Treatments for multi-system inflammatory syndrome in children - discharge, fever, and second-line therapies.

Scarce evidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analyzed the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, the probability of switching to second-line treatment over time, and the persistence of fever 2 days after treatment. We did a retrospective study to investigate the effect of different treatments on children with MIS-C from 1 March 2020 to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Thirty of 132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p = 0.013), but with a higher probability of needing second-line therapy compared to IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p = 0.028). Patients on IVIG had a higher likelihood of persistent fever than patients on steroids (odds ratio [OR] 4.23, 95% CI 1.43-13.5, p = 0.011) or on IVIG plus steroids (OR 4.4, 95% CI 2.05-9.82, p < 0.001). No differences were found for this endpoint between steroids or steroids plus IVIG.    Conclusions: The benefits of each approach may vary depending on the outcome assessed. IVIG seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever, and combination therapy reduced the need for escalating treatment. What is Known: • Steroids plus intravenous immunoglobulin, compared with intravenous immunoglobulin alone for multi-system inflammatory syndrome (MIS-C) might reduce the need for hemodynamic support and the duration of fever, but the certainty of the evidence is low. What is New: • Intravenous immunoglobulin, steroids, and their combination for MIS-C may have different outcomes. • In this study, intravenous immunoglobulin increased the probability of discharge over time, steroids reduced persistent fever, while combination therapy reduced the need for second-line treatments.

A brief history of crystalloids: the origin of the controversy.

Fluid resuscitation with crystalloids has been used in humans for more than 100 years. In patients with trauma, sepsis or shock of any etiology, they can help modify the clinical course of the illness. However, these solutions are medications which are not side-effect free. Recently, they have been questioned in terms of quantity (fluid overload) and their composition. The most frequently used crystalloids, both in high and low-income countries, are 0.9% normal saline (NS) and Ringer's lactate. The first descriptions of the use of sodium and water solutions in humans date from the cholera epidemic which spread throughout Europe in 1831. The composition of the fluids used by medical pioneers at that time differs greatly from the 0.9% NS used routinely today. The term "physiological solution" referred to fluids which did not cause red blood cell hemolysis in amphibians in in vitro studies years later. 0.9% NS has an acid pH, a more than 40% higher chloride concentration than plasma and a strong ion difference of zero, leading many researchers to consider it an unbalanced solution. In many observational studies and clinical trials, this 0.9% NS composition has been associated with multiple microcirculation and immune response complications, acute kidney injury, and worse clinical outcomes. Ringer's lactate has less sodium than plasma, as well as other electrolytes which can cause problems in patients with traumatic brain injury. This review provides a brief summary of the most important historical aspects of the origin of the most frequently used intravenous crystalloids today.

Admission, discharge and triage guidelines for paediatric intensive care units in Spain. / Guias de ingreso, alta y triage para las unidades de cuidados intensivos pediátricos en España.

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.

[Admission, discharge and triage guidelines for paediatric intensive care units in Spain]. / Guias de ingreso, alta y triage para las unidades de cuidados intensivos pediátricos en España.

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition.

[Spanish translation and validation of the EMPATHIC-30 questionnaire to measure parental satisfaction in intensive care units]. / Traducción y validación al español del cuestionario EMPATHIC-30 para medir la satisfacción de los padres en cuidados intensivos.

INTRODUCTION: Few validated surveys measuring parental satisfaction in the Paediatric Intensive Care Unit (PICU) are available, and none of them in Spanish language. The aim of this study is to translate and validate the questionnaire EMpowerment of PArents in THe Intensive Care (EMPATHIC). This questionnaire measures parental perceptions of paediatric intensive care-related satisfaction items in the Spanish language. MATERIAL AND METHODS: A prospective cohort study was carried out using questionnaires completed by relatives of children (range 0-17 years old) admitted into a tertiary PICU. Inclusion criteria were a length of stay more than 24h, and a suitable understanding of Spanish language by parents or guardians. Exclusion criteria were re-admissions and deceased patients. The questionnaire was translated from English to Spanish language using a standardised procedure, after which it was used in a cross-sectional observational study was performed to confirm its validity and consistency. Reliability was estimated using Cronbach's α, and content validity using Spearman's correlation analysis. RESULTS: A total of 150 questionnaires were collected. A Cronbach's α was obtained for domains greater than 0.7, showing a high internal consistency from the questionnaire. Validity was measured by correlating 5 domains with 4 general satisfaction items, documenting an adequate correlation (Rs: 0.41-0.66, P<.05). CONCLUSIONS: The Spanish version of EMPHATIC 30 is a feasible, easy, and suitable tool in this specific environment, based on the results. EMPATHIC 30 is able to measure parental satisfaction, and may serve as a valid indicator to measure quality of care in Spanish PICUs.

