Correlation between optic nerve sheath diameter and extracorporeal life support time.

INTRODUCTION: The objective of the study was to analyse the correlation between extracorporeal life support (ECLS) and aortic cross-clamp times and optic nerve sheath diameter (ONSD). PATIENTS AND METHODS: Study in a cohort of patients aged 0-15 years that underwent ECLS for cardiac surgery after obtention of signed informed consent. We calculated a sample size of 23 participants. First, we obtained 3 vertical and 3 horizontal measurements of the ONSD for each eye and calculated the mean of both eyes for each measurement to be used in the analysis. The measurements were made at admission and at 6 and 24 h post surgery. We retrieved the ECLS time and the aortic cross-clamp time were from the operative report. RESULTS: We analysed data for 23 participants, 52.2% female, with a median age of 14 months. The median ECLS time was 60 min; the median aortic cross-clamp time was 32 min. The median baseline ONSD was 3.1 mm. ONSD values had increased a median of 0.015 mm at 6 h post surgery (P = .03). We found a positive correlation between ECLS time and ONSD values (r = 0.476, P < 0,05). The ONSD values returned to baseline by 24 h post surgery. None of the patients developed signs or symptoms of increased intracranial pressure. CONCLUSION: Our study found a correlation between ECLS time and ONSD at 24 h post surgery. We found variations in the ONSD even in patients without signs or symptoms of increased ICP. Further research is required to identify the factors related to these variations.

[Correlation between optic nerve sheath diameter and extracorporeal life support time]. / Correlación del diámetro de la vaina del nervio óptico y el tiempo de circulación extracorpórea.

INTRODUCTION: The objective of the study was to analyse the correlation between extracorporeal life support (ECLS) and aortic cross-clamp times and optic nerve sheath diameter (ONSD). PATIENTS AND METHODS: Study in a cohort of patients aged 0 to 15 years that underwent ECLS for cardiac surgery after obtention of signed informed consent. We calculated a sample size of 23 participants. First, we obtained 3 vertical and 3 horizontal measurements of the ONSD for each eye and calculated the mean of both eyes for each measurement to be used in the analysis. The measurements were made at admission and at 6 and 24hours post surgery. We retrieved the ECLS time and the aortic cross-clamp time were from the operative report. RESULTS: We analysed data for 23 participants, 52.2% female, with a median age of 14 months. The median ECLS time was 60minutes; the median aortic cross-clamp time was 32minutes. The median baseline ONSD was 3.1mm. ONSD values had increased a median of 0.015mm at 6hours post surgery (P=.03). We found a positive correlation between ECLS time and ONSD values (r=0.476, p<,05). The ONSD values returned to baseline by 24hours post surgery. None of the patients developed signs or symptoms of increased intracranial pressure. CONCLUSION: Our study found a correlation between ECLS time and ONSD at 24hours post surgery. We found variations in the ONSD even in patients without signs or symptoms of increased increased intracranial pressure. Further research is required to identify the factors related to these variations.

[Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude]. / Factores asociados al fracaso de la terapia con cánulas nasales de alto flujo en pacientes pediátricos con insuficiencia respiratoria en dos unidades de cuidados críticos pediátricos a gran altitud.

INTRODUCTION: Acute respiratory failure is the leading cause of hospitalization in pediatrics. High-flow nasal cannulas (HFNCs) offer a new alternative, but the evidence and indications are still debated. The performance of HFNCs at high altitude has not been described to date. OBJECTIVE: To describe the use of HFNCs in pediatric patients admitted with respiratory failure and explore the factors associated with treatment failure. METHODOLOGY: A prospective cohort study was carried out in patients between 1 month and 18 years of age managed with HFNCs. The demographic and treatment response data were recorded at baseline and after 1, 6 and 24hours. The number of failures was determined, as well as the length of stay, complications and mortality. Patients with treatment failure were compared with the rest. RESULTS: A total of 539 patients were enrolled. Infants (70.9%) of male sex (58.4%) and airway diseases such as asthma and bronchiolitis (61.2%) were more frequent. There were 53 failures (9.8%), with 21 occurring in the first 24hours. The median length of stay was 4 days (IQR 4); there were 5 deaths (0.9%) and 13 adverse events (epistaxis) (2.2%). Improvement was observed in vital signs and severity over time, with differences in the group that failed, but without interactions. The final logistic model established an independent relationship of failure between the hospital (OR 2.78, 95%CI 1.48-5.21) and the initial respiratory rate (OR 1.56, 95%CI 1.21-2.01). CONCLUSIONS: HFNCs afford good clinical response, with few complications and a low failure rate. The differences found between institutions suggest a subjective relationship in the decision of therapy failure.

Clinical characteristics, prevalence, and factors related to delirium in children of 5 to 14 years of age admitted to intensive care. / Características clínicas, prevalencia y factores asociados al delirium en niños de 5 a 14 años de edad ingresados en cuidados intensivos.

OBJECTIVE: To evaluate the clinical characteristics, prevalence and factors associated with delirium in critical patients from 5 to 14 years of age. DESIGN: An analytical, cross-sectional observational study was made. Delirium was assessed with the Pediatric-Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU) and motor classification was established with the Delirium Rating Scale Revised-98. SETTING: A pediatric Intensive Care Unit. PATIENTS: All those admitted over a one-year period were assessed during the first 24-72h, or when possible in deeply sedated patients. EXCLUSION CRITERIA: Patients in stupor or coma, with severe communication difficulty, subjected to deep sedation throughout admission, and those with denied consent. RESULTS: Twenty-nine of the 156 assessed patients suffered delirium (18.6%) and 55.2% were hypoactive. The neurocognitive alterations evaluated by the pCAM-ICU were similar in the three motor groups. Intellectual disability (OR=17.54; 95%CI: 3.23-95.19), mechanical ventilation (OR=18.80; 95%CI: 4.29-82.28), liver failure (OR=54.88; 95%CI: 4.27-705.33), neurological disease (OR=4.41; 95%CI: 1.23-15.83), anticholinergic drug use (OR=3.23; 95%CI: 1.02-10.26), different psychotropic agents (OR=4.88; 95%CI: 1.42-16.73) and tachycardia (OR=4.74; 95%CI: 1.21-18.51) were associated to delirium according to the logistic regression analysis. CONCLUSION: The frequency of delirium and hypoactivity was high. It is therefore necessary to routinely evaluate patients with standardized instruments. All patients presented with important neurocognitive alterations. Several factors related with the physiopathology of delirium were associated to the diagnosis; some of them are modifiable through the rationalization of medical care.

Cuidados respiratorios en pacientes con atrofia muscular espinal para evitar el fallo ventilatorio agudo y la traqueostomía: revisión literaria y recomendaciones consensuadas / Respiratory care in patients with spinal muscular atrophy to avoid acute ventilatory failure and tracheostomy: literature review and consensus recommendations

La atrofia muscular espinal (AME) 5q es una de las enfermedades neuromusculares de mayor incidencia en la infancia. Sin embargo, la prevalencia de AME tipo 1, su forma más severa de presentación, es menor debido a muertes prematuras evitables antes de los dos años por insuficiencia ventilatoria subtratada. La irrupción de nuevos tratamientos modificadores de la enfermedad pueden cambiar dramáticamente este pronóstico y es una oportunidad para actualizar el manejo respiratorio, a través de cuidados estandarizados básicos, preferentemente no invasivos, abordando la debilidad de los músculos respiratorios, la insuficiencia tusígena y ventilatoria, con un enfoque preventivo. La siguiente revisión literaria entrega estrategias para evitar la intubación y la traqueostomía usando soporte ventilatorio no invasivo (SVN), reclutamiento de volumen pulmonar (RVP) y facilitación de la tos. Se analizan en detalle los protocolos de extubación en niños con AME tipo 1.

