Anales de pediatría : publicación oficial de la Asociación Española de Pediatría (A.E.P.)
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Weaning from mechanical ventilation can be defined as the process that allows the transition from mechanical ventilation to spontaneous breathing. This process can account for a significant proportion of total ventilation time and failure to resume spontaneous breathing affects patient outcome. Thus, to ensure maximum success, patient readiness for weaning and extubation should be evaluated through the following steps: the patient must fulfill pre-established clinical and ventilatory support criteria for extubation, the patient should be observed during a breathing trial on minimal or no ventilatory support, and variables used to predict weaning success should indicate a favorable outcome. ⋯ Neither of these methods has proved superior to the other. The best prognostic indicator of weaning outcome is clinical assessment of respiratory effort. Once mechanical ventilation is discontinued, it may be necessary to treat post-extubation complications or even to resume ventilatory support.
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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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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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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.