La mobilisation précoce en réanimation pédiatrique

Les enfants admis en réanimation bénéficient essentiellement de traitements de kinésithérapie respiratoire (KR) et/ou de postures. La mobilisation n’apparaît pas être une priorité chez les enfants instables : 9,5 % d’entre eux sont mobilisés précocement et 26 % sont mobilisés plus tardivement si la séance de KR prévaut sur la mobilisation. Les facteurs prédictifs d’une mobilisation précoce sont l’âge des patients, la défaillance multiviscérale, la présence d’une ventilation mécanique ou d’une sédation, l’administration de vasopresseurs ou de bloquants neuromusculaires et l’ad- mission pendant les mois d’hiver. Les principaux obstacles institutionnels à la mobilisation sont le manque de protocole et l’absence de prescription médicale pour débuter le traite- ment. La présence d’une sonde d’intubation ne devrait pas être un frein à la mobilisation précoce. Des études randomi- sées contrôlées restent nécessaires pour en comprendre la faisabilité, la sécurité et les bénéfices. Si l’intérêt de la mobilisation précoce ne peut s’appuyer sur des études de grande ampleur, les résultats obtenus pour l’oralité et le tor- ticolis postural sont très en faveur d’une prise en charge précoce motrice, kinesthésique et posturale de l’enfant. Des recommandations sur les pratiques pédiatriques à sui- vre lors de mobilisation précoce sont ainsi proposées dans cet article.[Early mobilization in the pediatric intensive care unit] Children admitted to the pediatric intensive care unit (PICU) can experience significant morbidity as a consequence of mechanical ventilation and sedative medications. This morbidity could potentially be decreased with the implementation of activities to promote early mobilization during critical illness. The objective of this systematic review is to summarize the current evidence regarding rehabilitation therapies in the PICU and to highlight the knowledge gaps and avenues for future research on early mobilization in the PICU. Using a combination of controlled vocabulary and key word terms PubMed, CINAHL, and EMBASE databases were searched; no limiters were imposed on search strategies. Two reviewers abstracted data and assessed quality independently. From the 1928 articles identified in the search 168 abstracts were identified for full text review. Fifty-nine articles were chosen for data extraction and five were identified for inclusion in review. A sixth article was identified through expert clinician query. The studies were categorized into three groups based on the outcomes discussed: safety and feasibility, functional outcomes, and length of stay. A synthesis of the studies indicates that early rehabilitation in the PICU is safe and feasible with potential short and long-term benefits. Institutional, provider and patient-related barriers to initiation of early rehabilitation in the PICU are identified. Recommendations for future investigation include early rehabilitation protocols for children hospitalized in the PICU and identification of outcome measures

Encéphalomyélite aigüe disséminée sur primo infection à EBV chez une enfant

no abstract availabl

Acquired long QT interval complicated with Torsades de Pointes as presentation of a pheochromocytoma in a paediatric patient: a case report

Torsades de Pointes is an extremely rare arrhythmia in children associated to LQT syndrome. Pheochromocytomas are also extremely rare tumours in the paediatric age. We present a case of a young patient with an acquired long QT syndrome complicating with Torsades de Pointes as first clinical manifestation of a pheochromocytoma

Quand l’insuffisance cardiaque se cache derrière la bronchiolite.

peer reviewe

Prehospital paediatric emergencies in Belgium: an epidemiologic study

OBJECTIVES: In Belgium, emergency medical services (EMS) are staffed with a medical team if mandatory according to the regulation authority procedures. Children are involved in interventions, but no extensive data are available in the country. We analysed the characteristics of the children involved in EMS to gain better knowledge of the pathologies and the needs of these patients. MATERIALS AND METHODS: A retrospective review of all patients under 16 years of age dealt with by our EMS team during a 2-year period. RESULTS: During the 2010-2011 period, our EMS performed 229 paediatric missions. Most of the patients (76.0%) presented medical conditions. Seizure was the most common diagnosis (34.1%), including febrile convulsions in 55.1% of the cases. Five patients (2.2%) suffered a cardiac arrest. All of them died despite advanced life support. Two more patients died before or just after admission to the emergency room. In the subgroup of patients admitted to our hospital, 26.6% needed drug administration and 43.2% were discharged home after emergency room management. CONCLUSION: Prehospital paediatric emergencies are rarely life-threatening conditions and seldom need advanced medical interventions. However, the outcome of real life-threatening conditions is poor, therefore emphasizing the need for better trained teams

Feasibility Study on Neurally Adjusted Ventilatory Assist in Noninvasive Ventilation After Cardiac Surgery in Infants.

