The value of procalcitonin as a prognostic indicator in polytraumatized patients in a pediatric critical care unit

Fonament. El politraumatisme (PT) greu té una morbimortalitat elevada. La procalcitonina PCT) podria ser útil com a indicador pronòstic. Objectiu. Definir els nivells de PCT en el pacient poli-traumàtic (PPT) i la seva implicació pronòstica. Mètode. Estudi prospectiu observacional. Criteris d'inclusió: pacients menors de 16 anys, ingressats per PT en una unitat de cures intensives pediàtrica (UCIP), amb determinació de PCT a l'ingrés i al cap de 24-48 hores. Període d'estudi: novembre del 2009 - novembre del 2011. Tractament esta- dístic mitjançant el paquet SPSS® versió 17.0. Resultats. De seixanta-set pacients amb politraumatisme, vint complien criteris. La mitjana d'edat era de 13,6 ± 4,2 anys i 19 (95%) eren homes. La puntuació del Pediatric Risk of Mortality Score Index (PRISM-III) era de 9,8 ± 7,38 i l'Índex de Trauma Pediàtric (ITP) de 5,5 ± 2,08. Els nivells mitjans de PCT a les 24 hores eren de 7,67 ± 18,05 ng/ml. Es van diagnosticar vuit casos d'infecció bacteriana. Cap pacient va ser èxitus. La PCT es va correlacionar amb la puntuació PRISM-III (R 0,6; p = 0,048). Els nivells mitjans de PCT eren significativament superiors en el grup que va necessitar ventilació mecànica respecte als que no en van necessitar(p = 0,046) i en el grup de pacients infectats (p = 0,039). Es va objectivar una tendència a la correlació entre els valors mitjans de PCT a l'ingrés i els dies d'ingrés (R 0,393, p = 0,1). Conclusions. Els valors de la PCT van ser elevats, per la freqüència de la complicació bacteriana en els PPT. La PCT podria ser útil com a factor pronòstic

Challenges in the application of non-servocontrolled therapeutic hypothermia during neonatal transport in Catalonia

Transporte neonatal; Encefalopatía hipoxico-isquémica; HipotermiaTransport neonatal; Encefalopatia hipoxico-isquèmica; HipotèrmiaNeonatal transport; Hypoxic-ischemic encephalopathy; HypothermiaIntroducción La hipotermia terapéutica (HTT) es el único tratamiento que ha demostrado aumentar la posibilidad de supervivencia libre de secuelas en los recién nacidos (RNs) afectos de encefalopatía hipóxico-isquémica (EHI), recomendándose iniciarla lo antes posible. Lo más frecuente es que los pacientes tributarios de HTT no nazcan en los centros de referencia (CR) .requiriendo ser transportados. Métodos Estudio observacional descriptivo prospectivo de RNs con EHI moderada-grave trasladados en hipotermia terapéutica no servo-controlada por los dos equipos de transporte neonatal y pediátrico terrestres de Cataluña (abril 2018-noviembre 2019). Resultados 51 pacientes. Mediana de tiempo de estabilización 68 minutos (p25-75, 45 – 85 min), traslado 30 minutos (p25-75, 15 – 45 min). Media de edad a la llegada al CR 4 horas y 18 minutos (DE 96 min). Medidas terapéuticas adoptadas: apagar la incubadora 43 (84,3%), bolsas de hielo 11 (21,6%) y ambas 11 (21,5%) pacientes. Se consiguió la temperatura rectal (TR) diana en 19 (37,3%) pacientes. No hubo diferencias en el sobre-enfriamiento según las medidas usadas para la aplicación de la HTT no servo-controlada (HTTnc). La duración del traslado no se relacionó con diferencias en la estabilización de la temperatura ni en la consecución de la temperatura objetivo. Conclusiones La monitorización de la TR en el centro emisor es un pilar fundamental en la estabilización del paciente y la aplicación de la HTTnc. Existe una clara área de mejora en la eficacia de la HTTnc durante el transporte. La HTT servo-controlada sería una opción para poder ofrecer las mismas posibilidades terapéuticas a los RNs extramuros de los CR.Introduction Therapeutic hypothermia (TH) improves survival and neurological prognosis in hypoxic-ischemic encephalopathic (HIE) babies, being better the sooner TH is implemented. HIE babies are born more frequently in a non-cooling centre and need to be referred. Methods Prospective-observational study (April 18–November 19). Newborns (≥34 weeks of gestational age (GA) and >1800 g) with moderate/severe HIE on non-servocontrolled therapeutic hypothermia by the two neonatal transport teams in Catalonia. Results 51 newborns. The median stabilisation and transport time were 68 min (p25–75, 45–85 min) and 30 min (p25–75, 15–45 min), respectively. The mean age at arrival at the receiving unit was 4 h and 18 min (SD 96.6). The incubator was set off in 43 (84%), iced-packs 11 (21.5%) and both (11, 21.5%). Target temperature was reached in 19 (37.3%) babies. There was no differences in the overcooling in relation to the measures applied. The transport duration was not related with temperature stabilisation or target temperature reachiness. Conclusions Rectal temperature monitorisation is compulsory for the stabilisation and the application of non-servocontrolled hypothermia during transport. There is still time for improving in the administration of this treatment during transport. Servo-controlled hypothermia would be a better alternative to improve the management of HIE babies

