Publications by authors named "Jesús López-Herce Cid"

19 Publications

  • Page 1 of 1

Description and assessment of medical student rotation in Primary Care Paediatrics.

An Pediatr (Engl Ed) 2021 Jun 11;94(6):413-415. Epub 2021 May 11.

Unidad de Pediatría, Departamento de Salud Pública y Materno-infantil, Universidad Complutense de Madrid, Madrid, Spain; Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

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http://dx.doi.org/10.1016/j.anpede.2020.05.009DOI Listing
June 2021

Microcirculatory Changes in Pediatric Patients During Congenital Heart Defect Corrective Surgery.

J Cardiovasc Transl Res 2021 May 4. Epub 2021 May 4.

Paediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Calle Dr. Castelo 47, 28007, Madrid, Spain.

A prospective, observational single-center study was carried out. Pediatric patients undergoing congenital heart defect surgery were evaluated before, during, and after surgery. At each time point, sublingual microcirculation and clinical parameters were assessed, along with analytical variables. Twenty-four patients were included. All microcirculatory parameters worsened during cardiopulmonary bypass and returned to baseline values after surgery (p ≤ 0.001). In the intraoperative evaluation, body temperature correlated with perfused small vessel density (p = 0.014), proportion of perfused small vessels (p < 0.001), small vessel microvascular flow index (p = 0.003), and small vessel heterogeneity index (p < 0.002). Patients with cyanotic disease exhibited higher small vessel density (p < 0.008) and higher density of perfused small vessels (p < 0.022) at baseline, and a lower microvascular flow index (p = 0.022) and higher heterogeneity (p = 0.026) in the intraoperative phase. Children with congenital heart disease exhibited decreased vascular density and microvascular blood flow and increased heterogeneity during cardiopulmonary bypass. All these parameters returned to baseline values after surgery.
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http://dx.doi.org/10.1007/s12265-021-10132-wDOI Listing
May 2021

A comparative two-cohort study of pediatric patients with long term stay in ICUs.

Sci Rep 2021 Feb 25;11(1):4631. Epub 2021 Feb 25.

Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, 2ª Planta Bloque D, Calle Doctor Castelo 47, 28007, Madrid, Spain.

During the last decades, the number of patients with long stay admissions (LSA) in PICU has increased. The purpose of this study was to identify factors associated with PICU LSA, assessing healthcare resources use and changes in the profile of these patients. A retrospective, observational, single-center study was carried out. Characteristics of LSA were compared between two periods (2006-2010 and 2011-2015). During the earlier period there were 2,118 admissions (3.9% of them LSA), whereas during the second period, there were 1,763 (5.4% of them LSA) (p = 0.025). LSA accounted for 33.7% PICU stay days during the first period and 46.7% during the second (p < 0.001). Higher use of non-invasive ventilation (80.2% vs. 37.8%, p = 0.001) and high-flow oxygen therapy (68.8% vs. 37.8%, p = 0.005) was observed in the 2011-2015 cohort, whereas the use of arterial catheter (77.1% vs. 92.6%, p = 0.005), continuous infusion of adrenaline (55.2% vs. 75.9%, p = 0.004), and hemoderivative transfusion (74% vs. 89.2%, p = 0.010) was less frequent. In the 2006-2010 cohort, hospital-acquired infections were more common (95.2% vs. 68.8%, p < 0.001) and mortality was higher (26.8% vs. 13.8%, p = 0.026). The number of long-stay PICU admissions have increased entailing an intensive use of healthcare resources. These patients have a high risk for complications and mortality.
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http://dx.doi.org/10.1038/s41598-021-84248-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907334PMC
February 2021

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain.

Crit Care 2020 11 26;24(1):666. Epub 2020 Nov 26.

Paediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Calle Doctor Castelo 47, 28007, Madrid, Spain.

Background: Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia.

Methods: A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared.

Results: Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group.

Conclusions: MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.
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http://dx.doi.org/10.1186/s13054-020-03332-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689392PMC
November 2020

[Description and assessment of medical student rotation in Primary Care Paediatrics].

An Pediatr (Barc) 2021 Jun 9;94(6):413-415. Epub 2020 Jul 9.

Unidad de Pediatría, Departamento de Salud Pública y Materno-infantil, Universidad Complutense de Madrid, Madrid, España; Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España.

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http://dx.doi.org/10.1016/j.anpedi.2020.05.020DOI Listing
June 2021

[Nutrition in children with continuous renal replacement therapy].

