressive ischemia of the right lower limb and intestinal ischemia. The ischemia did not improve despite withdrawal of the catheter and interruption of the terlipressin administration; it progressed to massive intestinal ischemia, and the patient died. CONCLUSIONS: Arterial catheterization combined with the administration of vasoconstrictor drugs, particularly vasopressin or terlipressin, can lead to local ischemic complications and severe intestinal ischemia in infants in shock.

Cardiac Output↗
PubMed2006

Pediatric defibrillation after cardiac arrest: initial response and outcome.

INTRODUCTION: Shockable rhythms are rare in pediatric cardiac arrest and the results of defibrillation are uncertain. The objective of this study was to analyze the results of cardiopulmonary resuscitation that included defibrillation in children. METHODS: Forty-four out of 241 children (18.2%) who were resuscitated from inhospital or out-of-hospital cardiac arrest had been treated with manual defibrillation. Data were recorded according to the Utstein style. Outcome variables were a sustained return of spontaneous circulation (ROSC) and 1-year survival. Characteristics of patients and of resuscitation were evaluated. RESULTS: Cardiac disease was the major cause of arrest in this group. Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) was the first documented electrocardiogram rhythm in 19 patients (43.2%). A shockable rhythm developed during resuscitation in 25 patients (56.8%). The first shock (dose, 2 J/kg) terminated VF or PVT in eight patients (18.1%). Seventeen children (38.6%) needed more than three shocks to solve VF or PVT. ROSC was achieved in 28 cases (63.6%) and it was sustained in 19 patients (43.2%). Only three patients (6.8%), however, survived at 1-year follow-up. Children with VF or PVT as the first documented rhythm had better ROSC, better initial survival and better final survival than children with subsequent VF or PVT. Children who survived were older than the finally dead patients. No significant differences in response rate were observed when first and second shocks were compared. The survival rate was higher in patients treated with a second shock dose of 2 J/kg than in those who received higher doses. Outcome was not related to the cause or the location of arrest. The survival rate was inversely related to the duration of cardiopulmonary resuscitation. CONCLUSION: Defibrillation is necessary in 18% of children who suffer cardiac arrest. Termination of VF or PVT after the first defibrillation dose is achieved in a low percentage of cases. Despite a sustained ROSC being obtained in more than one-third of cases, the final survival remains low. The outcome is very poor when a shockable rhythm develops during resuscitation efforts. New studies are needed to ascertain whether the new international guidelines will contribute to improve the outcome of pediatric cardiac arrest.

Adolescent↗
PubMed2005

Elevated carboxyhemoglobin associated with sodium nitroprusside treatment.

OBJECTIVE: To report four cases of carboxyhemoglobinemia associated with high doses of sodium nitroprusside after cardiac transplant in children. PATIENTS: Four children in the pediatric care unit of a university hospital aged 6 months-4 years. Carboxyhemoglonemia developed at levels of 5.5-7.7% in patients receiving high doses of sodium nitroprusside (7-16 microg/kg per minute and no other medication that could caused elevated carboxyhemoglobin). One patient died, and three recovered with no sequelae after discontinuation of sodium nitroprusside. CONCLUSIONS: High doses of sodium nitroprusside can induce carboxyhemoglobinemia in children after heart transplant, probably by inducing hemeoxygenase, with no other secondary effects.

Carboxyhemoglobin↗
PubMed2005

Long-term outcome of paediatric cardiorespiratory arrest in Spain.

OBJECTIVE: To analyse the final outcome of cardiorespiratory arrest (CRA) in children and the neurological and functional state of survivors at 1 year. METHODS: An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital CRA in children was carried out; 283 children between 7 days and 17 years of age were included. CRA and resuscitation data were registered according to Utstein style. The outcome variables were: sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). The status of survivors was evaluated by means of the paediatric cerebral performance category (PCPC) scale and the paediatric overall performance category (POPC) scale at Paediatric Intensive Care Unit discharge, at hospital discharge, and at 1 year follow-up. RESULTS: In 283 children, 311 CRA episodes, 73 respiratory arrests (23.5%) and 238 cardiac arrests (76.5%) were analysed. Seventeen children suffered more than one CRA episode (range: 2-6). The initial survival was 60.2% and 1-year survival was 33.2%. The final survival was significantly higher in respiratory arrest than in cardiac arrest patients (70.0% versus 21.1%) (P < 0.0001). After 1 year follow-up, 87.3% of patients had scores 1 or 2 on the PCPC scale and 84.0% had scores 1 or 2 in the POPC scale; these results indicate that 1 year after CRA, the majority of survivors had normal neurological and functional status or showed only mild disability. CONCLUSIONS: Prognosis of CRA in children continues to be poor in terms of survival but quite good in terms of neurological and functional status among survivors. Additional strategies and efforts are needed to improve the short-term prognosis of paediatric CRA. However, the long-term outcome of survivors is reassuring.