Guías de ingreso, alta y triage para las unidades de cuidados intensivos pediátricos en España / Admission, discharge and triage guidelines for paediatric intensive care units in Spain

La unidad de cuidados intensivos pediátricos (UCIP) es una unidad física asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediátricos quienes debido su gravedad o condiciones potencialmente letales requieren observación y asistencia médica intensiva integral y continua por un equipo médico que haya obtenido competencia especial en medicina intensiva pediátrica. La aplicación oportuna de terapia intensiva a los pacientes críticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos críticos, la Asociación Española de Pediatría (AEP), la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guías de ingreso, alta y triage para las UCIP en España. Mediante la aplicación de estas guías se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediátricos reciban el nivel de cuidados médicos más apropiado para su situación clínica

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous intensive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition

Guias de ingreso, alta y triage para las unidades de cuidados intensivos pediátricos en España / Admission, discharge and triage guidelines for paediatric intensive care units in Spain

La unidad de cuidados intensivos pediátricos (UCIP) es una unidad física asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediátricos quienes debido su gravedad o condiciones potencialmente letales requieren observación y asistencia médica intensiva integral y continua por un equipo médico que haya obtenido competencia especial en medicina intensiva pediátrica. La aplicación oportuna de terapia intensiva a los pacientes críticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del más alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitación de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediátricos críticos, la Asociación Española de Pediatría (AEP), la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP) y la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guías de ingreso, alta y triage para las UCIP en España. Mediante la aplicación de estas guías se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediátricos reciban el nivel de cuidados médicos más apropiado para su situación clínica

A paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical condition

Traducción y validación al español del cuestionario EMPATHIC-30 para medir la satisfacción de los padres en cuidados intensivos / Spanish translation and validation of the EMPATHIC-30 questionnaire to measure parental satisfaction in intensive care units

INTRODUCCIÓN: Existen pocas encuestas validadas para medir la satisfacción de los padres en las Unidades de Cuidados Intensivos Pediátricos (UCIP) y ninguna de ellas en idioma español. El objetivo de este estudio es traducir el cuestionario EMpowerment of PArents in THe Intensive Care (EMPATHIC), que mide la satisfacción y experiencias de los padres, a la lengua española y validarlo. MATERIAL Y MÉTODOS: Estudio prospectivo, realizado en la UCIP de un hospital terciario mediante encuestas a los familiares de pacientes ingresados (de entre 0 y 17 años). Los criterios de inclusión fueron una estancia mayor de 24 h y una buena comprensión del idioma de los padres/tutores. Los criterios de exclusión fueron los reingresos y los pacientes fallecidos. Se realizó la traducción del cuestionario mediante un procedimiento estandarizado. Tras la traducción, se hizo un estudio observacional transversal para confirmar su validez y consistencia. La fiabilidad se estimó mediante el alfa de Cronbach y la validez de contenido mediante el análisis de correlación de Spearman. RESULTADOS: Se reunieron 150 encuestas. El α de Cronbach por dominios se situó por encima de 0,7, lo que indica una alta consistencia interna del cuestionario. La validez fue medida correlacionando los 5 dominios con los 4 ítems de satisfacción general, lo que demostró una correlación adecuada (rs: 0,41-0,66; p < 0,05). CONCLUSIONES: Basados en estos resultados, la adaptación del EMPHATIC-30 a la cultura e idioma español es un instrumento válido, de fácil cumplimentación y adecuado para el entorno estudiado, capaz de medir la satisfacción de los padres y de servir como guía para mejorar la calidad de la atención en las UCIP españolas

INTRODUCTION: Few validated surveys measuring parental satisfaction in the Paediatric Intensive Care Unit (PICU) are available, and none of them in Spanish language. The aim of this study is to translate and validate the questionnaire EMpowerment of PArents in THe Intensive Care (EMPATHIC). This questionnaire measures parental perceptions of paediatric intensive care-related satisfaction items in the Spanish language. MATERIAL AND METHODS: A prospective cohort study was carried out using questionnaires completed by relatives of children (range 0-17 years old) admitted into a tertiary PICU. Inclusion criteria were a length of stay more than 24h, and a suitable understanding of Spanish language by parents or guardians. Exclusion criteria were re-admissions and deceased patients. The questionnaire was translated from English to Spanish language using a standardised procedure, after which it was used in a cross-sectional observational study was performed to confirm its validity and consistency. Reliability was estimated using Cronbach's α, and content validity using Spearman's correlation analysis. RESULTS: A total of 150 questionnaires were collected. A Cronbach's α was obtained for domains greater than 0.7, showing a high internal consistency from the questionnaire. Validity was measured by correlating 5 domains with 4 general satisfaction items, documenting an adequate correlation (Rs: 0.41-0.66, P < .05). CONCLUSIONS: The Spanish version of EMPHATIC 30 is a feasible, easy, and suitable tool in this specific environment, based on the results. EMPATHIC 30 is able to measure parental satisfaction, and may serve as a valid indicator to measure quality of care in Spanish PICUs