Prevalencia de ventilación mecánica en pacientes pediátricos con sepsis internados en Cuidados Intensivos / Prevalence of ventilation Mechanics in patients pediatric patients with sepsis interned in Intensive Care

Objetivo: Describir las características sociodemográficas y clínicas de niños con sepsis y ventilación mecánica. Métodos: Estudio observacional, transversal, multicéntrico, de un año de duración, en 19 Unidades de Cuidados Intensivos Pediátricos. Los datos se recolectaron a través de la página www.sepsisencolombia.com. Los pacientes fueron clasificados por diagnósticos, según tuvieran criterios de sepsis, sepsis grave, choque séptico y falla orgánica múltiple, y la necesidad o no de ventilación mecánica. Resultados: Se incluyeron 1051 pacientes con sepsis y el 67,7% de ellos requirió ventilación mecánica. El 43,1% eran niñas, la mediana de la edad era de 12 meses (rango intercuartílico 1-59). La mediana de estancia en la Unidad de Cuidados Intensivos Pediátricos de los pacientes ventilados fue de 8 días (rango intercuartílico 5-15) y de 4 días (rango intercuartílico 3-6) de los no ventilados. En el 97,1%, se conoció el origen de la sepsis, el más frecuente fue el aparato respiratorio. Se encontró relación entre tener sepsis y no requerir ventilación mecánica (rango intercuartílico 0,279-0,439) (p = 0,0000) y de requerirla, si había choque séptico (rango intercuartílico 0,694-0,781) (p = 0,0000). Los pacientes que requirieron ventilación mecánica tuvieron más probabilidad de morir (odds ratio 30,0; rango intercuartílico 11,5-78,6). Conclusiones: La sepsis y desarrollar choque séptico hacen más probable la necesidad de ventilación mecánica y hay una asociación entre ésta y mayor probabilidad de muerte.(AU)

Objective: To describe the sociodemographic and clinical characteristics of children with sepsis and mechanical ventilation. Methods: Observational, cross-sectional, multicenter study in 19 pediatric intensive care units. Data were collected through the website www. sepsisencolombia.com. Patients were classified by diagnosis, according to the following criteria: sepsis, severe sepsis, septic shock and multiple organ failure, with or without mechanical ventilation. Results: 1051 patients with sepsis were included and 67.7% of them required mechanical ventilation. 43.1% were female, median age: 12 months (interquartile range 1-59). The median stay in the PICU of ventilated patients was 8 days (interquartile range 5-15) and 4 days (interquartile range 3-6) of those without ventilation. The origin of sepsis was known in 97.1%, the most frequent source was the respiratory system. Relationship was found between having sepsis and not requiring mechanical ventilation (interquartile range 0.279 to 0.439) (p = 0.0000) and requiring it was found, if there was septic shock (interquartile range 0.694 to 0.781) (p = 0.0000). Patients who required mechanical ventilation were more likely to die (odds ratio 30.0; interquartile range 11.5 to 78.6. Conclusions: Sepsis and the development of septic shock make it more likely to need mechanical ventilation and there is an association between this and increased probability of death.(AU)

C4D immunostaining in surveillance endomyocardial biopsies from well-functioning heart allografts.

OBJECTIVE: The meaning of biopsy C4d detection in heart allografts without dysfunction or morphologic changes suggesting antibody-mediated rejection (AMR) is not clear. The aim of this study was to search for an association between C4d detection in allograft biopsies of well-functioning hearts without changes suggestive of AMR, and clinical outcomes. METHODS: Endomyocardial protocol biopsies from 44 heart transplant patients with well-functioning grafts and without changes suggesting AMR were performed at 1 month and 1 year after transplantation and analyze the presence of C4d deposition using immunohistochemistry. Two-year follow-up was based on clinical parameters and echocardiographic information. Heart graft function was categorized as good vs. poor. The presence of C4d, using diverse schemes to graduate the extension of the deposition, was correlated with clinical graft outcomes. RESULTS: C4d deposition was observed in the capillary walls of 33 biopsies (37.5%; n = 25 patients; 56.8%). No biopsy had diffuse (>50%) immunostaining. Six patients presented with multifocal capillary C4d immunostaining in at least 1 biopsy. Capillary positivity for C4d (if focal or multifocal) showed no statistical association with cellular rejection or graft function. Perimyocytic C4d detection was neither associated with rejection nor graft outcome. CONCLUSION: Our work failed to demonstrate an association between C4d detection in protocol biopsies of heart grafts and clinical outcomes. The clinical utility of C4d staining in solid organ transplantation may vary by organ. Our results suggest that C4d did not have clinical utility in surveillance biopsies of well-functioning heart grafts without morphological changes suggesting AMR.