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Abstract To evaluate the hemodynamic effects and the safety profile of fluid bolus resuscitation with hypertonic saline albumin (HSA) in critically ill children, we performed a prospective observational pilot study between October 2018 and May 2021 in the pediatric intensive care unit (PICU) in a tertiary hospital in Madrid, Spain. Sixty-four HSA boluses were analyzed in 23 patients. A mean volume of 5.7 ml/kg (Standard Deviation, SD 2.3 ml/kg) per bolus was infused. Acute hypotension was the main indication. 91% of the patients had a cardiac disease, 56% of them had undergone cardiac surgery in the previous 72 h, and 47.8% associated right ventricular dysfunction. A significant increase in systolic, mean, and diastolic blood pressure and a decrease in the vasoactive index was observed after the infusion of HSA. This effect lasted for twenty-four hours (p

ABSTRACTCashew (Anacardium occidentale L.) plays an important role in global agriculture, particularly in commercializing the cashew kernel. Nevertheless, kernel extraction poses a challenge due to the nut variable shape and size. Characterizing the properties of the cashew nut becomes a pivotal input for the advancement of processes and machinery. This work presents a comprehensive characterization of raw and steamed cashew nuts from Puerto Carreño, Colombia, with focus on morphological, physical, and mechanical properties. Cashew nut samples from different farms in the region were collected. Morphological properties, including size and shape, were analyzed by measuring length, width, and thickness for 100 nuts from each supplier, both in their raw state and after steaming. Geometric diameter and sphericity were calculated, and qualitative shape characterization was performed. Physical properties, such as mass, bulk density, true density, and moisture content, were also measured. Angle of repose and coefficient of friction were determined to assess flow and frictional behavior. Additionally, compressive mechanical properties were evaluated through uniaxial compression testing along three orientations. The findings indicated significant differences in morphological and mechanical properties between raw and steamed cashew nuts. Conversely, the results demonstrated that cashew nuts from Vichada region exhibit a noteworthy degree of dispersion and larger dimensions than those from Asia and Africa, comparable to those from Brazil. The findings guide machinery design in the cashew industry and offer insights into the physical, morphological, and mechanical properties of cashew nuts in Puerto Carreño, contributing to understanding and enabling quality assessment, processing optimization, and product development.

Background/objective This study aimed to explore physical literacy (PL) using the Canadian Assessment of Physical Literacy, second edition (CAPL-2), adapt it to the Spanish context and provide evidence of its validity for use in Spanish children aged 8–12.Methods A total of 280 students (150 girls, mean age 10.5±0.9 years) from Extremadura (Spain) completed the CAPL-2. Means and SDs were used to present CAPL-2 scores according to age and sex, as well as frequencies to place participants at different PL levels. Confirmatory factor analysis (CFA) was conducted to establish the best model fit for the data.Results The median PL of Spanish children was progressing, and girls had a lower PL than boys for all ages except 12 years. The results supported a four-domain model for the CAPL-2 Spanish version and reported good fit indices after CFA (χ2 per df ratio=1.118; P (χ2)=0.256; root mean square error of approximation=0.021; comparative fit index=0.987; Tuker-Lewis index=0.991; normed fit index=0.895).Conclusion The CAPL-2 model is a valid and reliable instrument for Spanish children aged 8–12. It represents the first tool that assesses PL in Spanish children, covering the domains of motivation and confidence, physical competence, knowledge and understanding, and daily behaviour. It may be relevant for all professionals related to physical activity, education and the health field.

Introduction and objectives: No studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350 + E) for constipation in critically ill children. Methods: We conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72 h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350 + E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances). Results: The sample included 56 patients with a mean age of 48.2 ± 11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350 + E and 12 (21.4%) with rectal enemas. The proportion of patients that responded well to treatment was greater in the PEG 3350 + E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P = .151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350 + E was more effective in children aged less than 2 years (100%) compared to older children (100% vs 65.4%; P

Alzheimer’s disease is the most common type of dementia, severely affecting the families and caregivers who live with those affected. The aim was to explore the physical, psychological, and behavioral benefits for caregivers of people with Alzheimer’s disease. Fifteen semi-structured interviews were conducted with informal Alzheimer’s caregivers upon completion of the program. Following a discussion on the topics, categories, and codes among the researchers, a consensus was reached to obtain the final themes and categories. Three main categories were obtained: (1) perceived benefits by the participants; (2) applicability of the knowledge; and (3) proposals for improvement. Participants expressed having perceived improvements in their ability to manage emotions and cope with the situation created by the disease, physical capacity, and in their relationships. In this sense, the application of the contents addressed during the intervention became a fundamental tool for the participants’ daily lives. This study showed how an interdisciplinary intervention with psychological sessions, health education, and physical activities could be beneficial for improving both the physical and mental health of caregivers.

