[Pulse Oximetry Values in Preterm infants at 34-36 weeks postmenstrual age]. / Valores de Oximetría de Pulso en Prematuros a las 34-36 semanas post-concepcional.

Pulse oximetry (SpO2) is essential for guiding oxygen therapy in preterm infants. Data on SpO2 values before discharge are limited. OBJECTIVE: To establish SpO2 values in asymptomatic premature infants at 34, 35, and 36 weeks of postmenstrual age (PMA). SUBJECTS AND METHOD: Longitudinal, multicen ter study carried out from May 2018 to May 2019 in three neonatal intensive care units in Santiago, Chile (altitude 579 m) which included premature infants born ≤ 32 weeks of gestational age, healthy, with clinical stability, and without respiratory morbidity at the moment of the study or until dis charge. The following parameters were analyzed: mean accumulated SpO2 and SD, minimum SpO2 value, SpO2 time percentage < 90%, SpO2 time percentage < 80%, DI4, and DI80. Continuous over night SpO2 was obtained with Masimo Radical-7 or Rad-8 (USA), mean artifact-free-recording-time (AFRT) ≥ 6 hours. RESULTS: 101 SpO2 recordings were registered in 44, 33, and 24 studies at 34, 35, and 36 weeks of PMA, respectively, from 62 preterm infants, twenty-eight (45%) were male, median gestational age at birth 30 weeks (range 26-32), and median birth weight 1480 g (range 785-2700g). Oximetry variables were mean AFRT (± SD) 8.6 (± 1.5) hours; median mean SpO2 96.9% (range 93.3-99.3%); median minimum SpO2 74% (range 51-89%); median time of SpO2 < 90% 2% (range 0-10.6%); median time of SpO2 < 80% 0.1% (range 0-1.3%); median desaturation event ≥ 4% (DI4) within ≥ 10 seconds per hour sampled 15 (range 3.5-62.5); and median desaturation event <80% (DI80) 0.58 (range 0-10.8). We found no differences in SpO2 values between the different PMA wee ks. CONCLUSIONS: We described SpO2 values in very preterm infants, asymptomatic at 34-36 PMA weeks. These values could be used as a reference for guiding oxygen therapy.

Effects of the First Spontaneous Breathing Trial in Children With Tracheostomy and Long-Term Mechanical Ventilation.

BACKGROUND: Weaning and liberation from mechanical ventilation in pediatric patients with tracheostomy and long-term mechanical ventilation constitute a challenging process due to diagnosis heterogeneity and significant variability in the clinical condition. We aimed to evaluate the physiological response during the first attempt of a spontaneous breathing trial (SBT) and to compare variables in subjects who failed or passed the SBT. METHODS: This was a prospective observational study in tracheostomized children with long-term mechanical ventilation admitted to the Hospital Josefina Martinez, Santiago, Chile, between 2014-2020. Cardiorespiratory variables such as breathing pattern, use of accessory respiratory muscles, heart rate, breathing frequency, and oxygen saturation were registered at baseline and throughout a 2-h SBT with or without positive pressure depending on an SBT protocol. Comparison of demographic and ventilatory variables between groups (SBT failure and success) was performed. RESULTS: A total of 48 subjects were analyzed (median [IQR] age of 20.5 [17.0-35.0] months, 60% male). Chronic lung disease was the primary diagnosis in 60% of subjects. Eleven (23%) total subjects failed the SBT (< 2 h), with an average failure time of 69 ± 29 min. Subjects who failed the SBT had a significantly higher breathing frequency, heart rate, and end-tidal CO2 than subjects who succeeded (P < .001). In addition, subjects who failed the SBT had significantly shorter duration of mechanical ventilation before the SBT, higher proportion unassisted SBT, and higher rate of deviation SBT protocol in comparison with subjects who succeeded. CONCLUSIONS: Conducting an SBT to evaluate the tolerance and cardiorespiratory response in tracheostomized children with long-term mechanical ventilation is feasible. Time on mechanical ventilation before the first attempt and type of SBT (with or without positive pressure) could be associated with SBT failure.

Factors Associated With Accidental Decannulation in Tracheostomized Children.