Spinal muscular atrophy (SMA) 5q is one of the neuromuscular diseases with the highest incidence in childhood. Nevertheless, the prevalence of its most severe form SMA1 is lower due to premature preventable deaths before two years of age related to ventilatory insufficiency undertreated. The emergence of new disease-modifying treatments can dramatically change this prognosis and is an opportunity to update respiratory management, through basic standardized care, mostly non-invasive, addressing respiratory muscles pump weakness, cough and ventilatory insufficiency with a preventive approach. This literature review provides consensus recommendations for strategies to avoid intubation and tracheostomy using noninvasive ventilatory support (NVS), lung volume recruitment (LVR), and cough facilitation. Extubation protocols in children with SMA type 1 are analyzed in detail.

Botulismo del lactante: estudio descriptivo en una unidad de cuidados intensivos pediátricos / Infant botulism: a descriptive study in a pediatric intensive care unit

Introducción. El botulismo del lactante (BL) es la forma más frecuente de botulismo humano en Argentina. El objetivo es describir aspectos esenciales del diagnóstico y tratamiento de pacientes con BL internados en el servicio de terapia intensiva pediátrica (STIP). Métodos. Estudio observacional, descriptivo y retrospectivo. Se utilizó la base de datos del STIP con diagnóstico de BL en el período 2005-2020. Se registraron variables demográficas, métodos de diagnóstico, días de asistencia respiratoria mecánica convencional (ARMC), de ventilación no invasiva (VNI), estadía en STIP, mortalidad al alta hospitalaria. Resultados. Se registraron 21 pacientes con BL; 14 pacientes fueron varones, con una mediana de edad de 5 meses (RIC 2-6 m). El diagnóstico se realizó mediante técnica de bioensayo y se detectó la toxina en suero en 12 pacientes. Uno solo no requirió ARMC; 1 paciente fue traqueostomizado; 18 pacientes recibieron antibióticos; 5 recibieron VNI. Ningún paciente recibió antitoxina y no hubo fallecidos. La mediana de estadía hospitalaria fue 66 días (RI: 42-76); de internación en STIP, 48 días (RI: 29-78); y de ARMC, 37 días (RI: 26-64). La demora en la confirmación diagnóstica fue 15,8 ± 4,8 días. Conclusiones. La totalidad de los pacientes fueron diagnosticados con la técnica de bioensayo, que generó un tiempo de demora diagnóstica que excede los lapsos recomendados para la administración del tratamiento específico. Ningún paciente recibió tratamiento específico. El BL presentó baja mortalidad, pero tiempos de ARM e internación prolongados, que se asocian a infecciones sobreagregadas y uso frecuente de antibióticos.

Introduction. Infant botulism (IB) is the most common form of human botulism in Argentina. Our objective was to describe the main aspects of diagnosis and management of patients with IB admitted to the pediatric intensive care unit (PICU). Methods. Observational, descriptive, and retrospective study. The PICU database with IB diagnosis in 2005­2020 period was used. Demographic variables, diagnostic methods, days of conventional mechanical ventilation (CMV), non-invasive ventilation (NIV), length of stay in the PICU and mortality upon hospital discharge were recorded. Results. In total, 21 patients with IB were recorded; 14 were male, their median age was 5 months (IQR: 2­6 m). Diagnosis was made by bioassay, and the toxin was identified in the serum of 12 patients. Only 1 patient did not require CMV; 1 patient had a tracheostomy; 18 patients received antibiotics; 5 received NIV. No patient was administered antitoxin and no patient died. The median length of stay in the hospital was 66 days (IQR: 42­76); in the PICU, 48 days (IQR: 29­78); and the median use of CMV, 37 days (IQR: 26­64). The delay until diagnostic confirmation was 15.8 ± 4.8 days. Conclusions. All patients were diagnosed using the bioassay technique, which resulted in a diagnostic delay that exceeds the recommended period for the administration of a specific treatment. No patient received a specific treatment. IB was related to a low mortality, but also to prolonged use of MV and length of hospital stay, which were associated with cross infections and frequent antibiotic use.

Perspectiva parental del cuidado humanizado de la Unidad de Cuidados Intensivos Pediátricos / Parental perspective of humanized care at the Paediatric Intensive Care Unit

Objetivo: describir el cuidado humanizado en Enfermería desde la perspectiva parental en la Unidad de Cuidados Intensivos Pediátricos (UCIP).Método: orientación fenomenológica de Husserl. Los participantes han sido progenitores de población infantil de entre 3 a 6 años ingresados en la UCIP en la Comunidad de Madrid. Se ha realizado un muestreo por conveniencia y bola de nieve con nueve participantes. La recopilación de datos ha sido mediante entrevistas semiestructuradas a partir de preguntas abiertas sobre temas de interés con una duración entre 40 y 50 minutos. El análisis de contenido se realizó siguiendo el método de Strauss y Corbin en tres fases.Resultados: se identificaron tres categorías: Disrupción del ingreso en la UCIP, Tiempo y espacio en la UCI Pediátricos y Atención enfermera en la UCIP. Los progenitores manifestaron un gran desconocimiento acerca de los cuidados y las labores realizadas en las unidades de cuidados intensivos antes del ingreso de sus hijos e hijas. En todos los casos sintieron miedo e incertidumbre. Los progenitores valoraron la constancia, el seguimiento exhaustivo y el apoyo emocional como una parte fundamental de los cuidados del personal de Enfermería en estas unidades.Conclusiones: todavía existe un desafío en la inclusión efectiva de los padres y hay una percepción insuficiente del apoyo del equipo de Enfermería hacia ellos y ellas. Se debe considerar incluir a las familias en los cuidados de sus hijos e hijas en una UCIP para disminuir el estrés y mejorar la percepción de la atención enfermera. (AU)

Objective: to describe the humanized Nursing care from the parental perspective at the Paediatric Intensive Care Unit (PICU).Method: husserlian-oriented descriptive phenomenological methodology. The participants were parents of the paediatric population (3-to-6 years old) admitted at the PICU in the Community of Madrid. Convenience and snowball sampling were conducted with nine participants. There was data collection through semistructured interviews based on open questions about topics of interest, with a duration between 40 and 50 minutes. Content analysis was conducted following the method in three stages by Strauss and Corbin.Results: three categories were identified: Disruption of admission at the PICU, Time and space at the Pediatric ICU, and Nursing care at the PICU. Parents showed a major lack of knowledge about the care and tasks conducted at the Intensive Care Units before their children were admitted. In all cases, they felt fear and uncertainty. Parents valued consistency, thorough follow-up and emotional support as an essential part of Nursing care in these units.Conclusions: the effective inclusion of parents still represents a challenge, and there is an insufficient perception of the support by the Nursing team towards them. It must be considered to include families in the care of their children at the PICU, in order to reduce stress and improve the perception of Nursing care. (AU)

Avaliação da gravidade (pim ii), funcionalidade (fss) e de desconforto respiratório (bsa) nos impactos e desfechos da internação hospitalar em utip / Assessment of severity (pim ii), functionality (fss) and of respiratory distress (bsa) in the impacts and outcomes of hospital admission in utip / Valoración de la gravedad (pim ii), funcionalidad (fss) y de la dificultad respiratoria (bsa) en los impactos y resultados del ingreso hospitalario en utip

