Postpyloric enteral nutrition in the critically ill child with shock: a prospective observational study

<p>Abstract</p> <p>Background</p> <p>Tolerance to enteral nutrition in the critically ill child with shock has not been studied. The purpose of the study was to analyze the characteristics of enteral nutrition and its tolerance in the critically ill child with shock and to compare this with non-shocked patients.</p> <p>Methods</p> <p>A prospective, observational study was performed including critically ill children with shock who received postpyloric enteral nutrition (PEN). The type of nutrition used, its duration, tolerance, and gastrointestinal complications were assessed. The 65 children with shock who received PEN were compared with 461 non-shocked critically ill children who received PEN.</p> <p>Results</p> <p>Sixty-five critically ill children with shock, aged between 21 days and 22 years, received PEN. 75.4% of patients with shock received PEN exclusively. The mean duration of the PEN was 25.2 days and the maximum calorie intake was 79.4 kcal/kg/day. Twenty patients with shock (30.7%) presented gastrointestinal complications, 10 (15.4%) abdominal distension and/or excessive gastric residue, 13 (20%) diarrhoea, 1 necrotising enterocolitis, and 1 duodenal perforation due to the postpyloric tube. The frequency of gastrointestinal complications was significantly higher than in the other 461 critically ill children (9.1%). PEN was suspended due to gastrointestinal complications in 6 patients with shock (9.2%). There were 18 deaths among the patients with shock and PEN (27.7%). In only one patient was the death related to complications of the nutrition.</p> <p>Conclusion</p> <p>Although most critically ill children with shock can tolerate postpyloric enteral nutrition, the incidence of gastrointestinal complications is higher in this group of patients than in other critically ill children.</p

Simulación avanzada en la docencia práctica de la signatura Pediatría

Depto. de Salud Pública y Materno - InfantilFac. de MedicinaFALSEsubmitte

Tonometría intragástrica en el niño grave: utilidad pronóstica y terapéutica

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina. Departamento de Pediatría. Fecha de lectura, 8 de Marzo de 200

Sedação e analgesia em crianças: uma abordagem prática para as situações mais freqüentes Analgesia and sedation in children: practical approach for the most frequent situations

OBJETIVOS: Revisar as indicações, doses e formas de administração dos sedativos, analgésicos e relaxantes musculares mais utilizados na criança, bem como os métodos de monitorização da sedação. FONTES DOS DADOS: Levantamento bibliográfico utilizando a base de dados MEDLINE e revisão da experiência em nossas unidades de cuidados intensivos pediátricos. SÍNTESE DOS DADOS: A administração contínua de drogas analgésicas e sedativas impede o aparecimento das fases de subsedação e requer menor assistência do que na administração intermitente. O midazolan é a droga mais utilizada para sedação contínua da criança gravemente enferma. Os derivados opiáceos e os antiinflamatórios não-hormonais são os analgésicos mais utilizados na criança gravemente enferma. Os opióides associados aos benzodiazepínicos em infusão contínua são os fármacos de eleição em crianças em ventilação mecânica, especialmente a morfina e o fentanil. O uso de protocolos e a monitorização com a utilização de escores clínicos e métodos objetivos como o BIS permitem ajustar mais corretamente a medicação, evitando a supersedação, a subsedação e a síndrome de abstinência. As intervenções não-farmacológicas, como a musicoterapia, o controle de ruídos, a adequada utilização da luz, a massagem e a comunicação com o paciente, são medidas complementares que auxiliam na adaptação da criança ao ambiente hospitalar adverso. CONCLUSÕES: A sedação deve ser adaptada a cada criança em cada momento. O emprego de protocolos que facilitem uma correta seleção de fármacos, uma administração adequada e uma monitorização cuidadosa melhoram a qualidade da sedoanalgesia e reduzem seus efeitos adversos.<br>OBJECTIVES: To review the most frequent recommendations, doses and routes of administration of sedatives, analgesics, and muscle relaxants in children, as well as the methods for monitoring the level of sedation. SOURCES: Review of the literature using the MEDLINE database and review of the experience in pediatric intensive care units. SUMMARY OF THE FINDINGS: The continuous administration of analgesics and sedatives prevents the development of undersedation and is less demanding in terms of care than intermittent administration. Midazolam is the most commonly used drug for continuous sedation of critically ill children. Opioid derivatives and nonsteroidal anti-inflammatory drugs are the most widely used analgesics in critically ill children. Opioids combined with benzodiazepines, given in continuous infusion, are the drugs of choice in mechanically ventilated children, especially morphine and fentanyl. The use of protocols and monitoring through clinical scores and objective methods (e.g. bispectral index) allow adjusting medication more appropriately, preventing oversedation, undersedation, and the withdrawal syndrome. Non-pharmacological interventions, such as music therapy, noise control, adequate use of light, massage, conversation with the patient, are ancillary measures that help children to adapt to the adverse hospital environment. CONCLUSIONS: Sedation should be tailored to each child for each specific situation. Protocols that facilitate the correct selection of drugs, their appropriate administration and careful monitoring improve the quality of sedation and analgesia and avoid their adverse effects

Continuous evaluation questionnaires with feedback to improve the teaching and learning process of the pediatrics subject

.OBJETIVOS Analizar si la utilización de la evaluación continua con cuestionarios con retroalimentación inmediata mejora los resultados de aprendizaje de la asignatura de Pediatría. Evaluar la satisfacción del estudiante con este método de enseñanza. Proporcionar al docente información objetiva sobre el proceso de aprendizaje del alumno. Integrar los cuestionarios en el proceso de enseñanza-aprendizaje en el aula y en la autoevaluación continua del aprendizaje. Estudiar la eficacia de los cuestionarios para la evaluación del aprovechamiento y motivación en la formación teóricaen estudiantes de Medicina. Comparar los resultados en la evaluación final entre estudiantes que acuden a clase con regularidad con aquellos que lo hacen intermitentemente.,Depto. de Salud Pública y Materno - InfantilFac. de MedicinaFALSEsubmittedPagado por el auto