An Pediatr (Engl Ed) 2020 Apr 13;92(4):208-214. Epub 2019 Nov 13.

Servicio de Cuidados Intensivos Pediátricos, Departamento de Salud Pública y Maternoinfantil, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Red de Salud Maternoinfantil y del Desarrollo, Madrid, España.

Introduction: The aim of this study was to analyse the nutritional state, diet and gastrointestinal complications of children that require continuous renal replacement therapy (CRRT).

Material And Methods: A retrospective analysis of a database, which included the information about patients who required CRRT between the years 2013 and 2017. Data were collected on the replacement technique, type of nutrition, calorie and protein intake, gastrointestinal complications, and clinical course.

Results: A total of 65 children (61.5% male) were treated with CRRT, and 24 patients (37%) also needed ECMO support. Just over one-quarter (27.7%) of patients had a weight less than P3, and 48.4% of them a height less than P3. At the beginning of the technique, 31 children (47.7%) received enteral nutrition, at the end, there were 52 patients receiving enteral nutrition (80%). The transpyloric tube was used to provide nutrition in 76% of the cases. The median caloric intake was 63kcal/kg/day, and the protein intake was 1.6g/kg/day. There were gastrointestinal difficulties during the process in 48 patients (73.8%), with 29 (44.6%) patients being diagnosed with gastric distension or excessive gastric remains, 22 (33.8%) with constipation, 8 (12.3%) with vomiting, and 4 (6.1%) diarrhoea. One patient treated with ECMO presented with intestinal ischaemia. Enteral nutrition was cancelled in 3 patients (4.6%) due to the complications. There was no relationship between complications and type of diet or ECMO assistance.

Conclusions: A high percentage of children treated with CRRT showed undernutrition but they had adequate tolerance to the enteral nutrition. Although the gastrointestinal complications percentage was high in few subjects, these complications are the reason why enteral nutrition was stopped.
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http://dx.doi.org/10.1016/j.anpedi.2019.08.006DOI Listing
April 2020

[Importance and difficulties of voluntary service and cooperation in medical degree students].

An Pediatr (Engl Ed) 2020 Apr 18;92(4):249-250. Epub 2019 Oct 18.

Unidad de Pediatría, Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense, Madrid, España; Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España.

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http://dx.doi.org/10.1016/j.anpedi.2019.09.003DOI Listing
April 2020

[Controlled asystole donation in the paediatric patient].

An Pediatr (Engl Ed) 2020 May 21;92(5):299-300. Epub 2019 Jul 21.

Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España.

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http://dx.doi.org/10.1016/j.anpedi.2019.06.006DOI Listing
May 2020

The Latin American and Spanish Survey on Nutrition in Pediatric Intensive Care (ELAN-CIP2).

Pediatr Crit Care Med 2019 01;20(1):e23-e29

Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.

Objective: To characterize the practices of nutritional support in Latin American and Spanish PICUs.

Design: Survey with a questionnaire sent to Latin American Society of Pediatric Intensive Care members.

Setting: PICUs of participant hospitals.

Patients: Critically ill children between 1 month and 18 years old.

Interventions: None.

Measurements And Main Results: Forty-seven surveys from 17 countries were analyzed. Sixty-seven percent of PICUs were from university-affiliated hospitals, with a median of 380 admissions/yr. Sixty-eight percent and 48.9% had a nutritional support team and nutritional support protocol, respectively. Seventy-five percent completed nutritional evaluations, with 34.2% at admission. PICUs with high-volume admissions were likely to have a nutritional support team (p < 0.005), and university-affiliated hospitals showed a trend of having a nutritional support team (p = 0.056). Measured, estimated, and ideal weights were used in 75%, 14.6%, and 10.4%, respectively. Energy requirements were calculated using Holliday & Segar and Schofield equations in 90% of the PICUs; 43% used correction factors. Only three PICUs had indirect calorimetry. At day 3 of initiation of nutritional support, 57.3% of PICUs provided at least 50% of the calculated energy requirement, and 91.5% at day 5. Protein needs were estimated according to American Society for Parenteral and Enteral Nutrition and European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition guidelines in 55.3% and 40.4%, respectively. Enteral nutrition was the preferred feeding method, initiated in 97.7% at 48 hours. The feeding route was gastric (82.9%), by bolus (42.5%) or continuous (57.4%). Monitoring methods included gastric residual measurement in 55.3%. Enteral nutrition was discontinued in 82.8% when gastric residual was 50% of the volume. Prokinetics were used in 68%. More than half of PICUs used parenteral nutrition, with 95.8% of them within 72 hours. Parenteral nutrition was administered by central vein in 93.6%. Undernourished children received parenteral nutrition sooner, whether or not enteral nutrition intolerance was present. When enteral nutrition was not tolerated beyond 72 hours, parenteral nutrition was started in 57.4%. Parenteral nutrition was initiated when enteral nutrition delivered less than 50% in 97%.

