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Biomedical subjects

L Sancho Pérez

Publications and source records attributed to L Sancho Pérez.

9 recordsLinked to original sources
PubMed2006

[Use of the Bispectral Index in monitoring critically-ill children].

The Bispectral Index (BIS) is a single numeric value that indicates the depth of hypnosis by estimating the level of electrical activity in the brain through analysis of the frequency bands in the electroencephalogram. The BIS was primarily developed to monitor the level of hypnosis during surgery and has recently begun to be used in critically-ill patients. Currently, there is little experience of the BIS in critically-ill children. We present 6 cases that illustrate the utility of BIS monitoring in the PICU. We assessed sedation and analgesia during mechanical ventilation with and without neuromuscular block in two patients, and the effect of anesthetic agents during a surgical procedure in the PICU. The BIS was also useful in the continuous monitoring of the level of consciousness in a patient with encephalitis and in the early detection of brain death. Pacer-induced artefacts in the BIS value are also described. We conclude that BIS monitoring may be a useful, noninvasive method for assessing the level of hypnosis in critically-ill children.

Brain Death↗
PubMed2003

[Transpyloric enteral nutrition in critically-ill children (I): technic and indications].

OBJECTIVE: To study the utility and efficacy of transpyloric enteral nutrition (TEN) in critically-ill children by analyzing the factors that determine enteral tolerance. PATIENTS AND METHODS: We performed a prospective, observational study between 1994 and 2002 of all critically-ill children admitted to our pediatric intensive care unit who received TEN. The indications for enteral nutrition, type of nutrition and its duration were studied. RESULTS: A total of 286 patients (8.4 % of patients admitted to the PICU in the study period), aged between 3 days and 17 years received TEN. Fifty-five children (19.2 %) were aged less than 1 month and 165 (27.7 %) were aged less than 6 months. Seventy percent received TEN exclusively. The most frequent indication for TEN was mechanical ventilation in 255 children (89.2 %). One hundred seventy-six patients (61.5 %) received TEN in the postoperative period after cardiac surgery. The mean duration of TEN was 15.4 25 days, the maximum volume of nutrition was 118.7 41 ml/kg/day, and the maximum caloric intake was 88.6 26.7 kcal/kg/day. During TEN, 227 patients received sedation (79.3 %), and 124 were administered muscle relaxants (43.3 %), with no increase in complications. CONCLUSIONS: TEN is a useful method of nutrition in critically-ill children.

Adolescent↗
PubMed2003

[Transpyloric enteral nutrition in critically-ill children (II): complications].

OBJECTIVE: To study tolerance to transpyloric enteral nutrition (TEN) and the incidence of secondary complications in critically-ill children. PATIENTS AND METHODS: We performed a prospective, observational study between 1994 and 2002 of all critically-ill children admitted to our pediatric intensive care unit who received TEN. Tolerance and complications were analyzed. RESULTS: Of 286 patients aged between 3 days and 17 years who received TEN, gastrointestinal complications occurred in 13.6 %, abdominal distention and/or excessive gastric residue in 8 % and diarrhea in 6.3 %. Diarrhea was associated with shock (p 0.01), abdominal distension and/ or excessive gastric residue (p 0.008), hypophosphatemia (p 0.001), and duration of TEN (p < 0.001). TEN was discontinued in 2.1 % of the patients because of gastrointestinal complications. Thirty-two patients (11.2 %) died during TEN. No relationship was found between the characteristics of nutrition and complications and mortality. CONCLUSIONS: TEN is a well tolerated method of nutrition in critically-ill children that produces few complications.

Adolescent↗
PubMed2000

[Evaluation of basic and advanced pediatric resuscitation courses].

AIM: To evaluate the efficacy of the teaching of basic and advanced pediatric life support courses. MATERIALS AND METHODS: From February 1994 to October 1996, 23 courses on the theory and practice of pediatric life support were organized: 6 were basic courses given to 265 trainees and 17 were advanced courses given to 409 trainees. Trainees were given a multiple-choice theory evaluation before and at the end of the course. Practical evaluation of basic and advanced life support skills was also performed. Teachers and students filled in a questionnaire to evaluate their satisfaction with the course. RESULTS: In basic life support courses mean score of the initial theory evaluation was 6.6 (1.7) and the final score was 9.3 (0.9) (p < 0.001). In advanced life support courses mean score of the initial evaluation was 25.7 (5.5) out of a maximum of 40, and the final score was 36.2 (2.5) (p < 0.001). In the practical evaluation of both basic and advanced courses the mean scores for all cardiopulmonary resuscitation maneuvers were higher than the minimum required value (3 out of a maximum of 5). The evaluation of the course by teachers and pupils yielded high scores for theoretical and practical content, as well as for the methodology used. The evaluation was useful for rectifying the deficiencies encountered. CONCLUSIONS: Basic and advanced pediatric life support courses are a useful method for providing training in the theory and practice of cardiopulmonary resuscitation to health personnel and the general population. Trainees and teachers were satisfied with the teaching and methodology. Evaluations of theory and practice and the questionnaire were useful in the quality control of the courses.

