Respiratory and pharmacological management in severe acute bronchiolitis: Were clinical guidelines not written for critical care?

PURPOSE: The treatment applied for children admitted to the pediatric intensive care unit (PICU) for severe acute bronchiolitis may differ from general recommendations. The first objective of our study was to describe the treatments offered to these children in a Spanish tertiary PICU. The second objective was to analyse the changes in management derived from the publication of the American Academy of Pediatrics (AAP) bronchiolitis guideline in 2014. METHODS: This was a retrospective-prospective observational study conducted during two epidemic waves (2014-2015 and 2015-2016). The AAP guidelines were distributed and taught to PICU staff between both epidemic waves. RESULTS: A total of 138 children were enrolled (78 male). In the first period, 78 children were enrolled. The median age was 1.8 months (IQR 1.1-3.6). There were no differences between the management in the two periods, except for the use of high-flow oxygen therapy (HFOT); its use increased in the second period. Overall, 83% of patients received non-invasive ventilation or HFOT. Children older than 12 months received HFOT exclusively. In comparison, continuous positive airway pressure and bi-level positive airway pressure were used less during the period 2015-2016 (P=0.036). Regarding pharmacological therapy, 70% of patients received antibiotics, 23% steroids, 33% salbutamol, 31% adrenaline, and 7% hypertonic saline. The mortality rate was zero. CONCLUSIONS: Our PICU did not follow the AAP recommendations. There were no differences between the two periods, except in the use of HFOT. All children older than 12 months received HFOT exclusively. The rate of using invasive mechanical ventilation was also low.

Flow cytometry analysis of CD64, CD18, CD11a and CD11b in four children with Bordetella pertussis infection and admitted to critical care: New biomarkers? / Análisis mediante citometría de flujo de CD64, CD18, CD11a and CD11b en cuatro niños con infección grave por Bordetella pertussis: ¿Nuevos biomarcadores?

No disponible

Accuracy of CD64 expression on neutrophils and monocytes in bacterial infection diagnosis at pediatric intensive care admission.

The CD64 receptor has been described as an interesting bacterial infection biomarker. Its expression has not been studied in previously healthy children admitted to pediatric critical care unit (PICU). Our objective was firstly to describe the CD64 expression and secondly study its diagnostic accuracy to discriminate bacterial versus viral infection in this children. We made a prospective double-blind observational study (March 2016-February 2018). A flow cytometry (FC) was done from peripheral blood at PICU admission. We studied the percentage of CD64+ neutrophils and the CD64 mean fluorescence intensity (MFI) on neutrophils (nCD64) and monocytes (mCD64). Statistical analyses were performed with non-parametric tests (p < 0.05). Twenty children in the bacterial infection group (BIG) and 25 in the viral infection group (VIG). Children in BIG showed higher values of CD64+ neutrophils (p = 0.000), nCD64 (p = 0.001), and mCD64 (p = 0.003). In addition, CD64+ neutrophils and nCD64 expression have positive correlation with procalcitonin and C reactive protein. The nCD64 area under the curve (AUC) was 0.83 (p = 0.000). The %CD64+ neutrophils showed an AUC of 0.828 (p = 0.000). The mCD64 AUC was 0.83 (p = 0.003). The nCD64 and %CD64+ neutrophils also showed higher combined values of sensitivity (74%) and specificity (90%) than all classical biomarkers.In our series CD64 expression allows to discriminate between bacterial and viral infection at PICU admission. Future studies should confirm this and be focused in the study of CD64 correlation with clinical data and its utility as an evolution biomarker in critical care children.