Objetivo: identificar o perfil de admissões e o impacto nos desfechos de crianças internadas em uma terapia intensiva pediátrica e comparar os escores de gravidade, funcionalidade e de desconforto respiratório avaliados respectivamente pelas escalas (PIM II, FSS e BSA). Métodos: Estudo de caráter descritivo, retrospectivo, quantitativo de amostragem censitária. Ferramentas de avaliação: Pediatric Index of Mortality - PIM II, Functional Status Scoret -FSS, Boletim de Silverman-Andersen -BSA e avaliação de prontuários médicos e assistenciais. Resultados: 257 crianças menores de 12 anos foram incluídas no estudo durante todo o ano de 2019. A maioria 56% (n 143) eram menores de um ano e masculino 64 % (n 164) por causas respiratórias 60,05 % (n 155). A mortalidade foi de 9,8% (n 25), e a quantidade média de dias de ventilação mecânica foi de 4,57 dias ± 1,31. A idade não influenciou na quantidade de dias de ventilação mecânica (p<0.05), e o BSA avaliado isoladamente, não se associou a necessidade imediata de intubação (p<0.05), os pacientes do desfecho óbito ficaram em média 8,88 e ±13,04 dias internados, e no desfecho alta 4,73 ±6,63 dias. O PIM II pode ser utilizado para o risco de óbito (p <0,05) e valores maiores ou iguais a 21,58 % foram associados a óbitos e menores ou iguais a 6,65 % foram associados à alta. A FSS dos 257 pacientes na admissão foram: normal (147), disfunção leve (37), moderada (47) e grave (26); na alta hospitalar a FSS foi: normal (178), leve (21), moderada (25) e grave (8) mostrando que grau de funcionalidade normal e leve na admissão esta significativamente associado com a alta hospitalar (p< 0,001). Conclusão: O escore de gravidade PIM II foram compatíveis com os desfechos óbito ou alta, as variações no escore BSA para necessidade de ventilação mecânica não estão associados com a idade e com grau do escore. A funcionalidade mais adequada na admissão está associada ao desfecho alta, e os pacientes em sua maioria saem funcionais.

Objective: To identify the profile of admissions and the impact on outcomes of children admitted to a pediatric intensive care unit and to compare severity, functionality and respiratory distress scores assessed respectively by the scales (PIM II, FSS and BSA). Methods: This was a descriptive, retrospective, quantitative study with census sampling. Assessment tools: Pediatric Index of Mortality - PIM II, Functional Status Scoret -FSS, Silverman-Andersen Bulletin -BSA and assessment of medical and health care records. Results: 257 children under the age of 12 years were included in the study throughout 2019. The majority 56% (n 143) were under one year and male 64 % (n 164) from respiratory causes 60.05 % (n 155). Mortality was 9.8% (n 25), and the average amount of days on mechanical ventilation was 4.57 days ± 1.31. Age had no influence on the number of days of mechanical ventilation (p<0.05), and the BSA assessed alone was not associated with the immediate need for intubation (p<0.05), the patients in the outcome death were hospitalized for an average of 8.88 ±13.04 days, and in the discharge outcome 4.73 ±6.63 days. The PIM II can be used for the risk of death (p <0.05) and values greater than or equal to 21.58 % were associated with death and less than or equal to 6.65 % were associated with discharge. The FSS of the 257 patients at admission were: normal (147), mild (37), moderate (47) and severe (26) dysfunction; at hospital discharge the FSS was: normal (178), mild (21), moderate (25) and severe (8) showing that the degree of normal and mild functionality at admission was significantly associated with hospital discharge (p < 0.001). Conclusion: The PIM II severity scores were compatible with the outcomes death or discharge, the variations in BSA score for mechanical ventilation need were not associated with age and score level. The most adequate functionality at admission is associated with the outcome discharge, and most patients leave the hospital functional.

Objetivo: Identificar el perfil de ingreso y el impacto en los resultados de los niños ingresados en una unidad de cuidados intensivos pediátricos y comparar las puntuaciones de gravedad, funcionalidad y distrés respiratorio evaluadas respectivamente por las escalas (PIM II, FSS y BSA). Métodos: Se trató de un estudio descriptivo, retros- pectivo y cuantitativo con muestreo censal. Instrumentos de evaluación: Índice de Mor- talidad Pediátrica - PIM II, Functional Status Scoret -FSS, Boletín de Silverman-Ander- sen -BSA y evaluación de historias clínicas y asistenciales. Resultados: 257 niños meno- res de 12 años fueron incluidos en el estudio a lo largo de 2019. La mayoría 56% (n 143) eran menores de un año y varones 64% (n 164) de causas respiratorias 60,05% (n 155). La mortalidad fue del 9,8% (n 25) y la media de días con ventilación mecánica fue de 4,57 días ± 1,31. La edad no influyó en el número de días de ventilación mecánica (p<0,05), y el BSA evaluado por sí solo no se asoció con la necesidad inmediata de intu- bación (p<0,05), los pacientes en el resultado muerte estuvieron hospitalizados una media de 8,88 ±13,04 días, y en el resultado alta 4,73 ±6,63 días. El PIM II se puede utilizar para el riesgo de muerte (p <0,05) y los valores mayores o iguales a 21,58 % se asociaron con la muerte y menores o iguales a 6,65 % se asociaron con el alta. La SFS de los 257 pacientes al ingreso fue: normal (147), disfunción leve (37), moderada (47) y grave (26); al alta hospitalaria la SFS fue: normal (178), leve (21), moderada (25) y grave (8) mos- trando que el grado de funcionalidad normal y leve al ingreso se asoció significativamente con el alta hospitalaria (p < 0,001). Conclusiones: Las puntuaciones de gravedad del PIM II fueron compatibles con los resultados muerte o alta hospitalaria, las variaciones en la puntuación del BSA para la necesidad de ventilación mecánica no se asociaron con la edad y el nivel de puntuación. La funcionalidad más adecuada al ingreso se asocia con el resultado alta, y la mayoría de los pacientes salen del hospital funcionales.

Correlación del diámetro de la vaina del nervio óptico y el tiempo de circulación extracorpórea / Correlation between optic nerve sheath diameter and extracorporeal life support time

Introducción: El objetivo de este estudio es establecer la correlación entre los tiempos de circulación extracorpórea (CEC) y pinzamiento aórtico y el diámetro de la vaina del nervio óptico (DVNO). Pacientes y métodos: Se estudió una cohorte de pacientes con edad de 0 a 15 años, sometidos a cirugía cardíaca con CEC. Se calculó un tamaño muestral de 23 participantes. Primero se obtuvo el promedio de tres mediciones verticales y tres horizontales del DVNO. Después, se utilizó para los análisis la media de los valores de ambos ojos. Las mediciones ocurrieron al ingreso y a las 6 y 24 horas poscirugía. Los tiempos de CEC y pinzamiento aórtico se obtuvieron del informe quirúrgico. Resultados: Se analizaron datos de 23 participantes, el 52,2% mujeres, con edad mediana de 14 meses. La mediana del tiempo de CEC fue 60 minutos; la mediana de tiempo de pinzamiento aórtico fue 32 minutos. La mediana del DVNO basal fue 3,1mm. Los valores de DVNO aumentaron por una mediana de 0,015mm a las 6 horas poscirugía (p=0,03). Encontramos una correlación positiva entre el tiempo de CEC y los valores de DVNO (r=0,476; p<0,05). Los valores de DVNO regresaron al valor basal a las 24 horas poscirugía. Ningún paciente desarrolló signos o síntomas de incremento de la presión intracraneal. Conclusión: El estudio encontró una correlación entre el tiempo de CEC y el DVNO medido 24 horas poscirugía. Hubo variaciones del DVNO incluso en pacientes sin signos o síntomas de incremento de la presión intracraneal. Se requiere más investigación para identificar los factores relacionados con estas variaciones. (AU)

