Author Of 4 Presentations
ACUTE SEVERE MYOCARDITIS WITH EXTENSIVE CARDIAC THROMBUS FORMATION IN A TEENAGE BOY: A THERAPEUTIC CHALLENGE
Abstract
Background
Acute myocarditis is a rare condition in pediatrics, but potentially lethal, that can culminate in cardiac disfunction and, rarely, intracardiac thrombus.
Objectives
Not Applicable
Methods
Not Applicable
Results
We report the case of a 16-year-old teenage male, previously healthy, that was transfered to the Pediatric Intensive Care Unit due to suspicion of acute myocarditis with multiorgan disfunction. Echocardiogram at admission revealed moderate to severe left ventricular (LV) disfunction (ejection fraction of 30-35%) and two hyperechoic masses in the LV suggestive of thrombus, given which he initiated non-fractionated heparin. The cardiac magnetic resonance at day 4 was compatible with acute myocarditis with moderate to severe ventricular disfunction and biventricular thrombus. Of the infectious investigation, the only relevant finding was a positive fecal culture for Campylobacter jejuni; remaining microbiological, immunological, and prothrombotic studies were negative. Despite the treatmentwith ceftriaxone, azithromycin and IV immunoglobulin, there was an increase of the thrombus, with decline of cardiac function and peripheric arterial embolization, which led to surgical thrombectomy on day 13. He was maintained on extracorporeal membrane oxygenation until day 28, when he was subjected to orthotopic cardiac transplant with no complications. Evolution was favorable, with progressive improvement of cardiac function and no recurrence of thrombus.
Conclusion
We present a case of acute myocarditis complicated with intracardiac thrombus and systemic embolization. The approach to these cases should be multifactorial and multidisciplinary and the decision of surgical treatment is difficult. Despite severe cardiac dysfunction and intraoperative risk of embolization, the surgery was successful and should be considered in the absence of improvement with medical treatment.
EXPERIENCE ON POSTOPERATIVE PAEDIATRIC CARDIAC SURGERY IN A PORTUGUESE PAEDIATRIC INTENSIVE CARE UNIT
Abstract
Background
Advances in cardiac surgery over the last few decades, including corrective operations in early life, have dramatically increased the survival of children, particularly those with congenital heart disease.
Objectives
To describe the evolution of patients undergoing cardiac surgery in a Portuguese Paediatric Intensive Care Unit (PICU).
Methods
Retrospective study through databasis of children admitted in PICU in the postoperative period of cardiac surgery, from January 2017 to August 2018.
Results
There were 91 hospitalizations; one of the patients was hospitalized two times in this period. Of 90 patients, 54,4% were male, mean age was 4,27 years [1 month to 18 years]. In this population, 93,3% had congenital heart disease, the most frequent were ventricular and atrial septal defect and Fallot tetralogy; 42,9% had history of another comorbidities and 20,9% have made other cardiac surgeries in the past. Median time of surgery was 287,5 minutes [45-1083min]. In postoperative period, 64,8% were intubated and 27,5% had non-invasive ventilation, with mean duration of mechanical ventilation of 7,8 days. Vasoactive drugs were needed in 48,4% and pacing device in 15,4%; 2 patients needed cardioversion and other 2 patients needed ECMO support. Complications were seen in 50,5%, the most frequent were respiratory and hematologic, and 8,8% of patients required peritoneal dialysis. Deferred closure of the chest was made in 4,4% and 8,8% were reoperated, with one of this patients undergoing heart transplantation. Mortality rate was 2,2% in 20 months of study.
Conclusion
Children undergoing cardiac surgery constitute a high-risk population, justifying a multidisciplinary, differentiated and integrated approach.
WEAPON RELATED TRAUMA IN A PEDIATRIC INTENSIVE CARE UNIT
Abstract
Background
Trauma in Portugal continues to be one of the main causes of death in children and adolescents. Yet, there is a shortage of population-based studies about weapon related trauma in our country.
Objectives
To describe patients hospitalized for weapon related trauma in a Portuguese Pediatric Intensive Care Unit.
Methods
Retrospective study through clinical processes analysis of hospitalized cases for a period of 10 years (January 2006 to December 2017).
Results
Were included 9 cases, 88,9% were male and mean age was 11,3 years. A firearm was used in 66.6% and a white weapon in the remaining cases, 44.4% happened at home, mainly on weekend. Two cases were suicide attempts while in the others the aggressor was either a friend, family or a neighbor. In 5 cases the aggression was intentional, 55,6% the injury was in the head, whereas the rest was in abdomen, back or neck. During hospitalization, all patients were intubated, 5 underwent surgery and 4 required inotropic and transfusional support. Median length of stay was 14,5 days. Overall mortality was 22,2%, corresponding to a 5 and a 14-year-old male, both with severe traumatic brain injury. Of those two patients, Pediatric Risk of Mortality calculated through PRIM III score was 29 and 30 and probability of death was 0.597 and 0.673, respectively. One patient persisted with major sequels and one with minor.