Protocol d'atenció i acompanyament al naixement a Catalunya

Acompanyament al naixement; Voluntats de la dona; Atenció al nadóBirth support; Women's wills; Newborn careAcompañamiento en el nacimiento; Voluntades de la mujer; Atención al recién nacidoL’Organització Mundial de la Salut, l’any 2018 va proposar una sèrie d’actuacions per a l’atenció al moment del part, que tenen per lema ‘Atenció per a una experiència positiva en el naixement’. En aquest document s’actualitza el ‘Protocol del part, puerperi i atenció al nadó’, document elaborat pel Departament de Salut, publicat l’any 2003 i actualitzat l’any 2019 com a ‘Protocol d’atenció i acompanyament al naixement’, seguint les recomanacions de l’OMS, així com totes aquelles basades en l’evidència científica, amb el màxim respecte a les opinions i voluntats de les dones gestants i amb l’objectiu d’ajudar-les a elles i a les seves famílies a tenir una experiència positiva en el part. Les activitats de promoció de la salut i prevenció de la malaltia són l’eix vertebrador d’aquest protocol i de tots els que es coordinen des del Servei de Salut Maternoinfantil de la Sub-direcció de Promoció de la Salut de l’Agència de Salut Pública de Catalunya del Departament de Salut. En aquest sentit, cal ressaltar la seva relació amb el Protocol del seguiment de l’embaràs a Catalunya (3a. edició) que es va presentar el 2018, amb el qual comparteix principis i enfocament. El protocol s’estructura en tres capítols en relació a les etapes (prepart, part i puerperi), recollint en el tercer, l’atenció la nadó. Cada capítol té diversos apartats en les activitats a realitzar, la informació a donar i el registre, entre d’altres. Es recull, després, la bibliografia i una sèrie de annexos amb eines pràctiques

Pro-adrenomedullin usefulness in the management of children with community-acquired pneumonia, a preliminary prospective observational study

BackgroundIn adult population with community acquired pneumonia high levels of pro-adrenomedullin (pro-ADM) have been shown to be predictors of worse prognosis. The role of this biomarker in pediatric patients had not been analyzed to date. The objective of this study is to know the levels of pro-ADM in children with community acquired pneumonia (CAP) and analyze the relation between these levels and the patients¿ prognosis.FindingsProspective observational study including patients attended in the emergency service (January to October 2009) admitted to hospital with CAP and no complications at admission. The values for pro-ADM were analyzed in relation to: need for oxygen therapy, duration of oxygen therapy, fever and antibiotic therapy, complications, admission to the intensive care unit, and length of hospital stay. Fifty patients were included. Ten presented complications (7 pleural effusion). The median level of pro-ADM was 1.0065¿nmol/L (range 0.3715 to 7.2840¿nmol/L). The patients presenting complications had higher levels of pro-ADM (2.3190 vs. 1.1758¿nmol/L, p¿=¿0.013). Specifically, the presence of pleural effusion was associated with higher levels of pro-ADM (2.9440 vs. 1.1373¿nmol/L, p¿<¿0.001).ConclusionsIn our sample of patients admitted to hospital with CAP, pro-ADM levels are related to the development of complications during hospitalization

Pro-adrenomedullin usefulness in the management of children with community-acquired pneumonia, a preliminary prospective observational study

BackgroundIn adult population with community acquired pneumonia high levels of pro-adrenomedullin (pro-ADM) have been shown to be predictors of worse prognosis. The role of this biomarker in pediatric patients had not been analyzed to date. The objective of this study is to know the levels of pro-ADM in children with community acquired pneumonia (CAP) and analyze the relation between these levels and the patients¿ prognosis.FindingsProspective observational study including patients attended in the emergency service (January to October 2009) admitted to hospital with CAP and no complications at admission. The values for pro-ADM were analyzed in relation to: need for oxygen therapy, duration of oxygen therapy, fever and antibiotic therapy, complications, admission to the intensive care unit, and length of hospital stay. Fifty patients were included. Ten presented complications (7 pleural effusion). The median level of pro-ADM was 1.0065¿nmol/L (range 0.3715 to 7.2840¿nmol/L). The patients presenting complications had higher levels of pro-ADM (2.3190 vs. 1.1758¿nmol/L, p¿=¿0.013). Specifically, the presence of pleural effusion was associated with higher levels of pro-ADM (2.9440 vs. 1.1373¿nmol/L, p¿<¿0.001).ConclusionsIn our sample of patients admitted to hospital with CAP, pro-ADM levels are related to the development of complications during hospitalization

Challenges in the application of non-servocontrolled therapeutic hypothermia during neonatal transport in Catalonia

