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Cabezudo Ballesteros S, Sanabria Carretero P, Reinoso Barbero F. Review of electrical impedance tomography in the pediatric patient. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00060-X. [PMID: 38458492 DOI: 10.1016/j.redare.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/28/2023] [Indexed: 03/10/2024]
Abstract
Electrical impedance tomography (EIT) is a new method of monitoring non-invasive mechanical ventilation, at the bedside and useful in critically ill patients. It allows lung monitoring of ventilation and perfusion, obtaining images that provide information on lung function. It is based on the physical principle of impedanciometry or the body's ability to conduct an electrical current. Various studies have shown its usefulness both in adults and in pediatrics in respiratory distress syndrome, pneumonia and atelectasis in addition to pulmonary thromboembolism and pulmonary hypertension by also providing information on pulmonary perfusion, and may be very useful in perioperative medicine; especially in pediatrics avoiding repetitive imaging tests with ionizing radiation.
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Affiliation(s)
| | - P Sanabria Carretero
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - F Reinoso Barbero
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
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Ferrer R, Báguena M, Balcells J, Bañeras J, Biarnes A, de Nadal M, Gracia RM, Martinez J, Nuvials X, Riera J, Roca O, Ruiz-Rodriguez JC. Planning for the assistance of critically ill patients in a Pandemic Situation: The experience of Vall d'Hebron University Hospital. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:71-77. [PMID: 34872890 DOI: 10.1016/j.eimce.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In the context of community transmission of the virus, the impact of the pandemic on health-care systems, mainly on intensive care units (ICU), was expected to be devastating. Vall d'Hebron University Hospital (HUVH) implemented an unprecedented critical patient-care planning and management of resources. METHODS We describe a cohort of critically ill patients during the first two months of the pandemic (from March 3, 2020, to May 2, 2020) in HUVH, Barcelona. In this manuscript, we report our previsions, strategies implemented, and the outcomes obtained. RESULTS Three-thousand and thirty-three patients were admitted to the HUVH Critical Care Units. Throughout the study period, the proportion of patients on IMV or IMV and ECMO remained above 78%. Most patients were men (65%); the most common age group was 60-70 years. Twenty-three patients received ECMO, and eighteen were cannulated at another center and transferred to HUVH. At the end of the study, fourteen patients were successfully decannulated, three patients died, and the rest of the patients were still on ECMO. Eight pregnant women have been treated in the ICU, with a survival rate of 100%. The ICU mortality of patients younger than 60 years was 3.2%. The mean ICU stay of both survivors and nonsurvivors was 14 days. CONCLUSION The adequate preparation for resource expansion for critically ill patients care, main challenges, and overall positive results can serve as a precedent for similar future scenarios.
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Affiliation(s)
- Ricard Ferrer
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain.
| | - Marcelino Báguena
- Servicio de Medicina Intensiva, Hospital Universitario de Traumatología, Rehabilitación y Quemados Vall d'Hebron, Barcelona, Spain
| | - Joan Balcells
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jordi Bañeras
- Acute Cardiovascular Care Unit, Department of Cardiology, Centre de Simulació Clínica Avançada VHISCA, Vall d'Hebron Hospital, Universidad Autónoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Alfons Biarnes
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Miriam de Nadal
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rosa María Gracia
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Jesús Martinez
- Coordinador de Críticos, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Xavier Nuvials
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Jordi Riera
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Oriol Roca
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Juan Carlos Ruiz-Rodriguez
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Sepsis Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca (VHIR), Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
