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Biomedical subjects

R Hernández Rastrollo

Publications and source records attributed to R Hernández Rastrollo.

10 recordsLinked to original sources
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↗
PubMed2002

[Neonatal chylothorax and conservative treatment].

Four cases of chylothorax are reported. Three cases were congenital and the fourth was secondary to surgical repair of esophageal atresia. Of the three cases of congenital chylothorax, two were diagnosed prenatally. In all three patients with congenital chylothorax, the clinical course was favorable and pleural effusion was resolved in 19-80 days. Treatment consisted of pleural taps when respiratory function was compromised, parenteral nutrition, and respiratory support as required. Enteral nutrition was started with a formula containing medium-chain triglycerides while some effusion remained. Weight gain during this period was slow. Follow-up oscillated between 12 months and 6 years with no recurrences. The case of postsurgical chylothorax appeared several days after the intervention. Pleural effusion increased to 705 ml/day and the patient received no enteral nutrition. The patient died from intestinal complications and multiorgan failure 8 days after the onset of chylothorax. The etiology and clinical features of this condition, as well as the short- and long-term outcome with conservative treatment, are reviewed.

Chylothorax↗
PubMed1996

[Prospective study of infective complications in newborns with fine silicone catheters used for parenteral nutrition infusion].

OBJECTIVE: Percutaneous silastic central venous catheters have contributed to improve the care of neonates. They are quite safe; however, sometimes complications occur, with infections being the most frequent. A prospective study was undertaken in our NICU to know the rate of catheter-related sepsis, the influence of the duration of catheterization, the predominant portal of entry and the microorganisms isolated. PATIENTS AND METHODS: Fifty-two catheters were analyzed. Cultures were obtained once a week by aspiration from the catheter hub, the luer-lock connection and parenteral nutrition solution directly from the bag. If sepsis was suspected, blood cultures were obtained from a different vein. The tip was cultured after catheter withdrawal by the semiquantitative technique of Maki. RESULTS: Nineteen catheters (36.5%), 19 luer-lock connections (21.3%) and 7 parenteral nutrition solutions were colonized. We found a significant increase of the rate of colonization after the catheter had been in place 3 weeks or more (p < 0.05). Coagulase negative Staphylococcus was isolated in 75.7% of the samples. The rate of catheter related sepsis was 15.4% (7/8 caused by coagulase negative Staphylococcus). CONCLUSIONS: Catheter related sepsis may be more frequent than expected it colonization of the catheter were analyzed systematically. Screening catheter colonization allows an earlier diagnosis of pathogens if sepsis develops. Finally, we believe that the use of sterile techniques to handle the catheter and connections will further decrease catheter related infections.

Catheterization↗