Advanced Cardiac Life Support↗
PubMed1999

[The teaching of basic pediatric cardiopulmonary resuscitation in the degree course in medicine and surgery].

OBJECTIVE: The aim of this study was to analyze the effectiveness of pediatric cardiopulmonary resuscitation training of medical students in pediatric basic life support (PBLS) courses. PATIENTS AND METHODS: Between 1995 and 1998, four theoretical and practical PBLS courses were given to 304 fifth and sixth-year medical students. The theoretical classes provided conceptual information about cardiorespiratory arrest and prevention, basic cardiopulmonary resuscitation maneuvers and practice sessions in basic cardiopulmonary resuscitation of infants and older children to groups of 6 to 8 students. At the beginning of the course, students took a theoretical test that consisted of 10 or 20 multiple-choice questions. At the end of the course, the theoretical test was repeated and a practical test of basic cardiopulmonary resuscitation skills for infants and children was given. Students evaluated the course by completion of an anonymous written questionnaire. RESULTS: The mean initial score (out of a maximum of 10) was 6.4 and the mean score on the final theoretical test was 9.6 (p < 0.001). The practical evaluation showed that 95% of the students mastered the skills of the basic pediatric cardiopulmonary resuscitation maneuvers. The student evaluation of the course yielded scores (on a scale of 5 points) of 4.4 for the theoretical classes, 4.4 for presentation, 4.7 for practical classes and 4.8 for professors' teaching skills. CONCLUSIONS: The pediatric basic life support courses were a useful method for providing theoretical-practical training to students of medicine and should be an essential part of the pediatric curricula in medical studies.

Cardiopulmonary Resuscitation↗
PubMed1999

[Metabolic changes in critically ill children].

OBJECTIVE: Our aim was to analyze the incidence of metabolic disturbances in critically ill children and to evaluate their correlation with severity of illness, complications, mortality and length of hospital stay. PATIENTS AND METHODS: We retrospectively studied 360 children who were admitted into a Pediatric Intensive Care Unit (PICU) between January 1995 and May 1996. We analyzed age, sex, initial diagnosis, complications, length of hospital stay and initial and final concentrations of serum glucose, calcium, phosphorus, magnesium and alkaline phosphatase. RESULTS: The incidence of different metabolic disturbances at admission to the PICU was: hyperglycemia 51.9%, hypoglycemia 1.9%, hypocalcemia 24.5%, hypercalcemia 5.8%, hyperphosphatemia 7.3%, hypophosphatemia 7.9%, hypomagnesemia 47.4% and hypermagnesemia 3%. Patients with shock had lower concentrations of calcium and higher phosphorus levels, while children with sepsis had lower magnesium concentrations. Patients who died had a higher incidence of hyperphosphatemia and higher values of serum glucose and magnesium at admission, while patients who survived had lower concentrations of calcium and higher incidence of hypomagnesemia. We did not find any correlation between the initial values for metabolites and length of stay in the PICU. CONCLUSIONS: Metabolic disturbances in critically ill children are frequent findings, correlate with important complications and can be prognostic markers. Thus, regular controls of different metabolites must be performed so we can precociously detect these disturbances and correct them.

Adolescent↗
PubMed1997

[Nitric oxide treatment in children: clinical course, toxicity and factors influencing its effects].

OBJECTIVE: The purpose of this study was to analyze the clinical evolution, acute toxicity and factors which influence the response to nitric oxide treatment in children. PATIENTS AND METHODS: We studied prospectively 25 children, 14 boys and 11 girls, between 15 days and 16 years of age. Seventeen patients were diagnosed with ARDS and 8 with PHT. All patients presented hypoxemia and/or PHT refractory to conventional therapy and were treated with inhaled NO (1.5 to 45 ppm) between 45 minutes to 47 days. We studied the secondary effects, morbidity and mortality, and analyzed the relationship between NO effects and age, sex, diagnosis, infection, previous PaO2/FiO2 ratio, previous oxygenation index and previous mean pulmonary arterial pressure (mPAP)/mean systemic arterial pressure (mSAP). RESULTS: The effect of NO was maintained during the time of administration without tachyphylaxis. There were no secondary effects of NO administration. NO2 was always < 2 ppm and metahemoglobinemia was below 3.5%. There was no relationship between the effect of NO and the rest of the factors analyzed. Twelve patients (48%) survived, 9 of the children with ARDS (53%) and 3 of the children with PHT (38%). Eleven of the 21 patients who improved with NO treatment survived (52%), as did 1 of the 4 patients who did not improve (25%). CONCLUSIONS: Prolonged administration of inhaled NO at low concentrations maintains the improvement of oxygenation and pulmonary hypertension without acute secondary effects. We have not found factors that could predict the clinical response to NO.

Acute Disease↗