Introduction: The objective of the study was to analyse the correlation between extracorporeal life support (ECLS) and aortic cross-clamp times and optic nerve sheath diameter (ONSD). Patients and methods: Study in a cohort of patients aged 0 to 15 years that underwent ECLS for cardiac surgery after obtention of signed informed consent. We calculated a sample size of 23 participants. First, we obtained 3 vertical and 3 horizontal measurements of the ONSD for each eye and calculated the mean of both eyes for each measurement to be used in the analysis. The measurements were made at admission and at 6 and 24hours post surgery. We retrieved the ECLS time and the aortic cross-clamp time were from the operative report. Results: We analysed data for 23 participants, 52.2% female, with a median age of 14 months. The median ECLS time was 60minutes; the median aortic cross-clamp time was 32minutes. The median baseline ONSD was 3.1mm. ONSD values had increased a median of 0.015mm at 6hours post surgery (P=.03). We found a positive correlation between ECLS time and ONSD values (r=0.476, p<,05). The ONSD values returned to baseline by 24hours post surgery. None of the patients developed signs or symptoms of increased intracranial pressure. Conclusion: Our study found a correlation between ECLS time and ONSD at 24hours post surgery. We found variations in the ONSD even in patients without signs or symptoms of increased increased intracranial pressure. Further research is required to identify the factors related to these variations. (AU)

Vivências dos familiares sobre a hospitalização de crianças em uma unidade de terapia intensiva pediátrica / Experiences of families on children's hospitalization in a pediatric intensive care unit / Experiencias de familiares sobre la hospitalización de niños en una unidad de terapia intensiva pediátrica

Objetivo: compreender a vivência dos familiares sobre a hospitalização da criança na perspectiva do cuidado humanizado. Métodos: pesquisa descritiva, caracterizada por abordagem qualitativa. O estudo foi realizado na Unidade de Terapia Intensiva Pediátrica do Hospital Municipal de Imperatriz, no estado do Maranhão. Participaram da pesquisa 10 familiares de crianças que estavam internadas por no mínimo 72 horas. As informações foram coletadas mediante a entrevista semiestruturada, no mês de novembro de 2019. Utilizou-se a análise do conteúdo na modalidade temática para tratamento dos dados. Resultados: emergiram quatro categorias: Sentimentos dos familiares diante da hospitalização da criança; Dificuldades enfrentadas pelas famílias durante o período de internação da criança; Cuidado Humanizado; e Estratégias de Enfrentamento dos familiares relacionados à hospitalização da criança. Conclusão: Constatou-se que os familiares vivenciam sentimentos de tristeza diante da hospitalização da criança na Unidade de Terapia Intensiva Pediátrica e desconhecem o significado de cuidado humanizado, associando-o com o fato de estarem sendo bem acolhidos. (AU)

Objective: to understand the experience of family members about the hospitalization of the child from the perspective of humanized care. Methods: descriptive and exploratory research, characterized by a qualitative approach. The study was carried out in the Pediatric Intensive Care Unit of the Municipal Hospital of Imperatriz, in the state of Maranhão. Ten relatives of children who were hospitalized for at least 72 hours participated in the study. The information was collected through the semi-structured interview in November 2019. Content analysis was used in the thematic modality for data processing. Results: four categories emerged: Feelings of family members regarding the hospitalization of the child; Difficulties faced by families during the child's hospitalization period; Humanized Care; and Strategies to cope with family members related to the hospitalization of the child. Conclusion: It was found that family members experience feelings of sadness before the child's hospitalization in the Pediatric Intensive Care Unit and were unaware of the meaning of humanized care, associating it with the fact that they are being welcomed. (AU)

Objetivo: entender la experiencia de los miembros de la familia sobre la hospitalización del niño desde la perspectiva de la atención humanizada. Métodos: investigación descriptiva y exploratoria, caracterizada por un enfoque cualitativo. El estudio se llevó a cabo en la Unidad de Cuidados Intensivos Pediátricos del Hospital Municipal de Imperatriz, en el estado de Maranhao. Diez familiares de niños que fueron hospitalizados durante al menos 72 horas participaron en el estudio. La información fue recopilada a través de la entrevista semiestructurada en noviembre de 2019. El análisis de contenido se utilizó en la modalidad temática para el procesamiento de datos. Resultados: surgieron cuatro categorías: Sentimientos de los miembros de la familia con respecto a la hospitalización del niño; Dificultades a las que se enfrentan las familias durante el período de hospitalización del niño; Cuidado Humanizado; y Estrategias para hacer frente a los miembros de la familia relacionados con la hospitalización del niño. Conclusión: Se encontró que los familiares experimentan sentimientos de tristeza ante la internación del niño en la Unidad de Cuidados Intensivos Pediátricos y desconocen el significado del cuidado humanizado, asociándolo al hecho de que están siendo bienvenido. (AU)

Management of central catheters in newborns and children hospitalized in intensive care units / Manejo de catéteres centrales en recién nacidos y niños hospitalizados en unidades de cuidados intensivos / Manejo de cateteres centrais em recém-nascidos e crianças internadas em unidades de terapia intensiva

Objective: to identify the care strategies adopted by nursing professionals in the handling of central catheters in children and newborns hospitalized in an Intensive Care Unit. Method: descriptive research, with quantitative approach, of the non-participant systematic observation type, in a tertiary public hospital in Rio de Janeiro. A structured checklist was applied to the professionals who assisted this clientele. The data were submitted to simple descriptive analysis and organized in graphs. Results: 80 observations were obtained, separated into three stages: moments of hand hygiene; manipulation of the deep catheter; equipment and connectors. Conclusion: the nursing team has satisfactory support to items considered essential in the care and prevention of bloodstream infections related to central catheters in children and newborns hospitalized in the Intensive Care Unit.

Objetivo: identificar las estrategias de cuidado adoptadas por los profesionales de enfermería en el manejo de catéteres centrales en niños y recién nacidos hospitalizados en una Unidad de Cuidados Intensivos. Método: investigación descriptiva, con enfoque cuantitativo, del tipo observación sistemática no participante, en un hospital público terciario de Río de Janeiro. Se aplicó una lista de verificación estructurada a los profesionales que asistieron a esta clientela. Los datos fueron sometidos a un análisis descriptivo simple y organizados en gráficos. Resultados: se obtuvieron 80 observaciones, separadas en tres etapas: momentos de higiene de manos; manipulación del catéter profundo; equipos y conectores. Conclusión: el equipo de enfermería cuenta con un apoyo satisfactorio a los ítems considerados esenciales en el cuidado y prevención de infecciones del torrente sanguíneo relacionadas con catéteres centrales en niños y recién nacidos hospitalizados en la Unidad de Cuidados Intensivos.

Objetivo: identificar as estratégias de cuidado adotadas pelos profissionais de enfermagem no manuseio dos cateteres centrais em crianças e recém-nascidos internados em Unidade de Terapia Intensiva. Método: pesquisa descritiva, com abordagem quantitativa, do tipo observação sistemática não participante, em um hospital público terciário do Rio de Janeiro. Foi aplicado um check-list estruturado aos profissionais que assistiram essa clientela. Os dados foram submetidos a análise descritiva simples e organizados em gráficos. Resultados: obteve-se 80 observações, separadas em três etapas: momentos da higienização das mãos; manipulação do cateter profundo; equipos e conectores. Conclusão: a equipe de enfermagem possui uma adesão satisfatória aos itens considerados essenciais no cuidado e na prevenção de infecções da corrente sanguínea relacionados a cateteres centrais em crianças e recém-nascidos internados em Unidade de Terapia Intensiva.