Abstract A secondary analysis of a randomized study was performed to study the relationship between volumetric capnography (VCAP) and arterial CO2 partial pressure (PCO2) during cardiopulmonary resuscitation (CPR) and to analyze the ability of these parameters to predict the return of spontaneous circulation (ROSC) in a pediatric animal model of asphyxial cardiac arrest (CA). Asphyxial CA was induced by sedation, muscle relaxation and extubation. CPR was started 2 min after CA occurred. Airway management was performed with early endotracheal intubation or bag-mask ventilation, according to randomization group. CPR was continued until ROSC or 24 min of resuscitation. End-tidal carbon dioxide (EtCO2), CO2 production (VCO2), and EtCO2/VCO2/kg ratio were continuously recorded. Seventy-nine piglets were included, 26 (32.9%) of whom achieved ROSC. EtCO2 was the best predictor of ROSC (AUC 0.72, p < 0.01 and optimal cutoff point of 21.6 mmHg). No statistical differences were obtained regarding VCO2, VCO2/kg and EtCO2/VCO2/kg ratios. VCO2 and VCO2/kg showed an inverse correlation with PCO2, with a higher correlation coefficient as resuscitation progressed. EtCO2 also had an inverse correlation with PCO2 from minute 18 to 24 of resuscitation. Our findings suggest that EtCO2 is the best VCAP-derived parameter for predicting ROSC. EtCO2 and VCO2 showed an inverse correlation with PCO2. Therefore, these parameters are not adequate to measure ventilation during CPR.

La evaluación de resultados de aprendizaje de programa es actualmente un tema con importante auge en aplicación para la educación superior en Colombia debido a los requisitos normativos; sin embargo, hay muy poca información sobre cómo planear dicha evaluación. Analizando la información disponible, se 233 Signos, Investigación en Sistemas de GestiónISSN: 2145-1389 | e -ISSN: 2463-1140 | http://doi.org/10.15332/24631140Vol. 15 N.º 1 | enero-junio del 2023 propone una metodología para la planeación de la evaluación de los resultados de aprendizaje de programa teniendo en cuenta el contexto internacional relacionado y los requisitos normativos a nivel nacional para la gestión de la calidad de la educación superior. Se presenta un ejemplo de planeación, usando la metodología propuesta, y se proyecta cómo al analizar los resultados se puede retroalimentar el proceso completo. Desarrollar un plan de evaluación anterior a la implementación con sus respectivas pruebas preliminares usando herramientas tecnológicas adecuadas y adaptadas, permitió identificar aspectos relevantes, y, consecuentemente, generar la información requerida que posibilite la realización de ciclos de mejora continua.

Physical activity (PL) is essential to achieve good health, prevent cardiovascular diseases, obesity and overweight, as well as to achieve a better quality of life. Therefore, PL could become the tool to increase the practice of physical activity among young people, thus increasing life satisfaction (LS) given its positive relationship with physical activity. A single-measure cross-sectional correlational study was carried out, involving 135 children aged 8–12 years from Extremadura. They were administered the SWLS questionnaire and the Canadian assessment of physical literacy (CAPL-2). Significantly higher levels of PL (p = 0.010) were found in normal-weight children compared to overweight and obese children, due to the physical competence domain score (p < 0.001). PL was directly related to SWLS (p < 0.001), but inversely related to BMI (p = 0.018). The daily physical activity behaviour domain was explained by SWLS (p < 0.001) and sex (p < 0.001). Physical competence was described by SWLS (p < 0.001) and BMI (p = 0.045). Finally, the motivation and confidence domain were only significantly associated with SWLS (p < 0.001). It was concluded that boys and girls of normal weight achieved higher levels of PL and LS than those with overweight and obesity, establishing a negative relationship of PL with BMI and positive with LS.

