[Lower socioeconomic conditions are associated with higher rates but similar outcomes in Sepsis in children]. / Condiciones socioeconómicas más bajas se asocian con tasas de sepsis infantil más altas pero con resultados similares.

Sepsis is an important cause of pediatric morbidity and mortality, especially in low-income countries. Data on regional prevalence, mortality trends, and their relationship with socioeconomic variables are scarce. OBJECTIVE: to determine the regional prevalence, mortality, and sociodemographic situation of patients diagnosed with severe sepsis (SS) and septic shock (SSh) admitted to Pediatric Intensive Care Units (PICUs). PATIENTS AND METHOD: patients aged 1 to 216 months admitted to 47 participating PICUs with a diagnosis of SS or SSh between January 1, 2010, and December 31, 2018, were included. Secondary analysis was performed on the Argentine Society of Intensive Care Benchmarking Quality Program (SATI-Q) database for SS and SSh and a review of the annual reports of the Argentine Ministry of Health and the National Institute of Statistics and Census for the sociodemographic indices of the respective years. RESULTS: 45,480 admissions were recorded in 47 PICUs, 3,777 of them with a diagnosis of SS and SSh. The combined prevalence of SS and SSh decreased from 9.9% in 2010 to 6.6% in 2018. The combined mortality decreased from 34.5% to 23.5%. Multivariate analysis showed that the Odds ratio (OR) of the association between SS and SSh mortality was 1.88 (95% CI: 1.46-2.32) and 2.4 (95% CI: 2.16-2.66), respectively, adjusted for malignant disease, PIM2, and mechanical ventilation. The prevalence of SS and SSh in different health regions (HR) was associated with the percentage of poverty and infant mortality rate (p < 0.001). However, there was no association between sepsis mortality and HR adjusted for PIM2. CONCLUSIONS: Prevalence and mortality of SS and SSh have decreased over time in the participating PICUs. Lower socioeconomic conditions were associated with higher prevalence but similar sepsis outcomes.

High mortality in patients with influenza A pH1N1 2009 admitted to a pediatric intensive care unit: a predictive model of mortality.

OBJECTIVE: To describe the clinical characteristics and outcome of patients admitted to pediatric intensive care with influenza A (pH1N1) 2009 in Argentina. DESIGN: Retrospective observational study. SETTING: Thirteen pediatric intensive care units in Argentina. SUBJECTS: One hundred and forty-two patients with confirmed or suspected influenza A (H1N1). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 142 critically ill patients. The median age was 19 months (range, 2-110 months) with 39% of the patients <24 months of age. Ninety-nine patients (70%) had an underlying disease. Influenza A (pH1N1) 2009 infection was confirmed in 90 patients and the remaining 52 had a positive direct immunofluorescence assay for influenza A. The median length of stay in the pediatric intensive care unit was 12 days (range, 2-52 days). One hundred eighteen patients (83%) received invasive mechanical ventilation and 19 patients were treated with noninvasive ventilation; however, seven of the patients receiving noninvasive ventilation later needed mechanical ventilation. Sixty-eight patients died (47%) with the most frequent cause refractory hypoxemia. Multivariate logistic regression analysis showed that age <24 months (odds ratio, 2.87; 2.35-3.93), asthma (odds ratio, 1.34; 1.20-2.91), and respiratory coinfection with respiratory syncytial virus (odds ratio, 2.92; 1.20-4.10) were associated with higher mortality. As expected, mechanical ventilation and treatment with inotropes were also associated with increased mortality. CONCLUSIONS: The mortality of children admitted to the pediatric intensive care unit with 2009 pH1N1 influenza was high (47%) in our population. Age <24 months, asthma, respiratory coinfection, need of mechanical ventilation, and treatment with inotropes were predictors of poorer outcome.