Transporte neonatal; Encefalopatía hipoxico-isquémica; HipotermiaTransport neonatal; Encefalopatia hipoxico-isquèmica; HipotèrmiaNeonatal transport; Hypoxic-ischemic encephalopathy; HypothermiaIntroduction Therapeutic hypothermia (TH) improves survival and neurological prognosis in hypoxic-ischemic encephalopathic (HIE) babies, being better the sooner TH is implemented. HIE babies are born more frequently in a non-cooling centre and need to be referred. Methods Prospective-observational study (April 18 2018 – November 19 2019). Newborns (≥34 weeks of gestational age (GA) and >1800 g) with moderate/severe HIE on non-servocontrolled therapeutic hypothermia by the two neonatal transport teams in Catalonia. Results 51 newborns. The median stabilisation and transport time were 68 min (p25–75, 45–85 min) and 30 min (p25–75, 15–45 min), respectively. The mean age at arrival at the receiving unit was 4 h and 18 min (SD 96.6). The incubator was set off in 43 (84%), iced-packs 11 (21.5%) and both (11, 21.5%). Target temperature was reached in 19 (37.3%) babies. There were no differences in the overcooling in relation to the measures applied. The transport duration was not related with temperature stabilisation or target temperature reachiness. Conclusions Rectal temperature monitorisation is compulsory for the stabilisation and the application of non-servocontrolled hypothermia during transport. There is still time for improving in the administration of this treatment during transport. Servo-controlled hypothermia would be a better alternative to improve the management of HIE babies.Introducción La hipotermia terapéutica (HTT) es el único tratamiento que ha demostrado aumentar la posibilidad de supervivencia libre de secuelas en los recién nacidos (RNs) afectos de encefalopatía hipóxico-isquémica (EHI), recomendándose iniciarla lo antes posible. Lo más frecuente es que los pacientes tributarios de HTT no nazcan en los centros de referencia (CR), requiriendo ser transportados. Métodos Estudio observacional descriptivo prospectivo de RNs con EHI moderada-grave trasladados en hipotermia terapéutica no servo-controlada por los dos equipos de transporte neonatal y pediátrico terrestres de Cataluña (abril 2018-noviembre 2019). Resultados 51 pacientes. Mediana de tiempo de estabilización 68 minutos (p25-75, 45 – 85 min), traslado 30 minutos (p25-75, 15 – 45 min). Media de edad a la llegada al CR 4 horas y 18 minutos (DE 96 min). Medidas terapéuticas adoptadas: apagar la incubadora 43 (84,3%), bolsas de hielo 11 (21,6%) y ambas 11 (21,5%) pacientes. Se consiguió la temperatura rectal (TR) diana en 19 (37,3%) pacientes. No hubo diferencias en el sobre-enfriamiento según las medidas usadas para la aplicación de la HTT no servo-controlada (HTTnc). La duración del traslado no se relacionó con diferencias en la estabilización de la temperatura ni en la consecución de la temperatura objetivo. Conclusiones La monitorización de la TR en el centro emisor es un pilar fundamental en la estabilización del paciente y la aplicación de la HTTnc. Existe una clara área de mejora en la eficacia de la HTTnc durante el transporte. La HTT servo-controlada sería una opción para poder ofrecer las mismas posibilidades terapéuticas a los RNs extramuros de los CR

The ECOTRANS Project: unraveling the trophic pathways and energy transfer from small pelagic fish to top predators in the Mediterranean Sea

Peer Reviewe

The influence of oceanographic scenarios on the population dynamics of demersal resources in the western Mediterranean: Hypothesis for hake and red shrimp off Balearic Islands

The aim of the present paper is to study the relationships between some climatic indices and parental stock, recruitment and accessibility to trawl fishery of hake (Merluccius merluccius) and red shrimp (Aristeus antennatus) off Balearic Islands (western Mediterranean). Available annual catch per unit effort, recruitment and spawning stock biomass have been used as biological data. As environmental data, the meso- scale IDEA index and the large-scale North Atlantic Oscillation (NAO) and Mediterranean Oscillation (MO) indices have been used. To analyze possible links between these indices with the population dynamics of demersal resources, two non-linear approaches have been applied: (i) stock–recruitment relationships from Ricker and Beverton–Holt models, by sequentially incorporating environment factors; (ii) generalized additive modelling, both classical general and threshold non-additive models were considered. The latter simulate an abrupt change in explicative variables across different phases (time periods or climatic index values). The results have shown that two oceanographic scenarios around the Balearic Islands, associated with macro and meso-scale climate regimes, can influence the population dynamics of hake and red shrimp. This is especially true for recruitment, which seems to be enhanced during low NAO and IDEA indices periods. During these periods, colder-than-normal winters generate high amounts of cold Western Mediterranean Intermediate Waters (WIW) in the Gulf of Lions, which flow southwards and reach the Balearic Islands channels in spring, increasing the productivity in the area. This oceanographic scenario could also be favourable to the distribution of hake on the fishing grounds where the trawl fleet targets this species, increasing its accessibility to the fishery. Both spawning stock and abundance of red shrimp seems to be also enhanced by high MO index periods, which could reflect the increased presence of the saline and warm Levantine Intermediate Waters (LIW) in the study area, extending over the fishing grounds of this species. The proposed interactions can be useful to assess and manage these important demersal resourcesPublicado