BACKGROUND: Tracheostomy has many benefits for pediatric patients in the ICU, but it is also associated with complications. Accidental decannulation (AD) is a frequent complication and cause of mortality in this population. Our study aimed to determine the factors associated with AD in tracheostomized pediatric subjects. METHODS: This was a case-control study with 1:2 allocation ratio. Participants were tracheostomized children hospitalized in a prolonged mechanical ventilation hospital between 2013-2018. Each child who experienced decannulation during the study period was included as a case at the time of the event. Controls were obtained from the same population and were defined as subjects without an AD event during the same period. RESULTS: One hundred forty patients were hospitalized at Josefina Martinez Hospital at the time, of whom 41 were selected as cases and 82 as controls. Median (interquartile range) age was 20 (12-36) months, being 60% male. The median time from tracheostomy placement to AD event was 364 (167-731) d. Eighty-four percent of subjects were mechanically ventilated. AD mainly occurred by self-decannulation (53.7%). The risk of AD was higher in children who reached the midline in a sitting position (odds ratio 9.5 [95% CI 1.59-53.90]), inner diameter (ID) tracheostomy tube size ≤ 4.0 mm (odds ratio 5.18 [95% CI 1.41-19.06]), and who had been hospitalized in hospital rooms with a low ratio of nursing staff for each subject (1 nurse to 4 subjects) (odds ratio 4.48 [95% CI 1.19-16.80]). CONCLUSIONS: Factors associated with a higher risk of AD in tracheostomized children included the ability to reach the midline in a sitting position, the use of a smaller tracheostomy tube (≤ 4.0 mm ID), and lower supervision from staff.

[Pediatric tracheostomy: Ten year experience in an Intensive Care Unit]. / Traqueostomía en niños: Experiencia de 10 años en una Unidad de Cuidados Intensivos Pediátricos.

INTRODUCTION: Pediatric tracheostomy indications have changed over the last 30 years, from acute and transient pro cedures secondary to airway obstruction to programmed tracheostomies indicated due to the need for chronic use of mechanical ventilation (MV). OBJECTIVE: To describe indications and morbidity associated with pediatric tracheostomies during a ten-year period. PATIENTS AND METHODS: Descrip tive study. Clinical records review of discharged patients (< 15 years old) tracheostomized during their hospital stay between 2005 and 2015. Demographic and clinical variables were evaluated before and after tracheostomy, stay in intensive care unit, age at the time of the tracheostomy, indication of tracheostomy, early complications (< 7 days), late complications (> 7 days), and mortality. RESULTS: 59 children with tracheostomy were analyzed, 36 (59%) tracheostomies were performed in children under 6 months, and 39 (60%) in males. 23 (39%) had a confirmed or under study genopathy and 25 (42%) had congenital heart disease. The main indications for tracheostomy were 58% secondary to airway disease and 42% due to chronic use of MV. Within the airway disease group, subglottic steno sis, vocal cord paralysis, and tracheobronchomalacia were the principal reasons for indication, and in the group of chronic use of MV, the main causes were bronchopulmonary dysplasia and chronic lung disease. We did not find tracheostomy-related mortality. 89% of the patients were discharged with tracheostomy and 59% with chronic use of MV. The probability of being discharged with a tracheos tomy was higher in younger patients while the chronic use of MV at discharge was higher in patients with a greater number of extubation failures before tracheostomy. CONCLUSION: Tracheostomy is a safe procedure in children, where the predominant causes of indication are airway disease and the need for chronic use of MV. Most children with tracheostomies are discharged with tracheostomy and chronic use of MV. Younger children, those with difficult weaning, confirmed or suspected ge nopathy, or special health needs are at greater risk of needing tracheostomy and chronic use of MV.

Definición de displasia broncopulmonar propuesta por la Comisión Neo SOCHINEP / Definition of bronchopulmonary dysplasia proposed by the Neo SOCHINEP Commission

