Revista chilena de pediatría
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Intravascular catheters are widely used in Neonatal Intensive Care Units. The major types of intravascular access in the newborn are peripheral catheters, venous or arterial umbilical catheters, central venous catheters and peripherally-inserted central venous catheters (PICC). ⋯ The radiographic assessment of the catheter performed by pediatricians and/or radiologists, who must be able to recognize those poorly positioned as they can cause serious complications, is essential. This article contains a sample of correct and misplaced catheter x-ray often used in a NICU.
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Educational programs in pediatric life support endorse a capillary refill time>2 s as an indicator of shock. In the emergency room, a barrier to the implementation of an early goal directed therapy, aiming at central venous oxygen saturation (ScvO2)≥70% is the insertion of central venous catheter (CVC). ⋯ A prolonged capillary refill time>2 s, is a predictor of ScvO2<70% in children admitted to ICU, which supports the current recommendations. This finding may be relevant in emergency units where the use of CVC is limited and ScvO2 is not available.
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Observational Study
[Characteristics of drug interactions in a pediatric intensive care unit].
The aim of this study is to calculate the theoretical frequency of potential drug interactions (PDI) and their characteristics in the therapeutic plan of hospitalized patients in a Pediatric Intensive Care Unit (PICU). ⋯ PDI were more frequent in patients associated with major polypharmacy and longer hospital stay.
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The ventilator-induced diaphragmatic dysfunction is a group of disorders caused by the inactivity of the diaphragm muscle during controlled mechanical ventilation. From a structural point of view, the diaphragm subjected to mechanical ventilation undergoes an atrophy process, in which decreased synthesis and increased muscle protein degradation are observed. Recent research has identified different molecular signaling pathways that link both processes in the diaphragm, describing compelling evidence that shows that oxidative stress contributes to this phenomenon. ⋯ The purpose of the present review is to analyze the impact of mechanical ventilation on the structure and function of the diaphragm muscle. Clinical implications and potential preventive steps are discussed. Since the duration of mechanical ventilation is the primary responsible for the absence of mechanical stimulation on the diaphragm, the use of ventilatory strategies for successful early weaning and early use of partial modalities should be the main pillars in the prevention of this condition.
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Tension gastrothorax is caused by the herniation of the stomach into the thorax due to a congenital defect of the diaphragm; the Bochdaleck diaphragmatic hernia (HDB) is the most frequent type. ⋯ The evolution of this case shows the difficulty differentiating a tension gastrothorax from tension pneumothorax in patients admitted to the emergency room who are in serious condition; therefore, a high index of suspicion is needed for its identification.