Abstract To compare the effect on the recovery of spontaneous circulation (ROSC) of early endotracheal intubation (ETI) versus bag-mask ventilation (BMV), and expiratory real-time tidal volume (VTe) feedback (TVF) ventilation versus without feedback or standard ventilation (SV) in a pediatric animal model of asphyxial cardiac arrest. Piglets were randomized into five groups: 1: ETI and TVF ventilation (10 ml/kg); 2: ETI and TVF (7 ml/kg); 3: ETI and SV; 4: BMV and TVF (10 ml/kg) and 5: BMV and SV. Thirty breaths-per-minute guided by metronome were given. ROSC, pCO2, pO2, EtCO2 and VTe were compared among groups. Seventy-nine piglets (11.3 ± 1.2 kg) were included. Twenty-six (32.9%) achieved ROSC. Survival was non-significantly higher in ETI (40.4%) than BMV groups (21.9%), p = 0.08. No differences in ROSC were found between TVF and SV groups (30.0% versus 34.7%, p = 0.67). ETI groups presented lower pCO2, and higher pO2, EtCO2 and VTe than BMV groups (p

Regular physical activity (PA) is an essential component of maintaining good health, thereby improving the physical and psychological well-being of the population. PA performed during childhood and adolescence can have repercussions in adulthood, contributing to the prevention of chronic activities and improving quality of life. Given its high relationship with PA, physical literacy could play a crucial role in valuing and participating in a physically active lifestyle, thus addressing low rates of PA participation from an early age. This bibliometric analysis provides a globalized view of physical literacy (PL) and its relationship with health, pathologies, prevention, or intervention among children and adolescents. Publications registered on Web of Science were analyzed using bibliometrics based on data from 141 documents published between 2014 and 2022, while the VOSviewer software v. 1.6.18. was used for the processing and visualization of the data and metadata. The results show an exponential growth in scientific research over the last 8 years, with an accumulation of documents in four journals and a distribution of publications spanning thirty-seven countries and regions. The network of researchers consists of 500 researchers, with the largest number of publications corresponding to 18 co-authors with at least 5 publications. The principal purpose of this research was to identify the most prolific co-authors, most-cited journals and co-authors, and the most relevant keywords.

Abstract Objective To evaluate the results and quality of pediatric cardiopulmonary resuscitation (CPR) instructor training courses. Methods A retrospective analysis was performed of the results of 24 pediatric CPR instructor courses held over 21 years (1999 to 2019). The results of participants’ evaluation of theory and practice sessions were analyzed. In addition, participants were asked to answer an anonymous survey to assess their opinion on the quality of theory and practice lessons, course organization and methodology, and instructor training. The results were compared by professional groups. Results A total of 560 participants completed the instructor course. Of them, 554 passed theory and practice tests (98.9 %). The mean score obtained in theory tests was 9.2 (0.8) out of 10. The mean score obtained in all practice tests was > 3.5 out of 5. Participants evaluated all the aspects of the course (theory and practice content, organization, teaching methodology, and instructors) with mean scores over 8 out of 10. Conclusions Specific pediatric and neonatal CPR instructor courses are a cornerstone in the process of CPR training and ensuring the homogeneity and quality of training. Most of the participants obtained the qualification of instructors and their evaluation of the course was very positive.

Abstract Background Cardiovascular instability is common in critically ill children. There is a scarcity of published high-quality studies to develop meaningful evidence-based hemodynamic monitoring guidelines and hence, with the exception of management of shock, currently there are no published guidelines for hemodynamic monitoring in children. The European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Cardiovascular Dynamics section aimed to provide expert consensus recommendations on hemodynamic monitoring in critically ill children. Methods Creation of a panel of experts in cardiovascular hemodynamic assessment and hemodynamic monitoring and review of relevant literature—a literature search was performed, and recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. The AGREE statement was followed to prepare this document. Results Of 100 suggested recommendations across 12 subgroups concerning hemodynamic monitoring in critically ill children, 72 reached “strong agreement,” 20 “weak agreement,” and 2 had “no agreement.” Six statements were considered as redundant after rephrasing of statements following the first round of voting. The agreed 72 recommendations were then coalesced into 36 detailing four key areas of hemodynamic monitoring in the main manuscript. Due to a lack of published evidence to develop evidence-based guidelines, most of the recommendations are based upon expert consensus. Conclusions These expert consensus-based recommendations may be used to guide clinical practice for hemodynamic monitoring in critically ill children, and they may serve as a basis for highlighting gaps in the knowledge base to guide further research in hemodynamic monitoring.

