Background

The optimal amounts of protein in critically ill infants are unknown.

Objectives

To study the effect of three different amounts of protein intake on protein balance in critically ill infants following cardiac surgery.

Methods

A randomized controlled open-label trial including infants between 1-24 months old was performed. Patients were randomized to receive: 1) standard diet (1.7 g protein/100 mL), 2) protein-enriched (2.6 g/100 mL), 3) high-protein enriched (5.1 g/100 mL). Blood and urine biochemical determinations, and nitrogen balance were performed during the first day of feeding and between the days 3 to 5.

Results

22 infants were included. Increase in total proteins, retinol-binding-protein, transferrin and nitrogen balance was higher in group 3. However, only a significant increase was observed in total protein in group 1, retinol and transferrin in group 3 and nitrogen balance in groups 1 and 2 (table). 1 patient of group 2 and 2 patients of group 3 presented urea increase higher than 80 mg/dl.

Conclusion

A higher protein intake was associated with higher increase of serum protein levels in infants following cardiac surgery. However, high-protein enriched diet could not be tolerated by some patients.

Background

Microcirculatory compartment involves those small blood vessels (below 20 micrometers) in which substance and gas exchange takes place between blood and tissue cells. Microcirculatory disturbances have been independently linked to adverse outcomes in critically ill patients. Although functioning of the microcirculatory compartment has been clearly linked to systemic hemodynamics, in certain clinical conditions, uncoupling of micro and macrocirculation might lead to tissue hypoperfusion and organ failure. Thus, in critically ill children, it is very important to guarantee both, adequate systemic and microcirculatory blood flow.

Microcirculation has been mostly evaluated using different indirect methods: from physical examination with determination of the temperature gradient or capillary refill time, to determination of different biochemical markers of tissue perfusion. In the last years introduction of different generations of hand-held videomicroscopy devices has allowed direct evaluation of different microcirculatory parameters.

Objectives

Main objective of the presentation is to discuss existing evidence about the use of different microcirculatory evaluation methods.

We will make special focus discussing last recommendations existing on microcirculatory evaluation using hand-held videomicroscopy devices, but also we will discuss applications and existing recommendations of microcirculatory evaluation in different critical clinical situations.

Methods

Revision of currently existing evidence of the aplication of microcirculatory evaluation in the management of pediatric critically ill patients and existing microcirculatory evaluation recommendations.

Results

We will review different aspects of the topic.

Conclusion

Adequate microcirculatory functioning is crucial to guarantee organ functioning in critically ill pediatric patients. Evaluation of microcirculation is possible using different techniques. Some of them have specific recommendations about their clinical use.

Background

The optimal amounts of protein in critically ill infants are unknown.

Objectives

To study the effect of three different amounts of protein intake on protein balance in critically ill infants following cardiac surgery.

Methods

A randomized controlled open-label trial including infants between 1-24 months old was performed. Patients were randomized to receive: 1) standard diet (1.7 g protein/100 mL), 2) protein-enriched (2.6 g/100 mL), 3) high-protein enriched (5.1 g/100 mL). Blood and urine biochemical determinations, and nitrogen balance were performed during the first day of feeding and between the days 3 to 5.

Results

22 infants were included. Increase in total proteins, retinol-binding-protein, transferrin and nitrogen balance was higher in group 3. However, only a significant increase was observed in total protein in group 1, retinol and transferrin in group 3 and nitrogen balance in groups 1 and 2 (table). 1 patient of group 2 and 2 patients of group 3 presented urea increase higher than 80 mg/dl.

Conclusion

A higher protein intake was associated with higher increase of serum protein levels in infants following cardiac surgery. However, high-protein enriched diet could not be tolerated by some patients.