Conclusions: Nutritional practices are heterogeneous in Latin American PICUs, but the majority use nutritional support strategies consistent with international guidelines.
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http://dx.doi.org/10.1097/PCC.0000000000001761DOI Listing
January 2019

Infectious complications in paediatric patients treated with extracorporeal membrane oxygenation.

Enferm Infecc Microbiol Clin (Engl Ed) 2018 Nov 6;36(9):563-567. Epub 2017 Dec 6.

Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Madrid, España; Red de Salud Maternoinfantil y del Desarrollo (Red SAMID) RD16/0022/0007; Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España. Electronic address:

Introduction: The aim of this study was to analyse the incidence, treatment and evolution of infections in children treated with ECMO.

Methods: A retrospective study based on a prospective database was performed. Children under the age of 18 years treated with ECMO from September 2006 to November 2015 were included. The patients' clinical characteristics were collected, together with ECMO technique, cultures and treatment of infection.

Results: One hundred patients with a median age of 11 months were analysed. Heart disease was diagnosed in 94 patients. An infection was suspected and antibiotic treatment was initiated in 51 patients, although only 22 of them were microbiologically confirmed. The most common infection was sepsis (49%), followed by pneumonia (35.3%) and urinary tract infection (9.8%). There were no differences in haematological parameters and acute phase reactants between children with infection and those without. Children who died had a higher incidence of infection during ECMO (60.4%) than the survivors (40.3%), but the difference did not reach statistical significance (P=.07). The duration of admission in the PICU was 57 days in patients with infection vs 37 days in patients without infection but the difference was not statistically significant (P=.067).

Conclusions: Infection in children with ECMO is common. There are no specific infection parameters and less than half of the clinical infections are confirmed microbiologically. There was no statistically significant correlation between infection and mortality or duration of PICU stay.
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http://dx.doi.org/10.1016/j.eimc.2017.10.025DOI Listing
November 2018

[Materials for the paediatric resuscitation trolley or backpack: Expert recommendations].

An Pediatr (Engl Ed) 2018 Mar 5;88(3):173.e1-173.e7. Epub 2017 Jul 5.

Emérito SAS. Asociado a UGC Críticos y Urgencias Pediátricas. Hospital Regional Universitario de Málaga. Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal.

Cardio-respiratory arrest (CPA) is infrequent in children, but it can occur in any place and at any time. This fact means that every health care facility must always have the staff and material ready to resuscitate a child. These recommendations are the consensus of experts of the Spanish Paediatric and Neonatal Resuscitation Group on the material and medication for paediatric and neonatal resuscitation and their distribution and use. CPR trolleys and backpacks must include the essential material to quickly and efficiently perform a paediatric CPR. At least one CPR trolley must be available in every Primary Care facility, Paediatric Intensive Care Unit, Emergency Department, and Pre-hospital Emergency Areas, as well as in paediatric wards, paediatric ambulatory areas, and radiology suites. This trolley must be easily accessible and exclusively include the essential items to perform a CPR and to assist children (from newborns to adolescents) who present with a life-threatening event. Such material must be familiar to all healthcare staff and also include the needed spare parts, as well as enough drug doses. It must also be re-checked periodically. The standardisation and unification of the material and medication of paediatric CPR carts, trolleys, and backpacks, as well as the training of the personnel in their use are an essential part of the paediatric CPR.
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http://dx.doi.org/10.1016/j.anpedi.2017.05.010DOI Listing
March 2018

Do we need guidelines for pediatric resuscitation carts/trolleys/backpacks content and management?

Resuscitation 2017 05 2;114:e19-e20. Epub 2017 Mar 2.

Spanish Pediatric and Neonatal Resuscitation Working Group, Spanish Resuscitation Council, Spain; SAMID-II Network, Madrid, Spain; Institute of Investigation, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Pediatric Critical Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain.