Abstract Objectives To analyze a training program in accident prevention and care and Pediatric Basic Cardiopulmonary Resuscitation taught by medical students. Results Medical students were trained as instructors. Four courses of were launched in Honduras, and the results were analyzed through a theoretical and practical evaluation and an anonymous survey. The volunteer experience for the students and the benefits to the population were positively valued. 37 students received the training. The score in the initial theoretical evaluation was 5.9 of 17 and in the final 10.5, p

Physical Activity (PA) could contribute to decreasing psychological distress and improving Self-Perceived Health (SPH) in adults with Asthma. The main objective of this study was to analyse the associations between the Physical Activity Level (PAL) Perceived Social Support (PSS) and Mental Health, using the Goldberg General Health Questionnaire (GHQ-12), and SPH in the adult population with Asthma. This descriptive cross-sectional study is based on data from the 2017 Spanish National Health Survey, including 1040 participants with Asthma in the study. The Kruskal–Wallis test was performed to study the hypothetical differences between the PAL and the different variables derived from the GHQ-12. In addition, correlations between the variables generated and the items of the GHQ-12, together with the PAL and the Duke-UNC-11, were analysed using Spearman’s rho correlation coefficients. Inverse correlations were found between Mental Health and PSS (rho: −0.351) and between Mental Health and PAL (rho: −0.209), as well as in the rest of the GHQ-12 items: successful coping (rho: −0.197), self-esteem (rho: −0.193) and stress (rho: −0.145). The more active subjects had better SPH. Therefore, the research showed how higher PAL and positive SPH are related to lower psychological distress in adults with Asthma.

Abstract Background Nutritional support is essential in the care of critically ill children since malnutrition in this population is associated with increased morbidity and mortality. Injury in patients admitted to pediatric intensive care units (PICU) results in a catabolic state and augmented protein breakdown, leading to a negative protein balance. Current recommendations about protein prescription in the PICU are fundamentally based on expert opinions, and the minimum threshold is 1.5 g/kg per day of protein, although protein needs could be higher in certain subgroups of patients. The main objectives of the present study are to examine whether the administration of a protein-enriched infant formula increases the serum levels of total proteins, albumin, prealbumin, transferrin, and retinol and improves nitrogen balance and to analyze the effect of the high-protein diet on energy expenditure. A secondary objective is to register possible secondary effects of the protein-enriched diet. Methods A multicenter prospective randomized controlled trial (RCT) will be performed in three hospitals. Patients meeting inclusion criteria will be randomly allocated to one of three enteral feeding formulae with different protein contents. Blood and urine test, nitrogen balance assessment, and energy expenditure testing by indirect calorimetry will be performed at the beginning of the nutrition regimen and at 24 h, 72 h and 5–7 days after initiation. The sample size for this trial is estimated to be 90 participants (about 30 participants in each group). The data analysis will be by intention to treat. Discussion This RCT will provide new data about the amount of protein needed to improve levels of serum protein and nitrogen balance, a surrogate of protein balance, in critically ill infants receiving enteral nutrition. Trial registration ClinicalTrials.gov identifier: NCT03901742. Registered April 1, 2019 – Retrospectively registered.

Abstract Background To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. Methods A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. Instructors from each country participated in the development of the next group in the following country. Paediatric Basic Life Support (BLS), Paediatric Intermediate (ILS) and Paediatric Advanced (ALS) courses were organized in each country adapted to local characteristics. Results Five Paediatric Resuscitation groups were created sequentially in Honduras (2), Guatemala, Dominican Republican and Mexico. During 5 years, 6 instructors courses (94 students), 64 Paediatric BLS Courses (1409 students), 29 Paediatrics ILS courses (626 students) and 89 Paediatric ALS courses (1804 students) were given. At the end of the program all five groups are autonomous and organize their own instructor courses. Conclusions Training of autonomous Paediatric CPR groups with the collaboration and scientific assessment of an expert group is a good model program to develop Paediatric CPR training in low- and middle income countries. Participation of groups of different countries in the educational activities is an important method to establish a cooperation network.

