Anales de pediatría : publicación oficial de la Asociación Española de Pediatría (A.E.P.)
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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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Noninvasive ventilation (NIV), i.e. without tracheal intubation, has been reintroduced for the treatment of respiratory failure to reduce the complications of mechanical ventilation. Nowadays, NIV with positive pressure is the preferred method, applied through a mask held in place by a harness. Several masks can be used (nasal, bucconasal facial) and a variety of means can be used to keep them in place. ⋯ The advantages of NIV derive mainly from avoiding the complications associated with invasive ventilation. NIV also presents some disadvantages, especially the greater workload involved to ensure good patient adaptation to the respirator. The most common sequelae of NIV are skin lesions due to pressure on the nasal bridge.
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Mechanical ventilation can produce multiple complications. The most important acute complications are mechanical problems (respirator failure, problems with the connections and circuit, incorrect parameters or alarms), problems in the airway (disconnection, extubation, mal-positioning of the endotracheal tube, leaks, nose erosions, obstruction of the endotracheal tube due to secretions or kinking, mainstem bronchus intubation, bronchospasm, postextubation croup), pulmonary complications (ventilator-induced lung injury with barotrauma, volutrauma and biotrauma), hemodynamic complications, nosocomial infections (tracheobronchitis, pneumonia, otitis, sinusitis), failure of adjustment of the respirator to the patient, and nutritional complications. The most important chronic problems are subglottal stenosis, chronic pulmonary injury, and psychological alterations.
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To study tolerance to transpyloric enteral nutrition (TEN) and the incidence of secondary complications in critically-ill children. ⋯ TEN is a well tolerated method of nutrition in critically-ill children that produces few complications.
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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.