The Bispectral Index (BIS) is a system used to measure sedation levels. Some investigators recently analyzed changes in the BIS during natural sleep in adults and found that the BIS diminished considerably as sleep became deeper. No such studies have been undertaken to investigate changes in the BIS in sleeping children. The aim of this work was to assess the trend of the BIS in the various stages of sleep in a group of children, performing a descriptive analysis on a limited number of cases. We evaluated 15 children with negative clinical findings and a normal electroencephalogram (EEG) as part of their follow-up for prior episodes of epilepsy, recording the BIS and EEG in a waking state, in the various stages of sleep and on reawaking. For each stage, the mean value, the standard deviation, and the range of BIS values were calculated. The results showed that the BIS decreased progressively as sleep became deeper. The correlation between the stage of sleep and the BIS was significant. On reawaking, a slow increase was apparent in the BIS.
The level of care provided nowadays to children admitted to adult ICUs in Italy is similar to that provided by Italian PICUs 10 years earlier. On the other hand, there is evidence that Italian PICUs have improved the level of care in the same period. These findings, if confirmed, suggest a better quality of care for children admitted to PICUs as compared to adult ICUs and support the indication, when possible, of early referral to more specialized units in countries where paediatric intensive care is not centralised.
Sedation and analgesia are priority issues in the management of critically ill children. None of the numerous drugs available is ideal and the protocols currently used in clinical practice involve the combined use of different drugs. There is currently no shared and validated approach as to which is the most effective and safest sedoanalgesic regimen in critically ill children.
(English) Sonographic cardiac evaluation of newborns with suspected aortic coarctation (AoC) should tend to demonstrate a good phasic and pulsatile flow and the absence of pressure gradient along a normally conformed aortic arch from the modified left parasternal and suprasternal echocardiographic views; these findings, however, may not necessarily rule out a more distal coarctation in the descending aorta. For this reason, the sonographic exam of newborns with suspected AoC should always include a Doppler evaluation of abdominal aortic blood flow from the subcostal view. Occasionally, however, a clearly pulsatile Doppler flow trace in abdominal aorta may be difficult to obtain due to the bad insonation angle existing between the probe and the vessel. In such suboptimal ultrasonic alignment situation, the use of Tissue Doppler Imaging instead of classic Doppler flow imaging may reveal a preserved aortic pulsatility by sampling the aortic wall motion induced by normal flow. We propose to take advantage of the TDI pattern as a surrogate of a normal pulsatile Doppler flow trace in abdominal aorta when the latter is difficult to obtain due to malalignment with the insonated vessel.Keywords Tissue Doppler Imaging Á Neonatology Á Aortic coarctation Á Newborn Á Pediatric cardiology Á Echocardiography Abstract (Italian) La valutazione ecocardiografica del neonato con sospetta coartazione aortica deve poter dimostrare, dalle proiezioni parasternale sinistra alta e soprasternale, un arco aortico normoconformato con traccia Doppler normale (flusso fasico) in assenza di gradiente transistmico; tali rilievi, tuttavia, non escludono la possibilità di una coartazione aortica più distale, sita in aorta discendente toracica. Per tale motivo, la valutazione ecografica neonatale nel sospetto di coartazione aortica deve sempre includere un'analisi Doppler del flusso in aorta discendente, visualizzata tramite approccio sottocostale. Talvolta, tuttavia, l'angolo che si viene a creare tra il fascio ultrasonoro e il vaso a questo livello può risultare subottimale ai fini di un adeguato campionamento Doppler che dimostri la presenza di flusso fasico e privo di run-off diastolico in aorta addominale. In tale situazione di allineamento non ottimale per l'analisi Doppler classica, la metodica TDI (Tissue Doppler Imaging) può rivelare una preservata pulsatilità aortica tramite l'analisi della motilità di parete del vaso indotta dal normale flusso fasico. Tale metodica di valutazione della pulsatilità di parete aortica potrebbe, se validata attraverso studi di numerosità adeguata sul neonato sano, rappresentare un adeguato surrogato di una traccia Doppler normale in aorta addominale nei casi in cui quest'ultima fosse difficoltosa da ottenere a causa di un malallineamento tra il vaso ed il fascio ultrasonoro esplorante.
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