Craniectomía descompresiva / No disponible

No disponible

Indicadores de calidad de Cuidados Intensivos Pediátricos en España (estudio QuaCIP) / Indicators of the quality of Pediatric Intensive Care in Spain (QuaCIP Study)

No disponible

Simulación de situaciones urgentes en Atención Primaria (taller instrumentalizado) / Simulation of Primary Care emergency situations (hands-on workshop)

No disponible

Actividad investigadora, asistencial y docente de la UCI Pediátrica del H. infantil Universitario Niño Jesús / Research, clinical and teaching activities of the Pediatric ICU of H. Universitario Niño Jesús Children

El Servicio de Cuidados Intensivos Pediátricos (UCIP) del Hospital Infantil Universitario Niño Jesús, de Madrid, es una Unidad polivalente de 14 camas, médico quirúrgica, que atiende a niños críticamente enfermos desde neonatos hasta 18 años. En los últimos seis años ha desarrollado un ambicioso programa investigador, asistencial y docente que se resume en el presente trabajo. En este periodo es la UCIP que más número de pacientes ha atendido en al Comunidad de Madrid, especialmente pacientes complejos, como niños oncológicos sometidos a trasplante de progenitores hemaopoyéticos o no; pacientes politraumatizados atendidos por un equipo multidisciplinar; niño sépticos; pacientes con patología neurológica sometidos a monitorización multiparamétrica avanzada; pacientes con patología respiratoria sometidos a diferentes formas de ventilación mecánica y otros. Se han desarrollado varias líneas de investigación clínica cuyos resultados se han publicado en diversas revistas científicas nacionales e internacionales. La actividad docente en este periodo ha sido muy amplia, basada en cursos teóricos-prácticos con simuladores, que ha contribuido a la formación de miles de pediatras. Producto de la experiencia asistencial, docente e investigadora se han editado 10 libros (AU)

The Paediatric Intensive Care Unit (PICU) of Hospital Infantil Universitario Niño Jesús is a polyvalent, surgical and medical 14 bed unit who assists critically ill patients since newborn age to 18 year-old. During the last 6 years we´ve developed an ambitious investigational, educational and clinical management programme that it´s summarized in the present paper. During this period of time our unit has got the highest admission rate in the whole Madrid area. The main pathological conditions attended are: oncological patients with and without bone marrow transplantation; multidisciplinary integrated management for the polytrauma patients; septic shock; neurological impaired patients under multiparameter advanced monitoring; respiratory failure under invasive or non invasive ventilation support. Many clinical investigations have been developed and published in several international and national journals. Thousands of paediatric physicians have accomplished our multiple simulation training programmes. As a result of our clinical, educational and investigational activity ten books have been published (AU)

Indicaciones actuales de la profilaxis y el tratamiento con antifúngicos / Current indications of prophylaxis and treatment with antifungal agents

No disponible

Infecciones por Staphylococcus aureus en cuidados intensivos: características clínicas y epidemiológicas / Staphylococcus aureus infections in the intensive care unit: clinical and epidemiological characteristics

Introducción: En los últimos años se ha producido un incremento de las infecciones invasivas por este patógeno que requieren ingreso en cuidados intensivos pediátricos (UCIP). Pacientes y métodos: Estudio retrospectivo (entre enero del 2006 y junio del 2010) en el que se incluyó a todos los pacientes con infección por Staphylococcus Aureus (S. aureus) que precisaron ingreso en UCIP. Estos fueron clasificados en 2 grupos: infección comunitaria (grupo 1) e infección nosocomial (grupo 2). Se recogieron los siguientes datos: epidemiológicos, tipo de aislamiento de S. aureus (S. aureus sensible a meticilina [SASM], S. aureus resistente a metilicina [SARM]), factores de riesgo, localización de la infección, presencia de inestabilidad hemodinámica, soporte respiratorio y mortalidad. Resultados: Se estudiaron a 51 pacientes, 21 pertenecientes al grupo 1 y 30 al grupo 2. La mediana de edad fue menor en el grupo 1 (1,6 años frente 3,2 años, p = 0,009). Se aisló SASM en el 88% de los casos. Se detectaron 6/51 (12%) pacientes con infección por SARM, los cuales se aislaron en el último periodo del estudio (enero 2009-junio 2010). Los factores de riesgo fueron: inmunosupresión, catéter venoso central, institucionalización, ventilación mecánica, cirugía previa, traumatismo previo y osteomielitis crónica. Un 83% de los pacientes con infección por SARM tenían factores de riesgo. La localización de la infección por S. aureus fue variada, siendo las infecciones respiratorias las más frecuentes (75%). Un 43% de los pacientes requirieron fármacos vasoactivos. La mayoría de los pacientes (86%) requirió soporte respiratorio. Un paciente del grupo 1 falleció por neumonía necrotizante por SAMS. Conclusiones: Las infecciones por S. aureus son graves y tienen elevada morbilidad. La infección pulmonar es la más frecuente en esta serie. Aunque el aislamiento de SASM es predominante en estas infecciones se ha visto una tendencia al incremento de las infecciones por SARM en el último periodo del estudio (AU)