Sepsis, sepsis severa y shock septico / Sepsis, severe sepsis and septic shock

La sepsis es un grave problema de salud en la población pediátrica, tanto en países subdesarrollados como industrializados. Sin embargo, es una enfermedad prevenible y tratable. La 70ª Asamblea Mundial de la Salud (AMS), llevada a cabo en mayo de 2017 en Ginebra, resolvió "Mejorar la prevención, el diagnóstico y la gestión de sepsis, haciendo de la sepsis una prioridad de salud mundial". Esto marca un salto cualitativo en la lucha global contra la sepsis. La comprensión de la epidemiología y la patogénesis de la sepsis, shock séptico y fallo multiorgánico en pediatría ha evolucionado con el conocimiento, mejorando la calidad y sobrevida de todos los niños, tanto sanos como crónicamente enfermos. Un estudio prospectivo observacional multicéntrico realizado en Unidades de Cuidados Intensivos Pediátricos de Sudamérica (LAPSES) mostró que la prevalencia de sepsis, sepsis severa y shock séptico era de 42,6%, 25,9% y 19,8% respectivamente, y la mortalidad asociada del 14,2%, aumentando considerablemente a mayor severidad del cuadro (4,4% para sepsis, 12,3% para sepsis severa y 23,1% para shock séptico). Esta actualización destaca la importancia de que el reconocimiento precoz y el tratamiento agresivo en los primeros 60 minutos en la sala de emergencia son una premisa básica y esencial en el manejo inicial de esta patología. Esta evidencia es concluyente, dado que modifica la evolución natural y el pronóstico de una patología potencialmente letal, sin la necesidad de la espera del ingreso en la unidad de cuidados intensivos

Sepsis is a serious health problem in the pediatric population, in both developing and industrialized countries; however, it is a preventable and treatable disease. The 70th World Health Assembly (WHA), held in May 2017 in Geneva, resolved to "Improve the prevention, diagnosis and management of sepsis", making sepsis a global health priority. This marks a quantum leap in the global fight against sepsis. The understanding of the epidemiology and pathogenesis of pediatric sepsis, septic shock, and multiple organ failure (MOF) has evolved with knowledge improving the quality of life and survival of all children, both healthy and chronically ill. A prospective multicenter observational study conducted conducted in Pediatric Intensive Care Units of South America (LAPSES) showed that the prevalence of sepsis, severe sepsis and septic shock were 42.6%, 25.9% and 19.8% respectively and sepsis related mortality was 14.2% and was consistently higher with increased disease severity (4.4% for sepsis, 12.3% for severe sepsis and 23.1% for septic shock). This update highlights the importance that early recognition and aggressive treatment in the first 60 minutes in the emergency room are essential in the initial management of this disease. This evidence is conclusive, modifying the natural history and the outcome of a potentially lethal disease, without waiting for the admission to the intensive care unit

Examen clínico objetivo estructurado (ECOE) / Clinical Exam Objective Structured (ECOE)

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Simulación de alta fidelidad en emergencias pediátricas como estrategia de formación en el posgrado / High fidelity simulation in pediatric emergencies as a training strategy in the graduate

Las emergencias pediátricas son poco frecuentes por lo que la enseñanza a través de la simulación se ha convertido en una estrategia metodológica valiosa que permite al médico enfrentarse a una situación similar a la realidad en un ambiente protegido y seguro, tanto para él como para el paciente.Describir los resultados de escenarios de alta fidelidad de emergencias pediátricas y el grado de satisfacción de los participantes.Participaron 81 alumnos en 11 jornadas.Los residentes logran realizar el manejo inicial de las emergencias, pero tienen dificultades con el tratamiento específico de cada algoritmo, la comunicación y el liderazgo, siendo éstos aspectos a reforzar.La mayoría de los residentes se mostraron totalmente satisfechos con la actividad, destacando en los comentarios el pedido de más simulaciones y cursos de habilidades psicosociales.

Pediatric emergencies are rare, so teaching through simulation has become a valuable methodological strategy that allows the doctor to face a situation similar to reality in a protected and safe environment, both for him and for the patient.Describe the results of high-fidelity scenarios of pediatric emergencies and the degree of satisfaction of the participants. 81 students participated in 11 days. Residents were ableto perform the initial management of emergencies, but have difficulties with the specific treatment of each algorithm, communication and leadership, these being aspects to be reinforced. Most of the residents were totally satisfied with the activity, highlighting in the comments the request for more simulations and psychosocial skills courses.