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http://dx.doi.org/10.1016/j.resuscitation.2017.02.027DOI Listing
May 2017

Diffuse persistent pulmonary interstitial emphysema secondary to mechanical ventilation in bronchiolitis.

BMC Pulm Med 2016 11 3;16(1):139. Epub 2016 Nov 3.

Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Red de Investigación en Salud Materno-Infantil y del Desarrollo (Red SAMYD), C/ Doctor Castelo 47, 28009, Madrid, Spain.

Background: Persistent interstitial pulmonary emphysema (PIE) is a rare disease and it is even more uncommon in full-term infants, like our patient. When conservative management is not successful, surgical treatment should be considered. In our case, ECMO support was iniciated to keep the patient ventilated in order to allow the lung to heal using lung protection strategies.

Case Presentation: We report an 18-day-old male infant with bronchiolitis that required mechanical ventilation with high positive airway pressures due to severe respiratory insufficiency. Chest X-rays and computed tomography scan revealed a severely hyperinflated left lung with extensive destructive changes and multiple small bullae. These findings were consistent with diffuse persistent interstitial emphysema (PIE), probably due to mechanical ventilation. The patient required high frequency oscillatory ventilation, inotropic support and continuous renal replacement therapy. He eventually suffered a cardiac arrest that required cardiopulmonary resuscitation and ECMO during 5 days with progressive clinical improvement and normalization of the X-ray.

Conclusion: We present a patient with diffuse persistent interstitial emphysema who, despite an unfavorable evolution with different mechanical ventilation strategies, had a good response after ECMO assistance.
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http://dx.doi.org/10.1186/s12890-016-0299-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094036PMC
November 2016

Exogenous surfactant and alveolar recruitment in the treatment of the acute respiratory distress syndrome.

Clin Respir J 2017 Nov 4;11(6):1032-1039. Epub 2016 Mar 4.

Pediatric Intensive Care Department, Gregorio Marañon University General Hospital, c/Puente cesures 1.B 1ºB, 28029, Madrid, Spain.

Objective: To investigate the effect of alveolar recruitment combined with surfactant administration on children with acute respiratory distress syndrome (ARDS).

Material And Methods: A prospective, randomized, controlled and sequential study was carried out. Group A (16 children) was treated with both the alveolar recruitment manoeuvres (ARM) and the administration of the surfactant every 8 h for 3 days; group B (15) received the usual treatment only. The alveolar recruitment was carried out by increasing positive end-expiratory pressure 2 by 2 cm H O to improve the transcutaneous oxygen saturation values up to 88% and 90%. Demographic data, gasometric and ventilator parameters, chest radiography and 28-day mortality were evaluated.

Results: There were no significant differences in baseline characteristics between groups. An hour after treatment, significant differences (P < 0.001) were observed in transcutaneous oxygen saturation (SaO ; Group A: 94.1%, Group B: 89.9%), PaO /FiO (212.7 and 126.4) and oxygenation index (OI; 11.4 and 18.5). After 8 h, the differences in SaO (Group A: 94.6%, Group B: 90.3%), PaO /FiO (225.8 and 126.9) and OI (10.8 and 18.4) were also significant (P < 0.001). From the fifth dose of the surfactant, the static compliance (P = 0.0034) and radiological images (P = 0.002) were more greatly improved in group A than in group B. Survival was significantly higher in group A (81.3%) than in group B (26.7%) (P = 0.006).

Conclusions: The combined treatment of surfactant administration and ARM resulted in a better oxygenation and survival in children with ARDS than when only recruitment was used.
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http://dx.doi.org/10.1111/crj.12462DOI Listing
November 2017

Gastroesophageal reflux in critically ill children: a review.

ISRN Gastroenterol 2013 31;2013:824320. Epub 2013 Jan 31.

Pediatric Intensive Care Department and Gastroenterology Section, Gregorio Marañón University General Hospital, 28009 Madrid, Spain.