Adolescent↗
PubMed2005

[Colorectal laparoscopy in the Canary Islands. A multicenter study of 144 patients].

INTRODUCTION: To analyze the short-term results of laparoscopic colorectal surgery (LCRS) in the Canary Islands. MATERIAL AND METHODS: A questionnaire was sent to hospitals performing laparoscopy and retrospective data on demographic, perioperative and pathological variables in 144 patients who underwent LCRS between May 1993 and May 2003 were obtained. RESULTS: Sixty-five men and 79 women underwent colon (n=126) and rectal (n=18) surgery in the last 16 months of the study period. The most frequently performed procedure was sigmoidectomy in 85 patients (59%). The most frequent diagnosis was colon adenocarcinoma in 73 patients (50%), followed by diverticular disease in 36 patients (25%). The mean values of the variables studied were: body mass index, 27.3 (range, 22-35); operating time, 175 min (range, 60-255); blood loss, 183.6 ml (range, 50-500). Peristalsis reinitiated at 45 h; oral diet was introduced at 67 h and the overall mean length of hospital stay was 7.8 days (range, 3-30). The length of hospital stay was significantly longer in patients with complications (14.5 vs 6.4; p <.01). There were 7 conversions (4.86%). There were no perioperative deaths. The overall morbidity rate was 28%. The most frequent early complication was surgical wound infection in 9 patients (6.2%). Anastomotic leak was detected in 5 patients (3.4%). CONCLUSIONS: LCRS has been shown to be a safe and effective technique that has recently increased in the centers surveyed. The factor with the greatest influence on length of hospital stay was the development of postoperative complications.

Adult↗
PubMed2005

Graves' disease in children and adolescents: response to long-term treatment.

BACKGROUND: Optimal treatment of Graves' disease in paediatric patients is still a matter of controversy. Antithyroid drugs, radioiodine and thyroidectomy are the three therapeutic options available. AIM: To report our experience of long-term medical treatment and outcome of paediatric Graves' disease. METHODS: A 5-y-long medical protocol was implemented in 20 children and adolescents with Graves' disease. All patients received antithyroid drugs as the first therapeutic option; patients who did not enter long-term remission received I(131) and/or surgery as the definitive treatment. RESULTS: The mean age at diagnosis was 12.1+/-4 y. Only two patients were males, both presenting concomitant type 1 diabetes. Mean follow-up was 13.8+/-5.5 y. Forty per cent of patients achieved long-term remission with low antithyroid drugs doses (mean treatment time: 5.4+/-1.4 y). Six patients received I(131) as definitive treatment and another six underwent surgery after completing medical treatment for 6.8+/-4.1 and 5.1+/-2 y, respectively. No patients requiring high antithyroid drugs doses to maintain euthyroidism reached long-term remission and needed I(131) and/or surgery. CONCLUSION: Implementation of a long-term antithyroid drug protocol achieved 40% long-term remissions in paediatric patients with Graves' disease. Need for maintained high doses of antithyroid drugs could be considered a predictive factor for no remission. When permanent remission was not obtained by medical treatment, I(131)and/or surgery allowed healing in all cases.

Adolescent↗
PubMed2005

Conservative treatment of a huge abdominal wall hematoma after laparoscopic appendectomy.

We report a case of a 30-year-old male patient who presented with a huge abdominal wall hematoma 60 minutes after laparoscopic appendectomy. During surgery there had been no sign of abdominal wall bleeding. We found a lateral abdominal wall hematoma caused by rupture of the abdominal epigastric artery after trocar insertion. We conclude that trocar injury is a potentially preventable complication in laparoscopic surgery if certain precautions are taken. Abdominal wall hematoma secondary to injury of an epigastric vessel can be successfully treated with conservative management.

Abdominal Wall↗
PubMed2005

Outcome of out-of-hospital cardiorespiratory arrest in children.