Conclusion
Weapon injuries in children can be associated with severe adverse outcomes including death, which makes this a significant public health problem and a focus to prevention measures in risk groups.
CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH ACUTE BRONCHIOLITIS IN A PORTUGUESE PEDIATRIC INTENSIVE CARE UNIT
Abstract
Background
Bronchiolitis remains a major cause of respiratory failure, with RSV infection being the most frequent cause.
Objectives
To characterize the cases of acute bronchiolitis admitted to a Pediatric Intensive Care Unit (PICU).
Methods
Retrospective study of patients admitted to our PICU with the diagnosis of acute bronchiolitis, from 1-10-2016 to 30-09-2018.
Results
26 patients were admitted with the diagnosis of bronchiolitis; 16 were males and the median age was 3 months [1-24]. The median duration of hospitalization was 6 days [2-44] and the main cause of hospitalization was acute respiratory failure (24/26). Thirteen patients had comorbidities, the most common being prematurity (7/13) and congenital heart disease (5/13). Fifteen patients required noninvasive ventilation (NIV, mean duration of 4 days) and 10 required invasive mechanical ventilation (IMV, mean duration of 6 days). One patient required extracorporeal membrane oxygenation. The most frequently isolated virus was RSV (15/20), followed by Metapneumovirus (3/20). Seventeen patients had bacterial infection; the most frequent agents were Staphylococcus aureus(11/17) and Haemophilus influenzae(10/17). RSV infection was associated with a median duration of hospitalization of more than 7 days (p <0.05), but not with superior requirement of NIV or IMV. No statistically significant differences were found between the groups of patients with and without comorbidities, regarding the duration of hospitalization and the need for NIV or IMV. No deaths were recorded.
Conclusion
Although NIV is increasingly used in bronquiolitis, 40% of our patients required IMV. We also highlight the fact that half of the children had comorbidities, which is according to the literature.
Presenter of 2 Presentations
EXPERIENCE ON POSTOPERATIVE PAEDIATRIC CARDIAC SURGERY IN A PORTUGUESE PAEDIATRIC INTENSIVE CARE UNIT
Abstract
Background
Advances in cardiac surgery over the last few decades, including corrective operations in early life, have dramatically increased the survival of children, particularly those with congenital heart disease.
Objectives
To describe the evolution of patients undergoing cardiac surgery in a Portuguese Paediatric Intensive Care Unit (PICU).
Methods
Retrospective study through databasis of children admitted in PICU in the postoperative period of cardiac surgery, from January 2017 to August 2018.
Results
There were 91 hospitalizations; one of the patients was hospitalized two times in this period. Of 90 patients, 54,4% were male, mean age was 4,27 years [1 month to 18 years]. In this population, 93,3% had congenital heart disease, the most frequent were ventricular and atrial septal defect and Fallot tetralogy; 42,9% had history of another comorbidities and 20,9% have made other cardiac surgeries in the past. Median time of surgery was 287,5 minutes [45-1083min]. In postoperative period, 64,8% were intubated and 27,5% had non-invasive ventilation, with mean duration of mechanical ventilation of 7,8 days. Vasoactive drugs were needed in 48,4% and pacing device in 15,4%; 2 patients needed cardioversion and other 2 patients needed ECMO support. Complications were seen in 50,5%, the most frequent were respiratory and hematologic, and 8,8% of patients required peritoneal dialysis. Deferred closure of the chest was made in 4,4% and 8,8% were reoperated, with one of this patients undergoing heart transplantation. Mortality rate was 2,2% in 20 months of study.
Conclusion
Children undergoing cardiac surgery constitute a high-risk population, justifying a multidisciplinary, differentiated and integrated approach.
WEAPON RELATED TRAUMA IN A PEDIATRIC INTENSIVE CARE UNIT
Abstract
Background
Trauma in Portugal continues to be one of the main causes of death in children and adolescents. Yet, there is a shortage of population-based studies about weapon related trauma in our country.
Objectives
To describe patients hospitalized for weapon related trauma in a Portuguese Pediatric Intensive Care Unit.
Methods
Retrospective study through clinical processes analysis of hospitalized cases for a period of 10 years (January 2006 to December 2017).
Results
Were included 9 cases, 88,9% were male and mean age was 11,3 years. A firearm was used in 66.6% and a white weapon in the remaining cases, 44.4% happened at home, mainly on weekend. Two cases were suicide attempts while in the others the aggressor was either a friend, family or a neighbor. In 5 cases the aggression was intentional, 55,6% the injury was in the head, whereas the rest was in abdomen, back or neck. During hospitalization, all patients were intubated, 5 underwent surgery and 4 required inotropic and transfusional support. Median length of stay was 14,5 days. Overall mortality was 22,2%, corresponding to a 5 and a 14-year-old male, both with severe traumatic brain injury. Of those two patients, Pediatric Risk of Mortality calculated through PRIM III score was 29 and 30 and probability of death was 0.597 and 0.673, respectively. One patient persisted with major sequels and one with minor.
Conclusion
Weapon injuries in children can be associated with severe adverse outcomes including death, which makes this a significant public health problem and a focus to prevention measures in risk groups.