Gastroesophageal reflux (GER) is very common in children due to immaturity of the antireflux barrier. In critically ill patients there is also a high incidence due to a partial or complete loss of pressure of the lower esophageal sphincter though other factors, such as the use of nasogastric tubes, treatment with adrenergic agonists, bronchodilators, or opiates and mechanical ventilation, can further increase the risk of GER. Vomiting and regurgitation are the most common manifestations in infants and are considered pathological when they have repercussions on the nutritional status. In critically ill children, damage to the esophageal mucosa predisposes to digestive tract hemorrhage and nosocomial pneumonia secondary to repeated microaspiration. GER is mainly alkaline in children, as is also the case in critically ill pediatric patients. pH-metry combined with multichannel intraluminal impedance is therefore the technique of choice for diagnosis. The proton pump inhibitors are the drugs of choice for the treatment of GER because they have a greater effect, longer duration of action, and a good safety profile.
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http://dx.doi.org/10.1155/2013/824320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572643PMC
February 2013

Malnutrition in the critically ill child: the importance of enteral nutrition.

Int J Environ Res Public Health 2011 11 21;8(11):4353-66. Epub 2011 Nov 21.

Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

Malnutrition affects 50% of hospitalized children and 25-70% of the critically ill children. It increases the incidence of complications and mortality. Malnutrition is associated with an altered metabolism of certain substrates, increased metabolism and catabolism depending on the severity of the lesion, and reduced nutrient delivery. The objective should be to administer individualized nutrition to the critically ill child and to be able to adjust the nutrition continuously according to the metabolic changes and evolving nutritional status. It would appear reasonable to start enteral nutrition within the first 24 to 48 hours after admission, when oral feeding is not possible. Parenteral nutrition should only be used when enteral nutrition is contraindicated or is not tolerated. Energy delivery must be individually adjusted to energy expenditure (40-65 kcal/100 calories metabolized/day) with a protein delivery of 2.5-3 g/kg/day. Frequent monitoring of nutritional and metabolic parameters should be performed.
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http://dx.doi.org/10.3390/ijerph8114353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228575PMC
November 2011

[Risk factors for prolonged mechanical ventilation after cardiac surgery in children].

Med Intensiva 2008 Nov;32(8):369-77

Sección de Cuidados Intensivos Pediátricos. Hospital General Universitario Gregorio Marañón. Madrid. España.

Objective: To study the postoperative factors associated with prolonged mechanical ventilation after cardiac surgery in children.

Design: Prospective observational study.

Setting: Pediatric intensive care unit (PICU).

Patients: 59 children aged between 2 months and 14 years after cardiac surgery.

Variables Of Interest: We analyzed postoperative parameters associated to mechanical ventilation lasting more than 3 and more than 7 days. We performed a stepwise multiple logistic regression analysis to study the influence of each factor on prolonged mechanical ventilation.

Results: Mechanical ventilation lasted more than 3 days in 19 (32%) children and more than 7 days in 12 (20%). Predictive factors at PICU admission and 24 hours after admission associated with mechanical ventilation at 3 and 7 days were age less than 12 months, weight less than 7 kg, extrapulmonary complications (hypotension, arrhythmias, postoperative bleeding, delayed sternal closure, and airway complications), nitric oxide treatment, midazolam perfusion more than 4 microg/kg/min or fentanyl perfusion more than 4 microg/kg/h, and continuous muscle relaxant treatment. In the logistic multiple regression study, weight less than 7 kg and extrapulmonary complications predicted 82.8% of children with mechanical ventilation more than 3 days and 87.9% with mechanical ventilation more than 7 days.

Conclusions: Weight less than 7 kg and extrapulmonary complications are the most important factors associated with prolonged mechanical ventilation after cardiac surgery in children.
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http://dx.doi.org/10.1016/s0210-5691(08)75707-3DOI Listing
November 2008

Continuous renal replacement therapy with a pulsatile tubular pump: parameters must be adjusted in each case.

Artif Organs 2007 Nov;31(11):846-50

Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.

A three-valve, pulsatile tubular pump was used in 24 pigs weighing 10.2 +/- 3.2 kg; the pump was connected to a neonatal hemofiltration circuit. Ninety-two periods of 30 min were studied to analyze the efficacy of the system with variations in the percentage time in diastole, the diastolic speed, the systolic speed, and the percentage time in systole during which the postfilter valve was closed. System efficacy was determined by the blood flow through the filter, the ultrafiltrate volume, the vascular overload measured by the inlet aspiration pressure, and the filter overload measured by the cross-filter pressure drop and the transmembrane pressure. The variations in the pump parameters did not lead to significant differences in the efficacy of the system or in the vascular or filter overload. The parameters must be adjusted in each case to obtain the best yield with the lowest vascular and filter overload.
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http://dx.doi.org/10.1111/j.1525-1594.2007.00473.xDOI Listing
November 2007