Factores asociados al fracaso de la terapia con cánulas nasales de alto flujo en pacientes pediátricos con insuficiencia respiratoria en dos unidades de cuidados críticos pediátricos a gran altitud / Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude

Introducción: El fallo respiratorio agudo es la principal causa de hospitalización en pediatría. Las cánulas nasales de alto flujo (CNAF) ofrecen una nueva alternativa, pero sigue existiendo debate en torno a la evidencia e indicaciones. No se ha descrito su comportamiento en gran altitud. Objetivo Describir el uso de CNAF en pacientes pediátricos que ingresan con insuficiencia respiratoria y explorar los factores asociados al fracaso de la terapia. Metodología Estudio de cohortes prospectivo. Pacientes entre un mes y 18 años manejados con CNAF. Se describieron datos demográficos y se evaluó la respuesta al inicio, 1.a, 6.a y 24.a horas. Se determinó el número de fracasos, así como estancia, complicaciones y mortalidad. Se compararon los pacientes con fracaso al tratamiento. Resultados Ingresaron 539 pacientes. Fueron más frecuentes los lactantes (70,9%) de sexo masculino (58,4%) con afecciones respiratorias como asma y bronquiolitis (61,2%). Se presentaron 53 fracasos (9,8%), 21 en las primeras 24 horas. La mediana de estancia fue de 4 días (RIQ 4), hubo 5 éxitus (0,9%) y 13 eventos adversos –epistaxis– (2,2%). Se observó mejoría de signos vitales y gravedad en el tiempo con diferencias en el grupo que fracasó, pero sin interacciones. El modelo logístico final estimó una relación independiente del fracaso, entre el hospital (OR 2,78; IC95% 1,48-5,21) y la frecuencia respiratoria inicial (OR 1,56; IC95% 1,21-2,01). Conclusión La CNAF es un sistema con buena respuesta clínica, pocas complicaciones y una baja tasa de fracasos. Las diferencias entre las instituciones sugieren una relación subjetiva de la decisión del fracaso. (AU)

Introduction: Acute respiratory failure is the leading cause of hospitalization in pediatrics. High-flow nasal cannulas (HFNCs) offer a new alternative, but the evidence and indications are still debated. The performance of HFNCs at high altitude has not been described to date. Objective To describe the use of HFNCs in pediatric patients admitted with respiratory failure and explore the factors associated with treatment failure. Methodology A prospective cohort study was carried out in patients between 1 month and 18 years of age managed with HFNCs. The demographic and treatment response data were recorded at baseline and after 1, 6 and 24hours. The number of failures was determined, as well as the length of stay, complications and mortality. Patients with treatment failure were compared with the rest. Results A total of 539 patients were enrolled. Infants (70.9%) of male sex (58.4%) and airway diseases such as asthma and bronchiolitis (61.2%) were more frequent. There were 53 failures (9.8%), with 21 occurring in the first 24hours. The median length of stay was 4 days (IQR 4); there were 5 deaths (0.9%) and 13 adverse events (epistaxis) (2.2%). Improvement was observed in vital signs and severity over time, with differences in the group that failed, but without interactions. The final logistic model established an independent relationship of failure between the hospital (OR 2.78, 95%CI 1.48-5.21) and the initial respiratory rate (OR 1.56, 95%CI 1.21-2.01). Conclusions HFNCs afford good clinical response, with few complications and a low failure rate. The differences found between institutions suggest a subjective relationship in the decision of therapy failure. (AU)

Biomarcadores associados à defechos clínicos pós-cirurgia cardíaca em terapia intensiva pediátrica / Biomarcadores relacionados con resultados clínicos en el posoperatorio de cirugía cardíaca en cuidados intensivos pediátricos / Biomarkers associated with postoperative cardiac surgery clinical outcomes in pediatric intensive care

Resumo Objetivo: Sintetizar e analisar criticamente a literatura a respeito de potenciais biomarcadores associados à desfechos clínicos no pós-operatório de cirurgia cardíaca em lactentes e crianças em cuidados intensivos. Métodos: Revisão integrativa, cuja busca ocorreu nos meses de setembro e dezembro de 2019, nas bases de dados MEDLINE, ISI of Knowledge, CENTRAL Cochrane, EMBASE, CINAHL, Science Direct e LILACS para responder à questão norteadora: "Quais as evidências científicas acerca de potenciais biomarcadores relacionados à desfechos clínicos no pós-operatório de cirurgia cardíaca de lactentes e crianças em cuidado intensivo?" Foram incluídos artigos originais publicados entre 2000 e 2019, nos idiomas inglês, português ou espanhol. Excluiu-se toda a literatura cinzenta. Resultados: A amostra final foi constituída por oito artigos, sendo seis estudos observacionais prospectivos descritivos e dois coortes prospectivas. Na maioria dos estudos os pacientes pediátricos foram submetidos à técnica de Bypass Cardiopulmonar (BCP) intraoperatória durante cirurgia de cardiopatia congênita. Os potenciais biomarcadores analisados foram moléculas participantes de processos imune-inflamatórios, predominantemente citocinas pró-inflamatórias tais como IL-1β, IL-6, IL-8 e o fator de necrose tumoral-α (TNF-α) e seu receptor, ou citocinas anti-inflamatórias como a IL-10. Conclusão: As citocinas IL-6, IL-8 e IL-10, o cortisol e o lactato, apresentaram-se como moléculas promissoras para elucidação de mecanismos subjacentes a desfechos clínicos no pós-operatório de cirurgia cardíaca em lactentes e/ou crianças em cuidado intensivo. Tais moléculas podem assumir um caráter preventivo, podendo futuramente ser utilizadas como ferramentas diagnósticas e prognósticas alternativas para um regime que permita identificar pacientes sob alto risco de desenvolver complicações clínicas nos pós-operatórios.

Resumen Objetivo: Sintetizar y analizar críticamente la literatura sobre potenciales biomarcadores relacionados con resultados clínicos en el posoperatorio de cirugía cardíaca de lactantes y niños en cuidados intensivos. Métodos: Revisión integradora, cuya búsqueda ocurrió en los meses de septiembre y diciembre de 2019, en las bases de datos MEDLINE, ISI of Knowledge, CENTRAL Cochrane, EMBASE, CINAHL, Science Direct y LILACS para responder la pregunta orientadora: "¿Cuáles son las evidencias científicas sobre potenciales biomarcadores relacionados con resultados clínicos en el posoperatorio de cirugía cardíaca de lactantes y niños en cuidados intensivos?". Se incluyeron artículos originales publicados entre los años 2000 y 2019, en idioma inglés, portugués o español. Se excluyó toda la literatura gris. Resultados: La muestra final fue formada por ocho artículos, de los cuales seis eran estudios observacionales prospectivos y dos cohortes prospectivas. En la mayoría de los estudios, los pacientes pediátricos fueron sometidos a la técnica de bypass cardiopulmonar (BCP) intraoperatoria durante la cirugía de cardiopatía congénita. Los potenciales biomarcadores analizados fueron moléculas participantes de procesos inmunoinflamatorios, predominantemente citocinas proinflamatorias tales como IL-1β, IL-6, IL-8 y el factor de necrosis tumoral-α (TNF-α) y su receptor, o citocinas antinflamatorias como la IL-10. Conclusión: Las citocinas IL-6, IL-8 e IL-10, el cortisol y el lactato, se presentaron como moléculas promisorias para explicar mecanismos subyacentes de los resultados clínicos en el posoperatorio de cirugía cardíaca de lactantes o niños en cuidados intensivos. Estas moléculas pueden asumir un carácter preventivo y, en un futuro, pueden utilizarse como herramientas alternativas de diagnóstico y pronóstico para un régimen que permita identificar pacientes con alto riesgo de presentar complicaciones clínicas en el posoperatorio.