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Ferrer R, Báguena M, Balcells J, Bañeras J, Biarnes A, de Nadal M, Gracia RM, Martinez J, Nuvials X, Riera J, Roca O, Ruiz-Rodriguez JC. Planning for the assistance of critically ill patients in a Pandemic Situation: The experience of Vall d'Hebron University Hospital. Enferm Infecc Microbiol Clin 2020; 40:S0213-005X(20)30272-X. [PMID: 33010961 PMCID: PMC7834691 DOI: 10.1016/j.eimc.2020.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/04/2020] [Accepted: 08/09/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION In the context of community transmission of the virus, the impact of the pandemic on health-care systems, mainly on intensive care units (ICU), was expected to be devastating. Vall d́Hebron University Hospital (HUVH) implemented an unprecedented critical patient-care planning and management of resources. METHODS We describe a cohort of critically ill patients during the first two months of the pandemic (from March 3, 2020, to May 2, 2020) in HUVH, Barcelona. In this manuscript, we report our previsions, strategies implemented, and the outcomes obtained. RESULTS Three-thousand and thirty-three patients were admitted to the HUVH Critical Care Units. Throughout the study period, the proportion of patients on IMV or IMV and ECMO remained above 78%. Most patients were men (65%); the most common age group was 60-70 years. Twenty-three patients received ECMO, and eighteen were cannulated at another center and transferred to HUVH. At the end of the study, fourteen patients were successfully decannulated, three patients died, and the rest of the patients were still on ECMO. Eight pregnant women have been treated in the ICU, with a survival rate of 100%. The ICU mortality of patients younger than 60 years was 3.2%. The mean ICU stay of both survivors and nonsurvivors was 14 days. CONCLUSION The adequate preparation for resource expansion for critically ill patients care, main challenges, and overall positive results can serve as a precedent for similar future scenarios.
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Affiliation(s)
- Ricard Ferrer
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España.
| | - Marcelino Báguena
- Servicio de Medicina Intensiva. Hospital Universitario de Traumatología, Rehabilitación y Quemados Vall d'Hebron, Barcelona, España
| | - Joan Balcells
- Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario Vall d'Hebron. Universidad Autónoma de Barcelona , Barcelona, España
| | - Jordi Bañeras
- Acute Cardiovascular Care Unit, Department of Cardiology, Centre de Simulació Clínica Avançada VHISCA, Vall d'Hebron Hospital, Universidad Autónoma de Barcelona. CIBERCV, Barcelona, España
| | - Alfons Biarnes
- Servicio de Anestesiología y Reanimación. Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Miriam de Nadal
- Servicio de Anestesiología y Reanimación. Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Rosa María Gracia
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - Jesús Martinez
- Coordinador de críticos. Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Xavier Nuvials
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - Jordi Riera
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - Oriol Roca
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España
| | - Juan Carlos Ruiz-Rodriguez
- Servicio de Medicina Intensiva. Hospital Universitario Vall d'Hebron. Sepsis Organ Dysfunction and Resuscitation (SODIR) Research group. Vall d'Hebron Institut de Recerca (VHIR). Universidad Autónoma de Barcelona (UAB), Barcelona, España
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de la Huerga López A, Sendarrubias Alonso M, Jiménez Jiménez AP, Matías Del Pozo V, Álvarez Colomo C, Muñoz Moreno MF. [Antenatal corticosteroids and incidence of neonatal respiratory distress after elective caesarean section in late preterm and term neonates]. An Pediatr (Barc) 2019; 91:371-7. [PMID: 30665860 DOI: 10.1016/j.anpedi.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/14/2018] [Accepted: 12/11/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Birth by elective caesarean section in late preterm and early term newborn increases the risk of respiratory distress. Administration of antenatal corticosteroids in these cases could reduce the respiratory distress and its severity. OBJECTIVES To determine the influence of antenatal corticosteroids use in elective caesarean sections in the respiratory distress of the newborn from 35+0 to 38+6 weeks of gestational age. PATIENTS AND METHODS Retrospective analytical study of caesarean sections from 35+0 to 38+6 gestational age was conducted in a tertiary hospital from January 2013 to April 2017. Data were collected from medical records of pregnant women and newborns after an implementation of new protocol of betamethasone administration to these elective caesarean sections. Analysis was performed on 2newborn subgroups: preterm newborn (PTN) 35-36 gestational age and term (TN) 37-38 weeks. RESULTS A total of 208 elective caesarean sections were performed in the study period. Corticosteroids were administered in 97 (46.6%) of cases. The percentage of respiratory distress was higher in the group of preterm newborn compared to term newborn (29% vs. 8.8%, P<.001) and in term newborn higher at a lower gestational age. Between treated with corticosteroids or not, no significant differences were found in the treated and non-treated in the development of respiratory distress (PTN 30 vs. 30%, TN 9.1 vs. 6.9%, P=.6). CONCLUSIONS No statistically significant differences were found in this study in favour of the administration of an antenatal dose of betamethasone in the reduction of respiratory distress in the elective caesarean sections from 35+0 to 38+6 gestational age. The delay in the indication of elective caesarean sections, whenever possible, could help reduce the incidence of newborn respiratory distress.
