Revista chilena de pediatría
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Nineteen childhood near drowning cases admitted to a private general hospital from December 31, 1983 through out December 1987 at a mean age of 2 years 3 months are discussed. All patients had diagnosis when first found by relatives, 16 were apneic and only 11 received some kind of resuscitation which complied with accepted standards in 4 of them. Seven cases were admitted in stage A of Conn, two in stage B and ten in stage C. ⋯ The main complications after resuscitation were hemodynamic instability, pulmonary problems and hypoxic encephalopathy. High ICP was not important in the first hours and when it rose it did so 24 to 48 hours after admission. The need for an active role in prevention, improved resuscitation and transport, is stressed.
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Physiological stability index (PSI) is a score proposed to evaluate the severity of different diseases in pediatric intensive care units (PICU) by giving scores to the deterioration of 34 measurable physiological variables. In order to validate PSI, it was prospectively applied to 132 patients who entered our PICU. A significant difference (p less than 0.001) was found between the average score of those patients who survived (means: 6.1) versus those who did not (means: 21); No difference was found between theoretical mortality rates obtained by logistic regression analysis and those obtained according to PSI score ranks even thought direct hemodynamic measurements like cardiac output and capillary (wedge) pulmonary pressure were not considered in this study. In conclusion, the PSI is a useful method to measure the severity of illness in pediatric intensive care and to compare results among PICU.
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Previous health state and acute failure of six organ system (cardiovascular, respiratory, neurologic, hematologic, renal and digestive systems) at admission to a pediatric intensive care unit (ICU) were evaluated in 71 patients that died along one year in an ICU of a pediatric hospital at Santiago, Chile. Acute organic system failure (AOF) and chronic organic failure (COF) were defined on clinical, laboratory and therapeutic standards at hand in this country. COF was present in 56% of the cases, and was mainly due to congenital heart malformations. ⋯ Multiple organ failure was the most frequent cause of death (33%) affecting preferentially patients with COF secondary to lung infections (40%) and central nervous system diseases (20%). AOF of the central nervous system was the second global cause of death and the first among previously healthy children. Irreversible respiratory malfunction caused 21% of deaths.
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Along one year, cardiorespiratory resuscitation was done to 71 patients, aged 3 days to 10 years (median 3.5 month), in a pediatric intensive care unit. Although 39 patients (55%) recovered through first-stage treatment, in 17 the arrest was recurrent and they died in the following 24 hours. Only 12 (16.9%) children definitely survived. ⋯ Asystole was the most frequent arrhythmia (92%). There were only 4 cases of ventricular fibrillation, all occurred in patients with congenital heart disease, and no one recovered. Survivors have not evidence of neurological deficiencies, and only one died along one year follow up, because of congenital heart disease.