+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Atencion del paciente crítico pediatrico en una UCI de adultos Utilidad del índice PIM

, : Atencion del paciente crítico pediatrico en una UCI de adultos Utilidad del índice PIM.

Analizar las caracter sticas de los pacientes menores de 14 a os atendidos en una UCI de adultos (UCIA), determinar los procedimientos y t cnicas que precisan y evaluar el uso del Paediatric Index of Mortality (PIM) para estratificar la gravedad. Estudio observacional retrospectivo. Unidad de Cuidados Intensivos polivalente de un hospital de segundo nivel. Se estudiaron 130 pacientes con edad entre 1 mes y 14 a os (edad media 6,1 4 a os) atendidos en UCIA desde enero de 1997 a diciembre de 2010. cl nico-demogr ficas, diagn stico, procedimientos, puntuaci n PIM, estancia, traslado a UCI pedi trica (UCIP) y mortalidad. Clasificaci n seg n el destino (UCIA, UCIP) y el resultado (VIVO, MUERTO). PIM y valoraci n de la curva de rendimiento diagn stico (ROC) para la mortalidad. Edad media de 6,1 4 a os. Los diagn sticos m s frecuentes fueron: traumatismo (26,9%) y sepsis (22,3%). Los principales procedimientos fueron: ventilaci n mec nica (58,5%), v a venosa central (74,6%) y f rmacos vasoactivos (20%). Traslado a UCIP en un 64,6% y mortalidad global de 13%. Los pacientes que permanecieron en la UCIA eran de mayor edad (8,2 4 vs. 5,5 4 a os, p<0,001), con poca comorbilidad y estancia corta (44,5 38 horas). ndice PIM significativamente m s alto en fallecidos (UCIA 60 20, UCIP 38 30) que en supervivientes (UCIA 4 1, UCIP 9 1) (p<0,001). Curva ROC con excelente capacidad discriminativa con rea bajo la curva=0,91, (intervalo de confianza del 95%, 0,85-0,98). El ndice PIM permite estratificar la gravedad e identificar los pacientes con mayor riesgo de muerte. La atenci n ocasional del ni o cr tico obliga a que exista una adecuaci n tanto en material como en la formaci n del personal de las UCIA para proporcionar una adecuada asistencia. An analysis is made of the characteristics of patients younger than 14 years treated in an adult ICU (AICU), to determine the procedures and techniques required by such patients, and to evaluate the use of the Pediatric Index of Mortality (PIM) in stratifying severity. A retrospective observational study was carried out. An AICU of a second level hospital. We studied 130 patients aged from 1 month to 14 years (average age 6.1 4 years) treated in the AICU from January 1997 to December 2010. Clinical-demographic parameters, diagnosis, clinical procedures, PIM score, length of stay, transfer to pediatric ICU (PICU), and mortality. Classification by destination (AICU, PICU) and outcome (alive, dead). PIM and assessment of the diagnostic performance curve (ROC) for mortality. The average age of the patients was 6.1 4 years. Most common diagnoses: trauma (26.9%) and sepsis (22.3%). Main procedures: mechanical ventilation (58.5%), central venous line (74.6%) and vasoactive drugs (20%). A total of 64.6% were transferred to PICU, and the overall mortality was 13%. Patients who stayed in the AICU were older (8.2 4 vs 5.5 4 years, p<0.001), had low morbidity, and their stay was short (44.5 38hours). The PIM score was significantly higher in the patients who died (60 20 AICU, 38 30 PICU) than in those who survived (4 1 AICU, 9 1 PICU) (p<0.001). ROC curve with AUC=0.91 (95%CI: 0.85 to 0.98). The PIM score can stratify severity and identify patients at an increased risk of death. Critical child care in the AICU requires the presence of adequate materials and the continuous learning of procedures adapted to pediatric patients in order to ensure adequate care.


Other references

Stroup, J.; Kane, M.P.; Busch, R.S.; Bakst, G.; Hamilton, R.A., 2004: The utility of insulin glargine in the treatment of diabetes mellitus. Study Objectives. To compare hemoglobin A1c (A1C) values at baseline with those after 1 year of insulin glargine therapy and, secondarily, to compare insulin dosage and patients' body weight at baseline and at 1 year. Design. Retrospective st...

Murphy, Jf, 1977: Depositional environment of Upper Cretaceous Black Sandstones of the Western Interior. Professional Papgeol. Surv: 1-29,illust.

Manderino, M.A.; Yonkman, C.A., 1985: Stress inoculation: a method of helping students cope with anxiety related to clinical performance. Journal of Nursing Education 24(3): 115-118

Park, W.; Madsen, E.L., 2004: Characterization in Pseudomonas putida Cg1 of nahR and its role in bacterial survival in soil. Sequencing, RFLP analyses and experiments utilizing a lacZ transcriptional reporter fused to the promoter regions of nahR and nahG in Pseudomonas putida Cg1 confirmed that regulation of naphthalene degradation in both P. putida Cg1 and the type st...

Clerc, M., 1950: Technic for extermination of rats on ships with chloropicrin. Les Entretiens de Bichat. Medecine. Entretiens de Bichat 31(8): 3-8

Piekarski, D.; Potier, P.; Giannotti, C., 1990: Study of the mode of action of some nitrodiphenyl ethers. Nitrosoderivatives of the nitrodiphenyl ether herbicides (nitrofen, bifenox) have been studied. UV irradiation in different organic solvents gives degradation products. In buffered aqueous media, in the presence of chloroplasts and spin traps such...

Rahovic, D.; Petrovic, M., 1974: The use of polyethylene film in pear growing. Seven-year-old palmette-trained trees of 3 early pear cvs on Quince A were mulched with black or white 0.06 mm polyethylene or were clean cultivated, and the effect of these treatments on stem and shoot growth, flower numbers and fruit set and dev...

Sánchez Álvarez, C.; Zabarte Martínez de Aguirre, M.; Bordejé Laguna, L., 2012: Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: gastrointestinal surgery. Gastrointestinal surgery and critical illness place tremendous stress on the body, resulting in a series of metabolic changes that may lead to severe malnutrition, which in turn can increase postsurgical complications and morbidity and mortality a...

Winkier, J.R., 1959: Trichodes crabroniformis hidalgo, nueva subespecie de Clerido de Espafia (Coleoptera). Graellsia Madrid, 17: 71-75

Hamid, J.J.M.; Amal, M.K.; Hasmiza, H.; Pim, C.D.; Ng, L.O.; Wan, M.W.M., 2012: Effect of gender and nutritional status on academic achievement and cognitive function among primary school children in a rural district in Malaysia. The aim of this study was to investigate the relationship between gender, birth weight, nutritional status, and iron status of children with their academic performance and cognitive function. Two hundred and forty-nine children, seven to nine year...