Anales de pediatría : publicación oficial de la Asociación Española de Pediatría (A.E.P.)
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Case Reports
[Psychological intervention for coping with painful medical procedures in pediatric oncology].
Psychological treatments for procedural distress have shown good results in pediatric oncology and several institutions recommend their implementation to reduce the procedural distress, anxiety and pain associated with painful medical procedures. ⋯ The potential benefits of this kind of intervention are discussed, and some recommendations for future research are proposed.
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In the last few years new mechanical ventilation modalities have been developed that aim to improve the characteristics of mechanical ventilation and its adaptation to the patient. Volume-programmed and pressure-controlled ventilation (volume-controlled pressure-adjusted, adaptable pressure ventilation, autoflow ventilation) attempt to combine the advantages of volume and pressure ventilation by controlling volume but with decelerated flow. These types of ventilation can be programmed in controlled, assisted, intermittent mandatory ventilation, or support ventilation mode. ⋯ These new modalities can improve the adaptation of mechanical ventilation to the patient. None of these modalities are superior to the others. The choice of ventilation mode should be individualized according to each patient's characteristics.
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Intermittent mandatory ventilation (IMV) is a mode of ventilation that allows the patient to make spontaneous breaths during the expiratory phase of mandatory ventilator breaths. There are two types of IMV according to whether respirator breaths are synchronized with the patient's respiratory efforts: Non-synchronized IMV and synchronized IMV (SIMV), and according to whether SIMV is volume- or pressure programmed. The main advantage of SIMV is that the respirator delivers the preset ventilator pressure and rate while allowing the patient to breath spontaneously, thus facilitating progressive weaning from mechanical ventilation. It diminishes the risk of barotrauma, produces less hemodynamic com-promise than control ventilation, reduces atrophy of respiratory muscles and the need for sedation and muscle relaxation and can be associated with pressure support ventilation.
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To study the utility and efficacy of transpyloric enteral nutrition (TEN) in critically-ill children by analyzing the factors that determine enteral tolerance. ⋯ TEN is a useful method of nutrition in critically-ill children.