[Increase in severe acute respiratory infections in children during the last phase of the COVID-19 pandemic]. / Incremento de infecciones respiratorias agudas graves en niños durante la última etapa de la pandemia COVID-19.

OBJECTIVE: The COVID-19 pandemic has caused a variation in the circulation of respiratory pathogens. Our aim was to analyze the epidemiology of severe acute respiratory infections (SARI) in children during 3 years of the COVID-19 pandemic, in comparison with a previous period. METHODS: An observational study was conducted in a tertiary hospital in Spain, which analyzed the frequency and characteristics of patients admitted for SARI in the Pediatric Intensive Care Unit (PICU) during the COVID-19 pandemic (1 March 2020 to 28 February 2023), compared to pre-pandemic period (1 March 2017 to 29 February 2020). RESULTS: A total of 268 patients were included (59.6% males). The median age was 9.6 months (IQR 1.7 - 37). In the pre-pandemic period, there were 126 admissions with an average of 42 admissions/year. During the pandemic, there were 142 admissions, observing a significant reduction in admissions in the first year (12 admissions/year), in contrast to 82 admissions during the third year, which represented an increase of 95% compared to the average of admissions/year in pre-pandemic. In addition, in the last year there was evidence of an increase in viral coinfections in relation to pre-pandemic period (54.9% vs 39.7%; p=0.032). There were no differences in length of hospital stay or PICU stay. CONCLUSIONS: During the last year, coinciding with low rates of hospitalization for COVID in Spain, we observed a notable increase in admissions to the PICU for SARI. Probably, the prolonged period of low exposure to pathogens due to the measures adopted during the pandemic might have caused a decrease in population immunity with a rise in severe respiratory infections.

[Treatment of septic shock with continuous plasmafiltration and hemodiafiltration]. / Tratamiento del shock séptico con plasmafiltración y hemodiafiltración continuas simultáneas.

Despite recent therapeutic advances, mortality due to septic shock remains high. The most important causes of mortality are refractory shock, uncontrollable alterations of coagulation, and multiorgan failure. Some authors have proposed the early use of plasmafiltration and high flow hemodiafiltration for refractory septic shock. Most authors initiate treatment with a short session of plasmafiltration followed by continuous hemodiafiltration. A 13-year-old girl presented refractory meningococcal septic shock, disseminated intravascular coagulation, and acute renal failure unresponsive to volume expansion and high doses of adrenalin and noradrenaline. She received simultaneous treatment with plasmafiltration and continuous venovenous hemodiafiltration for 30 hours. Two pumps of extrarenal purification placed in parallel through the same double line catheter were used. Fast hemodynamic stabilization and control of the coagulopathy were achieved. The patient survived with progressive recovery of renal function but required amputation of the inferior left limb. Continuous plasmafiltration and venovenous hemodiafiltration can be used simultaneously for the treatment of older children with septic shock, severe coagulopathy, and hypervolemia.

Tratamiento del shock séptico con plasmafiltración y hemodiafiltración continuas simultáneas / Treatment of septic shock with continuous plasmafiltration and hemodiafiltration

A pesar de los avances terapéuticos recientes la mortalidad del shock séptico sigue siendo muy elevada. Las causas más importantes de mortalidad son el shock refractario, la alteración incontrolable de la coagulación y el fallo multiorgánico. Algunos autores han propuesto la utilización precoz de plasmafiltración y hemodiafiltración de elevado flujo como tratamiento del shock séptico refractario, realizando la mayoría la plasmafiltración en sesiones cortas y a continuación la hemodiafiltración de forma continua. Una niña de 13 años de edad presentó shock séptico meningocócico refractario a tratamiento con expansión y dosis elevadas de adrenalina y noradrenalina, coagulación intravascular diseminada (CID) e insuficiencia renal aguda. Se realizó tratamiento simultáneo con plasmafiltración y hemodiafiltración venovenosa continua durante 30 h, utilizando dos bombas de depuración extrarrenal colocadas en paralelo a través del mismo catéter de doble luz, consiguiendo una rápida estabilización hemodinámica y control de la coagulopatía. La paciente sobrevivió recuperando de manera progresiva la función renal, pero se tuvo que realizar amputación de miembro inferior izquierdo. La plasmafiltración continua y la hemodiafiltración venovenosa pueden utilizarse simultáneamente como tratamiento de niños mayores con shock séptico, coagulopatía e hipervolemia grave (AU)