BACKGROUND: Our objective was to evaluate the feasibility, the quality of synchronization, and the influence on respiratory parameters of the noninvasive neurally adjusted ventilatory assist (NIV-NAVA) mode in infants after cardiac bypass surgery. We conducted a prospective, randomized cross-over study in infants undergoing noninvasive ventilation (NIV) after cardiac surgery. METHODS: Subjects were 10 infants < 5 kg. After extubation, subjects underwent 2 consecutive ventilatory modes after randomization into groups. In the CPAP first group, the subjects were ventilated first in nasal CPAP-1 and then in NIV-NAVA-2 for 30 min in each mode. In the NIV-NAVA first group, periods were reversed. All children were ventilated using the same interface. RESULTS: The analysis of curves showed a synchronization rate of 99.3% for all respiratory cycles. The rate of pneumatic inspiratory trigger was 3.4%. Asynchronies were infrequent. Some typical respiratory patterns (continuous effort and discontinuous inspiration) were found at rates of 10.9% and 31.1%, respectively. The respiratory trends showed a lower maximum diaphragmatic electrical activity (EAdi(max)) in NIV-NAVA periods compared with CPAP periods (P < .001 in the beginning of periods). The breathing frequency decreased significantly during the nasal CPAP-2 and NIV-NAVA-1 periods (P < .05). The inspiratory pressure increased significantly during the NIV-NAVA-1 and NIV-NAVA-2 periods (P < .05), but there was no significant difference for each parameter when comparing Δ values between the beginning and the end of each period. The EAdi signal was easy to obtain in all subjects, and no major side effects were associated with the use of NIV-NAVA. CONCLUSIONS: NIV-NAVA allows good synchronization in bi-level NIV in infant cardiac subjects weighing < 5 kg. The analysis of respiratory parameters shows that NIV NAVA decreases the work of breathing more effectively than nasal CPAP. The study shows some typical respiratory patterns in infants. (ClinicalTrials.gov registration NCT01570933.)

Quand l’insuffisance cardiaque se cache derrière la bronchiolite

Une enfant de 2 mois se présente avec un tableau de bronchiolite. Une symptomatologie prolongée, des troubles alimentaires prédominants et surtout l’apparition d’un souffle cardiaque conduisent à la réalisation d’une échocardiographie et à la découverte d’un syndrome ALCAPA (Anomalous Left Coronary Artery from Pulmonary Artery). L’ALCAPA est une pathologie cardiaque rare mais sévère dont le diagnostic et le traitement précoces sont indispensables au bon pronostic. Un épisode de bronchiolite peut favoriser une décompensation cardiaque, et l’insuffisance cardiaque peut aussi mimer la bronchiolite. Ce cas souligne l’importance d’un examen clinique complet et d’examens complémentaires orientés devant tout tableau respiratoire, surtout en cas de sévérité ou d’évolution inhabituelles

Unplanned intensive care unit admission after general anaesthesia in children: a single centre retrospective analysis.

Objectives: To determine the main causes for unplanned admission of children to the paediatric intensive care unit (PICU) following anaesthesia in our centre. To compare the results with previous publications and propose a data sheet for the prospective collection of such information. Methods: Inclusion criteria were any patient under 16 years who had an unplanned post-anaesthetic admission to the PICU from 1999 to 2010 in our university hospital. Age, ASA score, type of procedure, origin and causes of the incident(s) that prompted admission and time of the admission decision were recorded. Results: Out of a total of 44,559 paediatric interventions performed under anaesthesia during the study period, 85 were followed with an unplanned admission to the PICU: 67% of patients were younger than 5 years old. Their ASA status distribution from I to IV was 13, 47, 39 and 1%, respectively. The cause of admission was anaesthetic, surgical or mixed in 50, 37 and 13% of cases, respectively. The main causes of anaesthesia-related admission were respiratory or airway management problems (44%) and cardiac catheterisation complications (29%). In 62%, the admission decision was taken in the operating room. Conclusion: Unplanned admission to the PICU after general anaesthesia is a rare event. In our series, most cases were less than 5 years old and were associated with at least one comorbidity. The main cause of admission was respiratory distress and the main type of procedure associated with admission was cardiac catheterisation