Abstract Objective: To summarize and critically analyze the literature on potential biomarkers associated with clinical outcomes in the postoperative cardiac surgery period in infants and children under intensive care. Methods: Integrative review, whose search was carried out in September and December 2019 in the databases MEDLINE, ISI Web of Knowledge, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature, Science Direct, and Latin America and Caribbean Center on Health Sciences Information to answer the following guiding question: "What is the scientific evidence on potential biomarkers associated with clinical outcomes in the postoperative cardiac surgery period in infants and children under intensive care?". Original articles published between 2000 and 2019 in English, Spanish, or Portuguese were included. Gray literature was excluded. Results: Eight articles made up the final sample (six descriptive observational prospective studies and two prospective cohort studies). Most studies, pediatric patients were submitted to the intraoperative cardiopulmonary bypass technique during congenital heart disease surgeries. The potential biomarkers analyzed were molecules that participate in immune-inflammatory processes, mainly proinflammatory cytokines such as IL-1β, IL-6, IL-8, and tumor necrosis factor-alpha and its receptor, as well as anti-inflammatory cytokines such as IL-10. Conclusion: The IL-6, IL-8, and IL-10 cytokines, cortisol, and lactate showed as promising molecules for elucidating mechanisms underlying clinical outcomes in the postoperative cardiac surgery period in infants and/or children under intensive care. These molecules can take on a preventive role by being used as a diagnostic and prognostic tool in the future in a protocol that allows to identify patients with high risk to develop clinical complications during the postoperative period.

[Severe acute kidney injury in critically ill children: Epidemiology and prognostic factors]. / Daño renal agudo grave en niños críticos: epidemiología y factores pronósticos.

INTRODUCTION: Acute kidney injury (AKI) is a severe complication in critically ill children. The aim of the study was to describe the characteristics of AKI, as well as to analyse the prognostic factors for mortality and renal replacement therapy (RRT) in children admitted to Paediatric Intensive Care Units (PICUs) in Spain. PATIENTS AND METHODS: Prospective observational multicentre study including children from 7 days to 16 years old who were admitted to a PICU. A univariate and multivariate logistic regression analysis of the risk factors for mortality and renal replacement therapy at PICU discharge were performed. RESULTS: A total of 139 cases of AKI were analysed. RRT was necessary in 60.1% of cases. Mortality rate was 32.6%. At PICU discharge RRT was necessary in 15% of survivors. Thrombopenia and low creatinine clearance values were prognostic markers of RRT at PICU discharge. High values of platelets, serum creatinine and weight were associated with higher survival. CONCLUSIONS: Critically ill children with AKI had a high mortality and morbidity rate. Platelet values and creatinine clearance are markers of RRT at PICU discharge, whereas number of platelets, serum creatinine and weight were associated with mortality.

O processo de adaptação familiar à hospitalização infantil em Unidade de Terapia Intensiva / El proceso de adaptación familiar a la hospitalización infantil en una Unidad de Cuidados Intensivos / The family's adaptation process to their child's hospitalization in an Intensive Care Unit

RESUMO Objetivo Conhecer o processo de adaptação de familiares ao vivenciar a internação da criança em uma Unidade de Terapia Intensiva. Método Pesquisa qualitativa, descritiva e exploratória, realizada na Unidade de Pediatria, com familiares de crianças provenientes da Unidade de Terapia Intensiva Pediátrica. Utilizou-se a análise temática. Resultados Participaram 13 familiares, 12 mães e um pai. Dos resultados emergiram as categorias: Impacto da família frente à internação infantil em Unidade de Terapia Intensiva Pediátrica e Mecanismos de adaptação de familiares à internação em uma Unidade de Terapia Intensiva Pediátrica. Conclusão Os mecanismos adotados pela família no processo de adaptação da criança a internação na Unidade de Terapia Intensiva Pediátrica foram: pensamento positivo, entendimento do tratamento e de funcionamento da unidade. Os profissionais de saúde podem oferecer estratégias à família a fim de tornar a internação menos traumática, possibilitando o compartilhamento das experiências e a ampliação do conhecimento dos envolvidos.

RESUMEN Objetivo Conocer el proceso de adaptación de familiares que vivencian el internamiento del niño en una Unidad de Terapia Intensiva. Método Investigación cualitativa, descriptiva y exploratoria, realizada en la Unidad de Pediatría, con familiares de los niños provenientes de la Unidad de Terapia Intensiva Pediátrica. Utilizó se el análisis temático. Resultados Participaron 13 familiares, 12 madres y 1 padre. De los resultados emergieran las categorías: Impacto de la familia frente al internamiento infantil en una Unidad de Terapia Intensiva Pediátrica y Mecanismos de adaptación de los familiares al internamiento en una Unidad de Terapia Intensiva Pediátrica. Conclusión Los mecanismos adoptados por la familia en el proceso de adaptación del niño en la Unidad de Terapia Intensiva Pediátrica fueran: pensamiento positivo, entendimiento del tratamiento y del funcionamiento de la unidad. Los profesionales de la salud pueden ofrecer estrategias a la familia para tornar el internamiento menos traumático, posibilitando el compartiendo de las experiencias y la ampliación de lo conocimiento de los participantes envueltos.

ABSTRACT Objective To learn about the adaptation process of family members when experiencing their child's hospitalization in an Intensive Care Unit. Method A qualitative, descriptive and exploratory study conducted at the Pediatrics Unit with family members of children from the Pediatric Intensive Care Unit. The thematic analysis technique was used. Results Thirteen (13) family members, 12 mothers and one father participated. The following categories emerged from the results: Family impact on children's hospitalization in a Pediatric Intensive Care Unit and Mechanisms for adapting family members to hospitalization in a Pediatric Intensive Care Unit. Conclusion The mechanisms adopted by the family in the process of adapting the child to admission to the Pediatric Intensive Care Unit were: positive thinking, understanding the treatment and the operation of the unit. Health professionals can offer strategies to the family in order to make hospitalization less traumatic, making it possible to share experiences and expand the knowledge of those involved.

Capacidad diagnóstica de las escalas Braden Q y Norton para úlceras por presión en pacientes pediátricos de unidades críticas / Capacidade diagnóstica das escalas Braden Q e Norton para ulceres pressores em pacientes pediátricos de unidades críticas / Diagnostic capacity of the Braden Q and Norton Scales for pressure ulcers in pediatric patients of critical units

Resumen: El objetivo de la investigación fue conocer la capacidad diagnóstica de las escalas Braden Q y Norton para el desarrollo de úlceras por presión en pacientes pediátricos de Unidades Críticas en un hospital de alta complejidad en Chile. Es un estudio transversal de comparación de pruebas diagnósticas en pacientes ingresados a unidades críticas. La muestra fue no probabilística, por conveniencia de 118 niños. Se analizaron ambas escalas respetando los preceptos, para comparar la capacidad discriminativa de dos pruebas diagnósticas y verificar que ambas sean medidos simultáneamente aplicadas sobre los mismos sujetos. La investigación contó con aprobación de comité de Ética Servicio de Salud y Consentimiento Informado firmado de los padres de los niños. Se determinó que la sensibilidad de la escala Braden Q, a las 24 y 48 horas, es menor que la presentada por la Norton en las mismas evaluaciones; presenta valor predictivo positivo más alto en ambas mediciones, como también la razón de probabilidad (+). Se concluye que Braden Q es la escala idónea para valorar el riesgo de desarrollar UPP en la población pediátrica; presenta mayor confiabilidad

Resumo: O objetivo da investigação foi conhecer a capacidade diagnóstica das escalas Braden Q e Norton, para o desenvolvimento de úlceras de pressão (UPP) em pacientes pediátricos de unidades críticas, em um hospital altamente complexo, no Chile. É um estudo transversal que compara testes diagnósticos em pacientes admitidos em unidades críticas. A amostra não era probabilística, para a conveniência de 118 crianças. Ambas as escalas foram analisadas respeitando os preceitos, para comparar a capacidade discriminativa de dois testes de diagnóstico e verificar que ambos são medidos simultaneamente, aplicados nos mesmos assuntos. A pesquisa foi aprovada pelo Comitê de Ética, Serviço de Saúde e Consentimento Informado assinado por pais de crianças. Determinou-se que a sensibilidade da escala de Braden Q, às 24 e 48 horas, é menor que a apResentada por Norton nas mesmas avaliações, possui maior valor preditivo positivo em ambas as medidas, bem como a razão de probabilidade (+). Conclui-se que Braden Q é a escala ideal para avaliar o risco de desenvolver UPP na população pediátrica, e apresenta maior confiabilidade