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de la Quintana Gordon FB, Nacarino Alcorta B, Fajardo Pérez M. [Basic lung ultrasound. Part 2. Parenchymal diseases]. ACTA ACUST UNITED AC 2015; 62:337-49. [PMID: 25708093 DOI: 10.1016/j.redar.2015.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/15/2014] [Accepted: 01/14/2015] [Indexed: 11/25/2022]
Abstract
In this second part, an analysis is made of the pathology of lung parenchyma. This text is structured into different sections, including the study of atelectasias, pneumonia and abscess, interstitial/alveolar or Blines patterns, and finally an analysis is made of pulmonary embolism. With this second part, the basic knowledge to develop lung ultrasound in the anesthesia department has been presented.
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Affiliation(s)
- F B de la Quintana Gordon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Universitario de Móstoles, Móstoles, Madrid, España.
| | - B Nacarino Alcorta
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Universitario de Móstoles, Móstoles, Madrid, España
| | - M Fajardo Pérez
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Universitario de Móstoles, Móstoles, Madrid, España
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García-Muñoz-Rodrigo F, Diez Recinos AL, Aponte Contreras O, Pérez Matos C, Gutiérrez García L, García Hernández JA. [Influence of gestational age, type of delivery, and resuscitation, on the incidence of pneumothorax in term neonates]. An Pediatr (Barc) 2013; 80:138-43. [PMID: 24099928 DOI: 10.1016/j.anpedi.2013.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 05/23/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Elective caesarean section before 39 weeks gestational age (GA) has been associated with a higher incidence of iatrogenic respiratory distress and pneumothorax in term newborn babies, probably because of a higher respiratory morbidity and the need for resuscitation. These factors have not been systematically evaluated in our patients. OBJECTIVE To determine whether the gestational age, type of delivery, and intensity of resuscitation, are associated with an increase in the incidence of pneumothorax in term neonates. PATIENTS AND METHODS Full term neonates (≥ 37 weeks GA) born in our maternity unit from January 2006 to December 2010 were studied, along with the type of delivery (vaginal, forceps or caesarean section). Advanced cardiopulmonary resuscitation (CPR) was defined as the need of bag and mask intermittent ventilation, intubation, chest compression, and/or administration of medication. The diagnosis of pneumothorax was clinical and radiological in all cases. RESULTS A total of 32,238 full term newborns were included. Type of delivery: vaginal 76.1%, C-section 12.4%, and forceps 11.5%. The incidence of pneumothorax was 0.316%. It was significantly higher in C-section (0.85%), than in forceps (0.59%), or non-instrumental vaginal deliveries (0.19%) (P<.001), and in infants ≥ 40 weeks GA (0.37%) compared to ≤ 39 weeks GA (0.24%) (P=.033), and in advanced CPR (4.29%) compared to basic CPR (0.18%) (P<.001). CONCLUSIONS A GA ≥ 40 weeks, C-section, or forceps delivery, and advanced CPR immediately after birth were significantly associated with a higher incidence of pneumothorax in full term newborn babies. In our population, we did not observe an increase in pneumothorax among neonates born by elective C-section before 39 weeks of gestation.
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Affiliation(s)
- F García-Muñoz-Rodrigo
- Servicio de Neonatología, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - A L Diez Recinos
- Servicio de Neonatología, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - O Aponte Contreras
- Servicio de Neonatología, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - C Pérez Matos
- Servicio de Ginecología y Obstetricia, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - L Gutiérrez García
- Servicio de Ginecología y Obstetricia, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - J A García Hernández
- Servicio de Ginecología y Obstetricia, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
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