OBJECTIVE: To analyze the characteristics and outcome of out-of-hospital cardiorespiratory arrest in children in Spain. METHODS: Secondary analysis of data from a prospective, multicenter study analyzing cardiorespiratory arrest in children. Ninety-five children between 7 days and 16 years with cardiorespiratory arrest. Data were recorded according to the Utstein style. The outcome variables were the sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). Neurologic and general performance outcome was assessed by the Pediatric Cerebral Performance Category (PCPC) scale and the Pediatric Overall Performance Category (POPC) scale. RESULTS: Initial survival was 47.3% and 1-year survival was 26.4%. Mortality was higher in children younger than 1 year. Survival of patients with respiratory arrest (82.1%) was significantly higher than survival of cardiac arrest victims (14.4%). Patients who were initially resuscitated by laypersons or paramedics had higher survival (53.6%) than those who were initially resuscitated by doctors and/or nurses (15.2%) (P < 0.01). Mortality was higher in the patients who presented slow rhythms (asystole, severe bradycardia) or pulseless electrical activity than in those presenting ventricular fibrillation (P = 0.001). Multivariate logistic regression revealed that the best indicator of mortality was duration of cardiopulmonary resuscitation longer than 20 minutes. After 1 year, most survivors had normal or mild disability. CONCLUSIONS: Mortality of out-of-hospital cardiorespiratory arrest in children is high. When resuscitation is started soon by layperson or paramedics, survival is increased. Duration of resuscitation efforts is the best indicator of mortality. Most of survivors had good long-term neurologic outcome.

Adolescent↗
PubMed2004

The development of laparoscopic surgery in Spain.

AIM: To assess degree of development and level of acceptance of laparoscopic surgery in Spain. METHOD: A questionnaire was sent to all members of the Spanish Association of Surgeons in April 2003. It included 32 questions, 9 of which were general, and 23 referred to specific clinical situations, techniques, and standard practice. RESULTS: Eight hundred and fifty-eight (33.1%) surgeons replied. Only 211 (25%) surgeons reported performing advanced laparoscopic procedures. Four hundred and twenty (49%) surgeons believed that the results obtained with laparoscopic surgery were better than those obtained with conventional surgery, and 325 (40%) surgeons believed that laparoscopy would become a superspecialty. Laparoscopic surgery was considered the method of choice in the treatment of gallbladder stones (99%), gastroesophageal reflux disease (94%), acute cholecystitis (81%), in selected cases of inguinal hernia repair, and in procedures to be performed in spleen and adrenals, benign colon disease, and obesity. Three hundred and ninety-eight (47%) surgeons considered laparoscopic surgery the preferred approach for colon cancer, 292 (34%) for appendicitis, and 155 (18%) for incisional hernia. Five hundred and five (59%) surgeons considered that the use of laparoscopic surgery had grown less than expected. CONCLUSIONS: The vast majority of surgeons advocated laparoscopic surgery for the treatment of gallbladder stones and gastroesophageal reflux disease. Although most hospitals had the appropriate technical facilities for performing advanced laparoscopic procedures, few surgeons actually did so.

Cholecystectomy, Laparoscopic↗
PubMed2004

Characteristics and outcome of cardiorespiratory arrest in children.

OBJECTIVE: To analyse the present day characteristics and outcome of cardio-respiratory arrest in children in Spain. DESIGN: An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital cardio-respiratory arrest in children. PATIENTS AND METHODS: Two hundred and eighty-three children between 7 days and 17 years of age with cardio-respiratory arrest. Data were recorded according to the Utstein style. The outcome variables were the sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). Three hundred and eleven cardio-respiratory arrest episodes, composed of 70 respiratory arrests and 241 cardiac arrests in 283 children were studied. Accidents were the most frequent cause of out-of-hospital arrest (40%), and cardiac disease was the leading cause (31%) of in-hospital arrest. Initial survival was 60.2% and 1 year survival was 33.2%. The final survival was higher in patients with respiratory arrest (70%) than in patients with cardiac arrest (21.1%) (P <0.0001). Although many individual factors correlated with mortality, multivariate logistic regression revealed that the best indicator of mortality was a duration of cardiopulmonary resuscitation of over 20 min (odds ratio: 10.35; 95% CI 4.59-23.32). CONCLUSIONS: In Spain, the present mortality from cardio-respiratory arrest in children remains high. Survival after respiratory arrest is significantly higher than after cardiac arrest. The duration of cardiopulmonary resuscitation attempt is the best indicator of mortality of cardio-respiratory arrest in children.

Adolescent↗
PubMed2003

Newborn manikins.

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Cardiopulmonary Resuscitation↗