Background: Congenital heart disease (CHD) is one of the main causes of morbidity and mortality in children. Microcirculatory changes in CHD patients have previously been investigated using a variety of techniques. Handheld videomicroscopy enables non-invasive direct visualization of the microcirculatory bed. The aim of our study was to determine if there are microcirculatory differences among CHD patients based on age and the presence of cyanosis.Methods: A prospective observational study was carried out. Patients with CHD undergoing corrective surgery were evaluated after anesthetic induction prior to surgery. Microcirculation was evaluated using sidestream dark field (SDF) imaging. Hemodynamics and respiratory, biochemical, and tissue perfusion parameters were analyzed.Results: A total of 30 patients were included, of whom 14 were classified as cyanotic and 16 as non-cyanotic. Cyanotic patients had a higher total vessel density (TVD) (p = 0.016), small vessel density (p = 0.004), and perfused small vessel density (p = 0.013), while their microvascular flow index (MFI) was lower (p = 0.013). After adjustment for age and PaO2, cyanotic patients showed increased TVD (p = 0.023), and small vessel density (p = 0.025) compared to non-cyanotic patients but there were no differences on the MFI. Age was directly correlated with total MFI (spearman's rho = 0.499, p = 0.005) and small vessel MFI (spearman's rho = 0.420, p = 0.021). After adjustment for the type of CHD (cyanotic vs. non-cyanotic) patients with MFI and small MFI vessels

IntroductionThere are no studies comparing synchronized and non-synchronized ventilation with bag-valve mask ventilation (BVMV) during cardiopulmonary resuscitation (CPR) in pediatric patients. The main aim is to compare between synchronized and non-synchronized BVMV with chest compressions (CC), and between guided and non-guided CC with a real-time feedback-device in a pediatric animal model of asphyxial cardiac arrest (CA). The secondary aim is to analyze the quality of CC during resuscitation.Methods60 piglets were randomized for CPR into four groups: Group A: guided-CC and synchronized ventilation; Group B: guided-CC and non-synchronized ventilation; Group C: non-guided CC and synchronized ventilation; Group D: non-guided CC and non-synchronized ventilation. Return of spontaneous circulation (ROSC), hemodynamic and respiratory parameters, and quality of CC were compared between all groups.Results60 piglets were included. Twenty-six (46.5%) achieved ROSC: A (46.7%), B (66.7%), C (26.7%) and D (33.3%). Survival rates were higher in group B than in groups A+C+D (66.7% vs 35.6%, p = 0.035). ROSC was higher with guided-CC (A+B 56.7% vs C+D 30%, p = 0.037). Piglets receiving non-synchronized ventilation did not show different rates of ROSC than synchronized ventilation (B+D 50% vs A+C 36.7%, p = 0.297). Non-synchronized groups showed lower arterial pCO2 after 3 minutes of CPR than synchronized groups: 57 vs 71 mmHg, p = 0.019. No differences were found in arterial pH and pO2, mean arterial pressure (MAP) or cerebral blood flow between groups. Chest compressions were shallower in surviving than in non-surviving piglets (4.7 vs 5.1 cm, p = 0.047). There was a negative correlation between time without CC and MAP (r = -0.35, p = 0.038).ConclusionsThe group receiving non-synchronized ventilation and guided-CC obtained significantly higher ROSC rates than the other modalities of resuscitation. Guided-CC achieved higher ROSC rates than non-guided CC. Non-synchronized ventilation was associated with better ventilation parameters, with no differences in hemodynamics or cerebral flow.

[This corrects the article DOI: 10.1371/journal.pone.0149013.].

Chest compressions (CC) during cardiopulmonary resuscitation are not sufficiently effective in many circumstances. Mechanical CC could be more effective than manual CC, but there are no studies comparing both techniques in children. The objective of this study was to compare the effectiveness of manual and mechanical chest compressions with Thumper device in a pediatric cardiac arrest animal model.An experimental model of asphyxial cardiac arrest (CA) in 50 piglets (mean weight 9.6 kg) was used. Animals were randomized to receive either manual CC or mechanical CC using a pediatric piston chest compressions device (Life-Stat®, Michigan Instruments). Mean arterial pressure (MAP), arterial blood gases and end-tidal CO2 (etCO2) values were measured at 3, 9, 18 and 24 minutes after the beginning of resuscitation.There were no significant differences in MAP, DAP, arterial blood gases and etCO2 between chest compression techniques during CPR. Survival rate was higher in the manual CC (15 of 30 = 50%) than in the mechanical CC group (3 of 20 = 15%) p = 0.016. In the mechanical CC group there was a non significant higher incidence of haemorrhage through the endotracheal tube (45% vs 20%, p = 0.114).In a pediatric animal model of cardiac arrest, mechanical piston chest compressions produced lower survival rates than manual chest compressions, without any differences in hemodynamic and respiratory parameters.

