Multicenter validation of PIM3 and PIM2 in Brazilian pediatric intensive care units.

Objective: To validate the PIM3 score in Brazilian PICUs and compare its performance with the PIM2. Methods: Observational, retrospective, multicenter study, including patients younger than 16 years old admitted consecutively from October 2013 to September 2019. We assessed the Standardized Mortality Ratio (SMR), the discrimination capability (using the area under the receiver operating characteristic curve - AUROC), and the calibration. To assess the calibration, we used the calibration belt, which is a curve that represents the correlation of predicted and observed values and their 95% Confidence Interval (CI) through all the risk ranges. We also analyzed the performance of both scores in three periods: 2013-2015, 2015-2017, and 2017-2019. Results: 41,541 patients from 22 PICUs were included. Most patients aged less than 24 months (58.4%) and were admitted for medical conditions (88.6%) (respiratory conditions = 53.8%). Invasive mechanical ventilation was used in 5.8%. The median PICU length of stay was three days (IQR, 2-5), and the observed mortality was 1.8% (763 deaths). The predicted mortality by PIM3 was 1.8% (SMR 1.00; 95% CI 0.94-1.08) and by PIM2 was 2.1% (SMR 0.90; 95% CI 0.83-0.96). Both scores had good discrimination (PIM3 AUROC = 0.88 and PIM2 AUROC = 0.89). In calibration analysis, both scores overestimated mortality in the 0%-3% risk range, PIM3 tended to underestimate mortality in medium-risk patients (9%-46% risk range), and PIM2 also overestimated mortality in high-risk patients (70%-100% mortality risk). Conclusions: Both scores had a good discrimination ability but poor calibration in different ranges, which deteriorated over time in the population studied.

The care of a child with multiple trauma and severe anemia who was a Jehovah's Witness.

Jehovah's Witness followers do not accept blood derived transfusions and available methods for avoiding transfusion have been used with degrees of success, demonstrating that the probability of death after trauma in these patients may not be significantly different from religious groups. In this report, we describe the case of a child victim of a multiple trauma with severe anemia due to blood loss, whose family would not authorize blood transfusion because of their Jehovah's Witness faith. We discuss the current indications for restricting transfusion, as well as highlighting new tools that contribute to the success of minimizing blood loss, thus avoiding transfusion.

Infecção no período pós-operatório de cirurgia cardíaca / Infection in postoperative cardiac surgery

Apesar do emprego profilático de antibióticos, as taxas de infecção no período pós-operatório de cirurgia cardíaca variam de 10,71 a 13,30, envolvendo agentes que diferem de serviço a serviço. O presente estudo teve como objetivo investigar a taxa de infecção no período pós-operatório de cirurgia cardíaca e os tipos de agentes encontrados em nosso serviço, no período de junho de 1994 a janeiro de 1996, permitindo uma descrição dos dados encontrados em neste serviço e a comparação com os outros centros. Embora este serviço não atenda apenas pacientes submetidos à cirurgia cardíaca, a taxa de infecção encontrada não difere daquelas esperadas

Meningite por Streptococcus pneumoniae de evoluçäo clínica desfavorável a terapeutica com cefalosporinas / Streptococcus pneumoniae meningitis with bad clinical evoluation treated with cephalosporins

Relatamos o caso de um lactente com um mês de idade portador de miningite por Streptococcus pneumoniae de evoluçäo clínica desfavorável, sendo o agente sensível in vitro ao ceftriaxone, porém resistente in vivo. Comentamos a antibioticoterapia baseada nos testes de sensibilidade e sugerimos a associaçäo de antibióticos de largo espectro desde o início do tratamento, objetivando evitar sequelas neurológicas graves