Abstract: The objective of the investigation was to evaluate the diagnostic capacity of the Braden Q and Norton scales for the development of pressure ulcers in pediatric patients of Critical Units in a highly complex hospital in Chile. It is a cross-sectional study comparing diagnostic tests in patients admitted to critical units. The sample was non-probabilistic, for the convenience of 118 children. Both scales were analyzed respecting the precepts, in order to compare the discriminative capacity of two diagnostic tests verifying that both are measured simultaneously while applied on the same subjects. The research was approved by the Ethics Committee, Health Service and Informed Consent signed by the parents of the children. It was determined that the sensitivity of the Braden Q scale, at 24 and 48 hours, is lower than Norton´s in the same evaluations; it has a higher positive predictive value in both measurements, as well as the probability ratio (+). It is concluded that Braden Q is the ideal scale to assess the risk of developing pressure ulcers in the pediatric population; it presents greater reliability

Factores sociodemográficos y hospitalarios relacionados con el nivel de ansiedad en familiares con pacientes pediátricos / Social, demographic, and hospital factors related to anxiety levels among relatives of pediatric patients / Fatores sociodemográficos e hospitalares relacionados com o nível de ansiedade em familiares com pacientes pediátricos

Introducción: La asistencia al niño hospitalizado y su familia es uno de los ámbitos que hoy requiere un esfuerzo por investigar. Conocer los factores relacionados con la ansiedad que viven los familiares en la UCIP, abre caminos para desarrollar modelos de intervención y Planes de Cuidados de Enfermería dirigidos a favorecer el afrontamiento y mejorar el bienestar familiar intrahospitalario. Objetivo: Determinar la relación de los factores sociodemográficos y hospitalarios con el nivel de ansiedad que presentan los familiares con pacientes hospitalizados en la unidad de cuidados intensivos pediátricos (UCIP). Metodología: Estudio cuantitativo, descriptivo y transversal. Se utilizó un instrumento de elaboración propia para la identificación de factores sociodemográficos y hospitalarios; y la escala de Inventario de Ansiedad Estado-Rasgo de Spielberger (IDARE) para la medición del nivel de ansiedad. Resultados: 34 familiares que participaron -11.8% (4) hombres; y 88.2% (30) mujeres- la edad promedio fue de 29 años, las puntuaciones de ansiedad estado y ansiedad rasgo indican que al no conocer algún albergue se presenta una diferencia significativa en el nivel de ansiedad estado de los familiares (X

Introduction: Aid to hospitalized children and their relatives is an issue which requires further research. Knowing the factors related to the anxiety that these children's relatives experience in the PIUC can broaden the scope to develop intervention models and Nursing Care Plans to address these issues and improve the intra-hospital family wellbeing. Objective: To determine the relationship between the social, demographic, and hospital factors with the levels of anxiety experienced by the relatives of hospitalized patients in the Pediatric Intensive Care Unit (PICU). Methodology: Quantitative, descriptive, and transversal study. An own-designed instrument to identify social, demographic, and hospital factors, and the Spielberger's State-Trait Anxiety Inventory (STAI) to estimate the levels of anxiety were used. Results: Thirty four relatives participated, 11.8% (4) were male and 88.2% (30) female. The average age was 29 years old. The anxiety state and trait scores suggest that, when information on shelters in not available, there are significant differences in the state of anxiety (X

Introduçãoa: assistência da criança hospitalizada e da sua família, é um dos âmbitos que na atualidade requer um esforço para pesquisar. Conhecer os fatores relacionados com a ansiedade que experimentam os familiares na UCIP, abre caminhos para desenvolver modelos de intervenção e Planos de Cuidados de Enfermagem dirigidos a favorecer o enfrentamento e melhorar o bem-estar familiar intra-hospitalar. Objetivo: Determinar a relação dos fatores sociodemográficos e hospitalares com o nível de ansiedade que apresentam os familiares com pacientes hospitalizados na Unidade de Cuidados Intensivos Pediátricos (UCIP). Metodologia: Estudo Quantitativo, descritivo e transversal. Utilizou-se um instrumento de elaboração própria para a identificação de fatores sociodemográficos e hospitalares; e a escala de Inventário de Ansiedade Estado-Traço de Spielberger (IDARE) para a medição do nível de ansiedade. Resultados: 34 familiares participaram, 11.8% (4) homens e 88.2% (30) mulheres, a média da idade foi de 29 anos, as pontuações de ansiedade estado e ansiedade traço, indicam que quando conhecer algum abrigo se apresenta uma diferença significativa no nível de ansiedade estado dos familiares (X

Síndrome de desgaste profesional (burnout) en médicos de unidades de cuidados intensivos pediátricos en la Argentina / Physician's burnout in pediatric intensive care units from Argentina

Introducción. En la actualidad hay escasez de médicos en unidades de cuidados intensivos pediátricos (UCIP). La causa de este déficit es multifactorial, pero el "fenómeno de burnout" o agotamiento profesional se ha descripto como relevante. Objetivo. Analizar la situación del recurso humano en las UCIP de Argentina y medir el grado de agotamiento profesional. Métodos. Estudio observacional de corte transversal, mediante la administración de encuestas por vía electrónica; se usó el cuestionario Maslach Burnout Inventory. Se invitó a participar a médicos terapistas pediátricos que se desempeñaran en el sector público o privado de la Argentina durante al menos 24 h por semana. Resultados. Fueron completadas 162 encuestas (tasa de respuesta 60%). Presentaron alto riesgo de burnout en agotamiento emocional 40 terapistas (25%), en realización personal 9 (6%) y en despersonalización 31 (19%). En forma combinada, 66 profesionales (41%) tuvieron riesgo alto de burnout en alguna de las dimensiones; resultaron factores protectores e independientes de este riesgo estar certificado en la especialidad (ORA 0,38 IC 95% 0,19-0,75) y trabajar en UCIP del sector público (ORA 0,31 IC 95% 0,15-0,65), mientras que hacer más de 36 h/semana de guardia aumentó el riesgo (ORA 1,94 IC95% 1,1-3,85). El 31 % afirmó que no planeaba continuar con actividad en cuidados intensivos y 86% no pensaban continuar con guardias en los siguientes años. La mayoría de los encuestados comunicó que modificaciones en la práctica profesional (remuneración, cargos de planta, jubilación temprana, menor carga de guardia), podrían prolongar la expectativa de continuar con actividades en UCIP. Conclusiones. Un porcentaje significativo de médicos que trabajan en las UCIP de la Argentina tienen alto riesgo de burnout y baja expectativa de continuar en la especialidad.

