Anales de pediatría : publicación oficial de la Asociación Española de Pediatría (A.E.P.)
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Dissection of the internal carotid artery is an important cause of ischemic stroke in children and young patients. Trauma and/or an underlying structural defect of the arterial wall have been suggested to be predisposing factors. ⋯ Treatment of this type of injury includes anticoagulation therapy, antiplatelet therapy and surgery. We report a 14-year-old boy with internal carotid artery dissection who presented with ischemic stroke.
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Several parameters can be used to study respiratory mechanics in children on mechanical ventilation. Compliance is a measure of the distensibility of the respiratory system. In mechanical ventilation two measures of compliance can be used. ⋯ The latest respirators can perform these measurements almost automatically. Work of breathing and respiratory effort can also be analyzed by measuring several parameters (pressure-time product, imposed work of breathing, P 0.1, maximum inspiratory pressure). However, these measures have not yet been standardized in children.
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Noninvasive methods of monitoring are crucial in the management of intensive care patients, especially in the pediatric field. Pulse oxymetry measures arterial oxygen saturation in severely ill patients, allows oxygen requirements to be adjusted to the patient, reduces invasive gasometric studies and achieves continuous monitoring of the critically ill child. ⋯ Capnography produces a graphic curve of end-tidal CO2 while capnometry provides a numerical representation of this concentration. This technique is highly useful in the continuous monitoring of various respiratory problems and situations such as weaning or checking the correct placement of endotracheal cannulas.
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Microalbuminuria screening is justified on the grounds of its cost-benefit ratio in patients at risk of kidney damage while the process is still reversible. The aim of the present study was to evaluate the DCA 2000 analyser and the Clinitek 50 system (Bayer), which simultaneously measure urinary albumin and creatinine levels to adopt them as rapid methods for microalbuminuria detection. ⋯ The data obtained with the DCA 2000 system showed close agreement with those obtained with reference laboratory methods. The immediate availability of results is a great advantage in clinical practice. The Clinitek-Microalbumin dipstick system is a semiquantitative method that is easy to use, low in cost, simple and useful for screening, but it is less reliable as a follow-up method.
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In the era of lung-protective ventilation strategies, high frequency oscillatory ventilation (HFOV) has attracted renewed interest and its use has dramatically increased in neonatal and pediatric intensive care units. HFOV is able to reduce ventilator-induced lung injury by limiting the incidence of volutrauma, atelectrauma, barotrauma and biotrauma. During HFOV, adequate oxygenation and ventilation is achieved by using low tidal volumes and small pressure swings at supraphysiologic frequencies. ⋯ However, the elective use of HFOV requires further studies to identify its benefits over conventional modes of mechanical ventilation and to support its routine use as a first line therapy. In the present article, the Respiratory Working Group of the Spanish Society Pediatric Critical Care reviews the main issues in the pediatric application of HFOV. In addition, a general practical protocol and specific management strategies, as well as the monitoring, patient care and other special features of the use of HFOV in the pediatric setting, are discussed.