La displasia broncopulmonar (DBP) es la enfermedad crónica más frecuente del recién nacido prematuro. Los avances en su prevención y tratamiento han permitido una mayor sobrevida de prematuros más pequeños, pero su incidencia se ha mantenido estable en el tiempo, con una fisiopatología y presentación clínica que abarca un amplio espectro y que difiere de la DBP descrita originalmente hace más de 50 años. Aún existen controversias en su definición, la que se ha establecido en base al tratamiento, específicamente al requerimiento de soporte respiratorio. Las definiciones más utilizadas son el requerimiento de oxígeno por 28 días y a las 36 semanas de edad gestacional corregida (EGC). Recientemente se ha propuesto definirla en base al requerimiento de ventilación mecánica a las 36 semanas de EGC, lo que identificaría a los prematuros con DBP más grave y mayor probabilidad de complicaciones respiratorias y neurológicas en los 2 primeros años de vida. Nuestro objetivo en la comisión de Neo-SOCHINEP es el de recomendar la definición y clasificación que nos parece más adecuada para identificar a los prematuros portadores de DBP, considerando los aspectos fisiopatológicos, del compromiso de la función pulmonar y consecuencias prácticas de la definición en nuestro medio. También proponemos la definición del requerimiento de oxígeno en el prematuro cuando esta en neonatología, las condiciones e interpretación de la saturometría contínua cuando está pronto al alta y el seguimiento de la oxigenoterapia posterior al alta.

Bronchopulmonary dysplasia (BPD) is the most frequent chronic disease of the premature newborn. Advances in its prevention and treatment have allowed a greater survival of smaller preterm infants, but its incidence has remained stable over time, with a pathophysiology and clinical presentation that covers a wide spectrum and differs from the BPD originally described more than 50 years ago. There are still controversies in its definition, which has been established based on the treatment, specifically the requirement of respiratory support. The most used definitions are the oxygen requirement for 28 days and at 36 weeks of postmenstrual age (PMA). It has recently been proposed a definition based on the requirement of mechanical ventilation at 36 weeks of PMA, which would identify premature infants with more severe BPD and a greater probability of respiratory and neurological complications in the first 2 years of life. Our objective in the Neo-SOCHINEP commission is to recommend the definition and classification that we believe is most appropriate to identify premature infants with BPD, considering the pathophysiological aspects, the compromised lung function, and practical consequences of the definition in our medium. We also propose the definition of the oxygen requirement in premature infants when they are in neonatology, the conditions and interpretation of continuous saturation when they are soon discharged, and the follow-up of post-discharge oxygen therapy.

Función pulmonar: medición continua de la saturación del pulso arterial de oxígeno: propuesta para interpretación / Continuous measurement of oxygen arterial pulse saturation: an interpretation proposal

La medición continua de la saturación de pulso arterial de oxígeno (SpO2) es un método no invasivo, confiable y seguro. El consolidado permite obtener valores promedio de SpO2 y frecuencia cardiaca, gráficos y valores acumulados, rangos de valores de SpO2, que permiten definir si existe o no alguna alteración. Los avances tecnológicos han dado paso a la fabricación de equipos con alta exactitud de las mediciones, mediante algoritmos matemáticos que filtran los artefactos debido a movimientos y/o hipoperfusión. La ventaja, es una mayor precisión para determinar estados de hipoxemia en distintas situaciones clínicas. Las principales indicaciones en pediatría son la determinación de hipoxemia y titulación de oxígeno en niños con enfermedades que comprometen el sistema respiratorio, especialmente displasia broncopulmonar. También se usa como screening para apneas obstructivas del sueño en rango moderado a severo en situaciones en que no es posible realizar poligrafía o polisomnografía, dado la facilidad con la que se puede realizar la medición continua de SpO2 en domicilio u hospitalizado. En este artículo se describen características importantes del procedimiento, y se propone un esquema para ordenar su interpretación.

Continuous measurement of arterial oxygen saturation by pulse oximetry (SpO2) is a non-invasive, reliable, and safe method. The consolidated allows obtaining average values of SpO2 and heart rate, graphs and accumulated values, ranges of SpO2 values, which allow defining whether or not there is any alteration. Technological advances have given way to the manufacture of equipment with high measurement accuracy, using mathematical algorithms that filter artifacts due to movements and/or hypoperfusion. The main indications are the diagnosis of hypoxemia and titration of oxygen requirements in patients with chronic lung damage and other diseases that compromise the respiratory system. Also, it is used as screening of moderate to severe obstructive apneas when other sleep studies, such as polysomnography or polygraphy, are not available. It can be done at home or hospitalized. This article describes important characteristics of the procedure, and a scheme is proposed to order its interpretation.