Introduction: There has been an increase in invasive Staphylococcus Aureus infections over the last few years, which have required admission to the pediatric intensive care unit (PICU). Patients and methods: All patients with S. aureus infection who were admitted to PICU were enrolled in a retrospective study (January 2006-June 2010). The patients were classified into 2 groups: community-acquired infection (Group 1) and nosocomial infection (Group 2). We recorded epidemiological data, type of S. aureus (methicillin-susceptible S. aureus [MSSA], methicillin-resistant S. aureus [MRSA]), risk factors, site of infection, presence of hemodynamic instability, respiratory support, and mortality. Results: A total of 51 patients were enrolled, 21 belonging to Group 1 and 30 to Group 2. The median age was lower in Group 1 (1.6 years vs 3.2 years; P=0.009). MSSA was isolated in 88% of cases. MRSA was detected in 6/51 (12%) of cases, which were isolated in the later study period (January 2009-June 2010).The risk factors for infection were: immunosuppression, venous catheter, institutionalization, mechanical ventilation, previous surgery, previous trauma and chronic osteomyelitis. A large majority (83%) of the patients with MRSA infection had risk factors. The type of infection was varied, with respiratory tract infection being the most common (75%). Hemodynamic instability was observed in 43% of patients. Most patients (86%) required respiratory support. One patient in Group 1 died of necrotizing pneumonia caused by MSSA. Conclusions: Infections by S. aureus in children are severe and have a high morbidity. Respiratory infection was the most common in our series. Isolation of MSSA is common in these infections, although, an increase in the number of infections by MRSA was observed during the latter part of the study(AU)

[Staphylococcus aureus infections in the intensive care unit: clinical and epidemiological characteristics]. / Infecciones por Staphylococcus aureus en cuidados intensivos: características clínicas y epidemiológicas.

INTRODUCTION: There has been an increase in invasive Staphylococcus Aureus infections over the last few years, which have required admission to the pediatric intensive care unit (PICU). PATIENTS AND METHODS: All patients with S. aureus infection who were admitted to PICU were enrolled in a retrospective study (January 2006-June 2010). The patients were classified into 2 groups: community-acquired infection (Group 1) and nosocomial infection (Group 2). We recorded epidemiological data, type of S. aureus (methicillin-susceptible S. aureus [MSSA], methicillin-resistant S. aureus [MRSA]), risk factors, site of infection, presence of hemodynamic instability, respiratory support, and mortality. RESULTS: A total of 51 patients were enrolled, 21 belonging to Group 1 and 30 to Group 2. The median age was lower in Group 1 (1.6 years vs 3.2 years; P=.009). MSSA was isolated in 88% of cases. MRSA was detected in 6/51 (12%) of cases, which were isolated in the later study period (January 2009-June 2010). The risk factors for infection were: immunosuppression, venous catheter, institutionalization, mechanical ventilation, previous surgery, previous trauma and chronic osteomyelitis. A large majority (83%) of the patients with MRSA infection had risk factors. The type of infection was varied, with respiratory tract infection being the most common (75%). Hemodynamic instability was observed in 43% of patients. Most patients (86%) required respiratory support. One patient in Group 1 died of necrotizing pneumonia caused by MSSA. CONCLUSIONS: Infections by S. aureus in children are severe and have a high morbidity. Respiratory infection was the most common in our series. Isolation of MSSA is common in these infections, although, an increase in the number of infections by MRSA was observed during the latter part of the study.