Francisco Prado A

Ventilación no invasiva como tratamiento de la insuficiencia respiratoria aguda en Pediatría

Themain indication of BiPAP, in 80% of cases, was pulmonary restrictive disease. Indications ofNIV were acute exacerbations in patients with chronic domiciliary NIV in three patients,hypoxic ARF in six and hypercapnic ARF in five. The diagnoses were pneumonia/atelectasis inseven patients, bilateral extensive pneumonia in three, RSV bronchiolitis in two, apnea in one,and asthma exacerbation in one. Only one patient required intubation for mechanicalventilation, all others improved. The procedures did not have complications. NIV lasted less thanthree days in 5 patients, 4 to 7 days in four patients and more than 7 days in five. One third ofthe patients required fiberoptic bronchoscopy for massive or lobar atelectasis and one thirdremained on domiciliary NIV program.

Enfoque Pediátrico para el Estudio de los Trastornos Respiratorios del Sueño

Sleep Disorders can generate significant impact in the health of children and adolescents at a highly vulnerable period for neurodevelopment. A proper history and physical exam can lead the diagnosis, however there are significant limitations especially in the early phases of illness. Children with specific risks require a high level of suspicion, and early diagnostic studies. This review describes various diagnostic alternatives, feasible in different clinical situations, during sleep or wakefulness. These diagnostic studies may be useful in detection and early treatment of Sleep Disorders.

Apnea severa: signo precoz de neumonía por Pneumocystis carinii en un lactante VIH negativo

A few reports in the medical literature suggest an association between Pneumocystis caring and apnea in small infants. This patient, a 1 month 20 days old, HIV negative, infant girl weighing 2,000 grams was admitted to hospital after presenting a severe episode of apnea with cyanosis and bradicardia. She progressively developed bronchopneumonia by P. carinii that required prolonged mechanical ventilation with high ventilatory parameters. The clinical course of this patient illustrates that apnea can be an early sign of P. carinii infection in small infants. Early diagnosis and specific therapy might prevent morbidity and mortality and also decrease the length of hospitalization. (Rev Med Chile 2000; 128: 425-429).

Utilidad de un cuestionario clínico para el diagnóstico de trastornos respiratorios del sueño en niños con enfermedades neuromusculares

Usefulness of a clinical questionnaire for diagnosis of respiratory disorders of sleep in children with neuromuscular diseases Objectives: To analyze the usefulness of a clinical questionnaire for the diagnosis of sleep disordered brea- thing in children with neuromuscular diseases. Patients and Methods: A sleep questionnaire and a polysom- nography were performed in a cohort of 21 children (14 boys) with neuromuscular diseases. ROC analysis was used to assess the diagnostic accuracy of the questionnaire for diagnosing sleep disordered breathing compared with polysomnography. Results: Median age was 10.7 years (2-17). According to polysomnogra- phy, 8 patients were classifi ed as normal, 3 had primary snoring, 5 had central sleep apnea syndrome and 5 an obstructive sleep apnea syndrome. Eleven questionnaires scores suggested sleep disordered breathing. The questionnaires score showed a sensitivity of 75%, specifi city of 60%, positive predictive value of 33% and negative predictive value of 90% for the diagnosis of an obstructive sleep apnea syndrome. The same fi gure for the diagnosis of a central sleep apnea syndrome was 80%, 64%, 44% and 90%. Conclusions: The ques- tionnaire showed a moderate sensitivity and specifi city. Nevertheless, the high negative predictive value of the questionnaire may support its use for screening of sleep disordered breathing. A follow-up of questionnaires scores may identify patients, who would benefi t from performance of polysomnography. (Key words: Sleep, obstructive sleep apnea, neuromuscular, hypoventilation). Rev Chil Pediatr 2011; 82 (4): 319-328

Obstrucción de la vía aérea por cuerpo extraño: Manejo endoscópico combinado

Se analizan 21 pacientes ingresados al Servicio de Urgencia del Hospital Clinico San Borja-Arriaran entre enero 1996 y junio 1999, 8 por sospecha y 13 por certeza de cuerpo extrano (CE) en la via aerea. La edad promedio de los primeros fue 6 anos 7 meses, 4 varones. En 5 de ellos la sospecha se baso en atelectasia, en 2 hubo sofocacion transitoria durante la alimentacion y 1 presento una neumonia atipica. Se hizo fibrobroncoscopia (FBC ) en los 8, y en 3 de ellos FBC + broncoscopia rigida (BR). Dos (25%) tenia CE endobronquial y 3 oclusion de la via aerea por tapon mucopurulento. La exploracion fue normal en 3 pacientes (38%). Los 13 pacientes con certeza de CE tenian edad promedio de 3 anos 8 meses, 10 hombres. Todos tuvieron crisis asfictica, 6 insuficiencia respiratoria aguda, uno de ellos paro cardiorrespiratorio (PCR) y 2 obstruccion grave de la via respiratoria alta. 6 tenian examen fisico normal. En 2 se extrajo el CE con laringoscopia y pinza Magill, en 9 con BR + FBC y en 1 con FBC + canastillo Dormia a traves de BR. En 5 pacientes la localizacion CE fue supracarinal (36%) y endobronquial en 9 (64%). Cinco CE (36%) fueron radioopacos y 9 radiolucidos (64%): 5 vegetales (36%) y 3 partes plasticas de juguetes (21%). Fallecio 1 paciente (4.8%) ingresado al SU en paro cardiorrespiratorio al septimo dia postprocedimiento. 20 (95.2%) fueron dados de alta sanos. CE se presenta como crisis asfictica por aspiracion de alimentos o pequenas partes de juguetes. El examen fisico y la radiografia pueden ser normales, obligando a explorar la via aerea con FBC, en caso de sospecha, y BR para extraccion. La combinacion BR+FBC permite revisar la via aerea totalmente, manejar el CE de migracion distal y la manipulacion atraumatica en aquellas muy inflamadas por CE vegetales o en los casos de sospecha sin CE. La prevencion se debe orientar a modificar habitos alimentarios y evitar manipulacion de juguetes con partes pequenas en los menores de 5 anos