Aspectos clinicos, laboratoriais, evolutivos e fatores associados ao obito em crianças com diarreia aguda e choque internadas em unidade de terapia intensiva




Objective: To relate clinical signs, epidemiology, evaluative and laboratory data about acute diarrhea and shock in children, to conftont the evolution of clinical and laboratory data between the patients who survive and those who do not and identify the risk factors for death in children with acute diarrhea and shock admitted in Pediatric Intensive Care Unit. Methods: A descriptive and retrospective study, in 71 children admitted consecutively in Pediatric Intensive Care of HC-UNICAMP, from 02/1994 until 12/1998. The clinical, epidemiological and laboratorial data at admission were ana1yzed and the groups of patients who survive (56) and do not survive (15) were compared. The Mann-Whitney test (p=0,05) was used. For continuous variables, the Chi-Square test was used and for categorical variables, the Fisher s Exact test, for values lower than five. Results: The patients age ranged from 0 to 14 months (median, 3 months), 33 children were female and 38 were male. Low birth weight was found in 18,1% and the media time of breast-feeding was 1,1 month. The average length of stay was 5,6 days. The average weight gain, in percentage, was 7,7% and the solution utilized in hydration was crystalloid (63,4%). 73,2% of the children needed mechanical ventilation. The use of vasoactive drugs and sodium bicarbonate was necessary in 32,9% and 21,1 %, respectively. The deaths were high (22,1 %) and 4 deaths occurred in the first 24 hours after admission. The sodium and potassium seric levels and hemoglobin at admission ranged from 107 to 169 mEq/L, 0,9 to 7,4 mEq/L and 4,4 to 16,6 g/L, respectively. 93% of children used antibiotics and the main one was amicacyn (95,4%). Gram-negative bacteria were the principal microorganisms found in cultures (3 in blood and 17 in feces) with emphasis to Enteropathogenic E. coli. The average time of breast-feeding was 1,92 months in the non-survival group and 1,67 months in the survival group. The use of sodium bicarbonate showed an association with the risk of death, this association was observed with the variables percentage of weight gain, use of vasoactive drugs, colloid solution and mechanical ventilation. Conclusions: The acute diarrhea and shock occurred mainly in lactents under 3 months with severe clinical laboratorial presentation. The difficulty to reverse the clinical picture, the aggressive management and the high lethality may be correlated with the association of the sepsis and the hypovelemia. The high risk of death in children with acute diarrhea and shock was related with the dehydratation grade and the support management used in critical patients. There were no risk factors for deaths, neither clinical nor laboratorial, in the patients admission


septicemia lactentes desidratação infantil

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