RESUMO
OBJECTIVES: To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). DESIGN: Secondary analysis of a prospective cohort. SETTING: PICUs in centers that are part of the LARed Network between April 2017 and January 2022. PARTICIPANTS: Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. RESULTS: 1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21). CONCLUSIONS: Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay.
Assuntos
Respiração Artificial , Insuficiência Respiratória , Recém-Nascido , Humanos , Criança , Lactente , Estudos de Coortes , Estudos Prospectivos , Hospitalização , Unidades de Terapia Intensiva Pediátrica , Insuficiência Respiratória/terapiaRESUMO
Neuromuscular complications in paediatric patients with severe coronavirus disease 2019 (COVID-19) are poorly characterised. However, adult patients with severe COVID-19 reportedly present with frequent neuromuscular complications that mainly include critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and focal neuropathies. We examined the records of all paediatric patients with severe COVID-19 who were mechanically ventilated and experienced neuromuscular complications from our single tertiary centre between March 2020 and August 2021. During this period, 4/36 (11%) patients admitted to the paediatric ICU who were mechanically ventilated experienced neuromuscular complications (one CIM, two focal neuropathies, and one CIP associated with plexopathy). In three of them, the gamma genetic variant of SARS-CoV-2 was identified. At the 4-5 month follow-up, three of our patients exhibited slight clinical improvement. We conclude that paediatric patients with severe COVID-19 may present neuromuscular complications similar to adults (11%), and their medium-term prognosis seems unfavourable.
Assuntos
COVID-19 , Doenças Musculares , Doenças do Sistema Nervoso Periférico , Polineuropatias , Adulto , COVID-19/complicações , Criança , Estado Terminal , Seguimentos , Humanos , Unidades de Terapia Intensiva , Doenças Musculares/complicações , Doenças do Sistema Nervoso Periférico/complicações , Polineuropatias/complicações , SARS-CoV-2Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Saúde Global , Unidades de Terapia Intensiva Pediátrica/organização & administração , Pandemias/estatística & dados numéricos , Pneumonia Viral/terapia , Síndrome Respiratória Aguda Grave/terapia , Adolescente , COVID-19 , Criança , Pré-Escolar , Chile , Estudos de Coortes , Colômbia , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Estado Terminal/mortalidade , Estado Terminal/terapia , Quimioterapia Combinada , Feminino , Mortalidade Hospitalar , Humanos , Internacionalidade , Itália , Masculino , Pediatria/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Respiração Artificial/métodos , Estudos Retrospectivos , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/mortalidade , Espanha , Estados UnidosRESUMO
OBJECTIVES: It is currently recommended that after return of spontaneous circulation following cardiac arrest, fever should be prevented using TTM through a servo-controlled system. This technology is not yet available in many global settings, where manual physical measures without servo-control is the only option. Our aim was to compare feasibility, safety and quality assurance of servo-controlled system versus no servo-controlled system cooling, TTM protocols for cooling, maintenance and rewarming following return of spontaneous circulation after cardiac arrest in children. DESIGN: Prospective, multicenter, nonrandomized, study. SETTING: PICUs of 20 hospitals in South America, Spain, and Italy, 2012-2014. PATIENTS: Under 18 years old with a cardiac arrest longer than 2 minutes, in coma and surviving to PICU admission requiring mechanical ventilation were included. METHODS: TTM to 32-34°C was performed by prospectively designed protocol across 20 centers, with either servo-controlled system or no servo-controlled system methods, depending on servo-controlled system availability. We analyzed clinical data, cardiac arrest, temperature, mechanical ventilation duration, length of hospitalization, complications, survival, and neurologic outcomes at 6 months. PRIMARY OUTCOME: feasibility, safety and quality assurance of the cooling technique and secondary outcome: survival and Pediatric Cerebral Performance Category at 6 months. MEASUREMENTS AND MAIN RESULTS: Seventy patients were recruited, 51 of 70 TTM (72.8%) with servo-controlled system. TTM induction, maintenance, and rewarming were feasible in both groups. Servo-controlled system was more effective than no servo-controlled system in maintaining TTM (69 vs 60%; p = 0.004). Servo-controlled system had fewer temperatures above 38.1°C during the 5 days of TTM (0.1% vs 2.9%; p < 0.001). No differences in mortality, complications, length of mechanical ventilation and of stay, or neurologic sequelae were found between the two groups. CONCLUSIONS: TTM protocol (for cooling, maintenance and rewarming) following return of spontaneous circulation after cardiac arrest in children was feasible and safe with both servo-controlled system and no servo-controlled system techniques. Achieving, maintaining, and rewarming within protocol targets were more effective with servo-controlled system versus no servo-controlled system techniques.
Assuntos
Reanimação Cardiopulmonar/métodos , Protocolos Clínicos/normas , Parada Cardíaca/terapia , Hipotermia Induzida/métodos , Hipotermia Induzida/normas , Adolescente , Temperatura Corporal , Criança , Pré-Escolar , Europa (Continente) , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Estudos Prospectivos , Reaquecimento/métodos , América do SulRESUMO
La bronquiolitis obliterante (BO) es un síndrome clínico poco frecuente en niños, caracterizado por la obstrucción crónica al flujo de aire asociado a cambios inflamatorios y distintos grados de fibrosis en la vía aérea pequeña. Si bien existen muchas etiologías, la causa mas frecuente se asocia a infeccionesrespiratorias virales, principalmente adenovirus. No existe un consenso para establecer su diagnóstico; sin embargo, se considera un espectro de síntomas persistentes asociados a un patrón en mosaico, bronquiectasias y atelectasias persistentes. El rol de la biopsia pulmonar ha sido cuestionado por subajo rendimiento, invasividad y complicaciones. No existe un tratamiento específico por lo que elmanejo es soporte. Probablemente la mejor estrategia constituya el empleo de antibióticos en forma agresiva, soporte kinésico y nutricional constante y una precoz rehabilitación pulmonar. Estas guías clínicas representan un esfuerzo multidisciplinario, basado en evidencias actuales para brindarherramientas prácticas para el diagnóstico y cuidado de niños y adolescentes con BO post infecciosa.
Assuntos
Humanos , Adolescente , Criança , Bronquiolite Obliterante/diagnóstico , Bronquiolite Obliterante/terapia , Pneumologia/normas , Bronquiolite Obliterante/etiologia , Infecções Bacterianas/complicações , Viroses/complicaçõesRESUMO
Se trataron 15 pacientes con el diagnóstico clínico y ecográfico de Absceso tubo-ovárico mediante antibioterapia sistémica y punción guiada por ultrasonografía: transvaginal (12 casos) y transabdominal (3 casos). En 8 casos existió el antecedente de uso de Dispositivo Intrauterino (DIU). El volumen de los abscesos osciló entre 56 y 475 cc. La evolución clínica fue satisfactoria en 14 casos. Una paciente, diabética insulino dependiente, requirió tratamiento quirúrgico. El promedio de hospitalización postpunción fue de 4 días en los casos existosos, con remisión rápida de la sintomatología, evitando la intervención quirúrgica