OBJECTIVE:To design an experimental pediatric animal model of acute kidney injury induced by cisplatin. METHODS:Prospective comparative observational animal study in two different phases. Acute kidney injury was induced using three different doses of cisplatin (2, 3 and 5 mg/kg). The development of nephrotoxicity was assessed 2 to 4 days after cisplatin administration by estimating biochemical parameters, diuresis and renal morphology. Analytical values and renal morphology were compared between 15 piglets treated with cisplatin 3 mg/kg and 15 control piglets in the second phase of the study. RESULTS:41 piglets were studied. The dose of 3 mg/kg administered 48 hours before the experience induced a significant increase in serum creatinine and urea without an increase in potassium levels. Piglets treated with cisplatin 3 mg/kg had significantly higher values of creatinine, urea, phosphate and amylase, less diuresis and lower values of potassium, sodium and bicarbonate than control piglets. Histological findings showed evidence of a dose-dependent increase in renal damage. CONCLUSIONS:a dose of 3 mg/kg of cisplatin induces a significant alteration in renal function 48 hours after its administration, so it can be used as a pediatric animal model of non-oliguric acute kidney injury.

AIMS:Actual resuscitation guidelines recommend 10 respirations per minute (rpm) for advanced pediatric life support. This respiratory rate (RR) is much lower than what is physiological for children. The aim of this study is to compare changes in ventilation, oxygenation, haemodynamics and return of spontaneous circulation (ROSC) rates with three RR. METHODS:An experimental model of asphyxial cardiac arrest (CA) in 46 piglets (around 9.5 kg) was performed. Resuscitation with three different RR (10, 20 and 30 rpm) was carried out. Haemodynamics and gasometrical data were obtained at 3, 9, 18 and 24 minutes after beginning of resuscitation. Measurements were compared between the three groups. RESULTS:No statistical differences were found in ROSC rate between the three RR (37.5%, 46.6% and 60% in the 10, 20 and 30 rpm group respectively P = 0.51). 20 and 30 rpm groups had lower PaCO2 values than 10 rpm group at 3 minutes (58 and 55 mmHg vs 75 mmHg P = 0.08). 30 rpm group had higher PaO2 (61 mmHg) at 3 minutes than 20 and 10 rpm groups (53 and 45 mmHg P = 0.05). No significant differences were found in haemodynamics or tissue perfusion between hyperventilated (PaCO2 50 mmHg) animals. PaO2 was significantly higher in hyperventilated (PaO2 153 mmHg) than in normoventilated (79 mmHg) and hypoventilated (47 mmHg) piglets (P

In series of cases and animal models suffering hemorrhagic shock, the use of vasopressors has shown potential benefits regarding hemodynamics and tissue perfusion. Terlipressin is an analogue of vasopressin with a longer half-life that can be administered by bolus injection. We have previously observed that hypertonic albumin improves resuscitation following controlled hemorrhage in piglets. The aim of the present study was to analyze whether the treatment with the combination of terlipressin and hypertonic albumin can produce better hemodynamic and tissular perfusion parameters than normal saline or hypertonic albumin alone at early stages of hemorrhagic shock in an infant animal model.Experimental, randomized animal study including 39 2-to-3-month-old piglets. Thirty minutes after controlled 30 ml/kg bleed, pigs were randomized to receive either normal saline (NS) 30 ml/kg (n = 13), 5% albumin plus 3% hypertonic saline (AHS) 15 ml/kg (n = 13) or single bolus of terlipressin 15 μg/kg i.v. plus 5% albumin plus 3% hypertonic saline 15 ml/kg (TAHS) (n = 13) over 30 minutes. Global hemodynamic and tissular perfusion parameters were compared.After controlled bleed a significant decrease of blood pressure, cardiac index, central venous saturation, carotid and peripheral blood flow, brain saturation and an increase of heart rate, gastric PCO2 and lactate was observed. After treatment no significant differences in most hemodynamic (cardiac index, mean arterial pressure) and perfusion parameters (lactate, gastric PCO2, brain saturation, cutaneous blood flow) were observed between the three therapeutic groups. AHS and TAHS produced higher increase in stroke volume index and carotid blood flow than NS.In this pediatric animal model of hypovolemic shock, albumin plus hypertonic saline with or without terlipressin achieved similar hemodynamics and perfusion parameters than twice the volume of NS. Addition of terlipressin did not produce better results than AHS.