Introduction: there is currently a deficiency of physicians in pediatric intensive care units (PICU). The cause of this deficit is multifactorial, although the burnout phenomenon has been described as relevant. Objective: to analyze the situation of human resource in the pediatric intensive care units in Argentina and measure the level of burnout. Methods: an observational cross-sectional study through surveys administered electronically; the Maslach Burnout Inventory was used. Physicians that work at public o private pediatric intensive care units in Argentina during at least 24 hours per week were invited to participate. Results: a total of 162 surveys were completed (response rate 60%). We observed a high risk of burnout in emotional exhaustion in 40 therapists (25%), in fulfillment in 9 (6%), and depersonalization in 31 (19%). In combination, 66 professionals (41%) had a high risk of burnout to some extent; there were independent protective factors of this risk as to be certified in the specialty (ORA 0.38, 95% CI 0.19 to 0.75) and work in public sector PICU (ORA 0.31, 95% CI 0.15 to 0.65), while working more than 36 hours/week on duty increased the risk (ORA 1.94, 95% CI 1.1 to 3.85). Additionally, 31% said that they did not plan to continue working in intensive care, and 86% did not think to continue with on call duties in the following years. Over 60% of respondents reported that changes in professional practice (salary, staff positions, early retirement, fewer loads on call) could prolong the expectation of continuing activities in PICU. Conclusions: a significant percentage of doctors working in the PICU of Argentina have a high risk of burnout syndrome and a low expectation of continuing in the field.

Physician's burnout in pediatric intensive care units from Argentina / Síndrome de desgaste profesional (burnout) en médicos de unidades de cuidados intensivos pediátricos en la Argentina

Introduction. There is currently a deficiency of physicians in pediatric intensive care units (PICU). The cause of this deficit is multifactorial, although the burnout phenomenon has been described as relevant. Objective. To analyze the situation of human resource in the pediatric intensive care units in Argentina and measure the level of burnout. Methods. An observational cross-sectional study through surveys administered electronically; the Maslach Burnout Inventory was used. Physicians that work at public o private pediatric intensive care units in Argentina during at least 24 hours per week were invited to participate. Results. A total of 162 surveys were completed (response rate 60%). We observed a high risk of burnout in emotional exhaustion in 40 therapists (25%), in fulfillment in 9 (6%), and depersonalization in 31 (19%). In combination, 66 professionals (41%) had a high risk of burnout to some extent; there were independent protective factors of this risk as to be certified in the specialty (ORA 0.38, 95% CI 0.19 to 0.75) and work in public sector PICU (ORA 0.31, 95% CI 0.15 to 0.65), while working more than 36 hours/week on duty increased the risk (ORA 1.94, 95% CI 1.1 to 3.85). Additionally, 31% said that they did not plan to continue working in intensive care, and 86% did not think to continue with on call duties in the following years. Over 60% of respondents reported that changes in professional practice (salary, staff positions, early retirement, fewer loads on call) could prolong the expectation of continuing activities in PICU. Conclusions. A significant percentage of doctors working in the PICU of Argentina have a high risk of burnout syndrome and a low expectation of continuing in the field.

Introducción. En la actualidad hay escasez de médicos en unidades de cuidados intensivos pediátricos (UCIP). La causa de este déficit es multifactorial, pero el "fenómeno de burnout" o agotamiento profesional se ha descripto como relevante. Objetivo. Analizar la situación del recurso humano en las UCIP de Argentina y medir el grado de agotamiento profesional. Métodos. Estudio observacional de corte transversal, mediante la administración de encuestas por vía electrónica; se usó el cuestionario Maslach Burnout Inventory. Se invitó a participar a médicos terapistas pediátricos que se desempeñaran en el sector público o privado de la Argentina durante al menos 24 h por semana. Resultados. Fueron completadas 162 encuestas (tasa de respuesta 60%). Presentaron alto riesgo de burnout en agotamiento emocional 40 terapistas (25%), en realización personal 9 (6%) y en despersonalización 31 (19%). En forma combinada, 66 profesionales (41%) tuvieron riesgo alto de burnout en alguna de las dimensiones; resultaron factores protectores e independientes de este riesgo estar certificado en la especialidad (ORA 0,38 IC 95% 0,19-0,75) y trabajar en UCIP del sector público (ORA 0,31 IC 95% 0,15-0,65), mientras que hacer más de 36 h/semana de guardia aumentó el riesgo (ORA 1,94 IC 95% 1,1-3,85). El 31% afirmó que no planeaba continuar con actividad en cuidados intensivos y 86% no pensaban continuar con guardias en los siguientes años. La mayoría de los encuestados comunicó que modificaciones en la práctica profesional (remuneración, cargos de planta, jubilación temprana, menor carga de guardia), podrían prolongar la expectativa de continuar con actividades en UCIP. Conclusiones. Un porcentaje significativo de médicos que trabajan en las UCIP de la Argentina tienen alto riesgo de burnout y baja expectativa de continuar en la especialidad.

Physicians burnout in pediatric intensive care units from Argentina / Síndrome de desgaste profesional (burnout) en médicos de unidades de cuidados intensivos pediátricos en la Argentina

Introduction. There is currently a deficiency of physicians in pediatric intensive care units (PICU). The cause of this deficit is multifactorial, although the burnout phenomenon has been described as relevant. Objective. To analyze the situation of human resource in the pediatric intensive care units in Argentina and measure the level of burnout. Methods. An observational cross-sectional study through surveys administered electronically; the Maslach Burnout Inventory was used. Physicians that work at public o private pediatric intensive care units in Argentina during at least 24 hours per week were invited to participate. Results. A total of 162 surveys were completed (response rate 60%). We observed a high risk of burnout in emotional exhaustion in 40 therapists (25%), in fulfillment in 9 (6%), and depersonalization in 31 (19%). In combination, 66 professionals (41%) had a high risk of burnout to some extent; there were independent protective factors of this risk as to be certified in the specialty (ORA 0.38, 95% CI 0.19 to 0.75) and work in public sector PICU (ORA 0.31, 95% CI 0.15 to 0.65), while working more than 36 hours/week on duty increased the risk (ORA 1.94, 95% CI 1.1 to 3.85). Additionally, 31% said that they did not plan to continue working in intensive care, and 86% did not think to continue with on call duties in the following years. Over 60% of respondents reported that changes in professional practice (salary, staff positions, early retirement, fewer loads on call) could prolong the expectation of continuing activities in PICU. Conclusions. A significant percentage of doctors working in the PICU of Argentina have a high risk of burnout syndrome and a low expectation of continuing in the field.(AU)

Introducción. En la actualidad hay escasez de médicos en unidades de cuidados intensivos pediátricos (UCIP). La causa de este déficit es multifactorial, pero el "fenómeno de burnout" o agotamiento profesional se ha descripto como relevante. Objetivo. Analizar la situación del recurso humano en las UCIP de Argentina y medir el grado de agotamiento profesional. Métodos. Estudio observacional de corte transversal, mediante la administración de encuestas por vía electrónica; se usó el cuestionario Maslach Burnout Inventory. Se invitó a participar a médicos terapistas pediátricos que se desempeñaran en el sector público o privado de la Argentina durante al menos 24 h por semana. Resultados. Fueron completadas 162 encuestas (tasa de respuesta 60%). Presentaron alto riesgo de burnout en agotamiento emocional 40 terapistas (25%), en realización personal 9 (6%) y en despersonalización 31 (19%). En forma combinada, 66 profesionales (41%) tuvieron riesgo alto de burnout en alguna de las dimensiones; resultaron factores protectores e independientes de este riesgo estar certificado en la especialidad (ORA 0,38 IC 95% 0,19-0,75) y trabajar en UCIP del sector público (ORA 0,31 IC 95% 0,15-0,65), mientras que hacer más de 36 h/semana de guardia aumentó el riesgo (ORA 1,94 IC 95% 1,1-3,85). El 31% afirmó que no planeaba continuar con actividad en cuidados intensivos y 86% no pensaban continuar con guardias en los siguientes años. La mayoría de los encuestados comunicó que modificaciones en la práctica profesional (remuneración, cargos de planta, jubilación temprana, menor carga de guardia), podrían prolongar la expectativa de continuar con actividades en UCIP. Conclusiones. Un porcentaje significativo de médicos que trabajan en las UCIP de la Argentina tienen alto riesgo de burnout y baja expectativa de continuar en la especialidad.(AU)