Time Course of Mechanical Ventilation Driving Pressure Levels in Pediatric Acute Respiratory Distress Syndrome: Outcomes in a Prospective, Multicenter Cohort Study From Colombia, 2018-2022.

OBJECTIVES: High driving pressure (DP, ratio of tidal volume (V t ) over respiratory system compliance) is a risk for poor outcomes in patients with pediatric acute respiratory distress syndrome (PARDS). We therefore assessed the time course in level of DP (i.e., 24, 48, and 72 hr) after starting mechanical ventilation (MV), and its association with 28-day mortality. DESIGN: Multicenter, prospective study conducted between February 2018 and December 2022. SETTING: Twelve tertiary care PICUs in Colombia. PATIENTS: One hundred eighty-four intubated children with moderate to severe PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The median (interquartile range [IQR]) age of the PARDS cohort was 11 (IQR 3-24) months. A total of 129 of 184 patients (70.2%) had a pulmonary etiology leading to PARDS, and 31 of 184 patients (16.8%) died. In the first 24 hours after admission, the plateau pressure in the nonsurvivor group, compared with the survivor group, differed (28.24 [IQR 24.14-32.11] vs. 23.18 [IQR 20.72-27.13] cm H 2 O, p < 0.01). Of note, children with a V t less than 8 mL/kg of ideal body weight had lower adjusted odds ratio (aOR [95% CI]) of 28-day mortality (aOR 0.69, [95% CI, 0.55-0.87]; p = 0.02). However, we failed to identify an association between DP level and the oxygenation index (aOR 0.58; 95% CI, 0.21-1.58) at each of time point. In a diagnostic exploratory analysis, we found that DP greater than 15 cm H 2 O at 72 hours was an explanatory variable for mortality, with area under the receiver operating characteristic curve of 0.83 (95% CI, 0.74-0.89); there was also increased hazard for death with hazard ratio 2.5 (95% CI, 1.07-5.92). DP greater than 15 cm H 2 O at 72 hours was also associated with longer duration of MV (10 [IQR 7-14] vs. 7 [IQR 5-10] d; p = 0.02). CONCLUSIONS: In children with moderate to severe PARDS, a DP greater than 15 cm H 2 O at 72 hours after the initiation of MV is associated with greater odds of 28-day mortality and a longer duration of MV. DP should be considered a variable worth monitoring during protective ventilation for PARDS.

Convulsión febril en niños de 0 a 14 años de edad: Hospitales de San José e Infantil Universitario de San José, Bogotá D. C / Febrile convulsions in children aged 0 to 14 yearsconsulting to Hospital de San José and Hospital infantil Universitario de San José, Bogotá DC

Las convulsiones febriles en niños son un problema común a nivel mundial, debido a las múltiples patologías que pueden cursar con fiebre y desencadenar una convulsión. Un cuadro gripal con temperatura superior a 38°C puede ser suficiente para provocarlas. Consideramos indispensable conocer más acerca de esta patología y por ello nos propusimos profundizar e informar. Objetivo: describir las características clínicas y sociodemográficas de los pacientes con convulsión febril. Metodología: estudio descriptivo. Se incluyeron pacientes que consultaron a los Hospitales de San José e Infantil Universitario de San José en el período agosto 2007 a agosto 2009, que hubiesen presentado una primera convulsión febril. Se excluyeron aquellos con diagnóstico de epilepsia, en tratamiento con anticonvulsivantes, que no presentaran fiebre o no se describiera la convulsión en la historia clínica. Resultados: de un total de 468 casos (213 HSJ + 255 HIUSJ) 147 eran de 0 a 14 años de edad, encontrando que el 80,3% (118/147) presentó convulsiones tonicoclónicas. De ellos 53,4% fueron niñas, 48,3% cursaron con convulsiones simples, 80,5% no tuvieron período posictal, 43,2% no presentaron ninguna comorbilidad y cuando las hubo fueron las infecciones del sistema respiratorio las más frecuentes (23,7%). Conclusiones: se identificaron las características clínicas y sociodemográficas de los pacientes con convulsión febril, mediante la revisión de las historias clínicas, tabulación de los datos obtenidos y comparación de resultados.

A febrile convulsion is a common medical problem affecting children worldwide for it is associated to a great number of febrile conditions in which a convulsion may be precipitated. A common cold with temperature that rises over 38°C may be enough to provoke a seizure. We consider it essential to gain further knowledge on this topic, thus, we intended to explore and report. Objective: to describe the clinical and socio-demographic features of patients presenting a febrile convulsion. Methodology: descriptive study. Children who consulted to Hospital San José (HSJ) and Hospital Infantil Universitario de San José (HIUSJ) between August 2007 and August 2009, including those who had presented their first febrile convulsion. Excluding those with diagnosed epilepsy receiving anticonvulsant therapy, those who presented afebrile convulsions and those in which seizure was not described in clinical record. Results: of 468 cases (213 HSJ + 255 HIUSJ) 147 were aged 0 to 14 years, 80.3% (118/147) presented tonic-clonic seizures. 53.4% were girls, 48.3% were simple convulsions, 80.5% had no postictal period, 43.2% had no comorbidities and when present were usually related to respiratory infections (23.7%). Conclusions: clinical and socio-demographic features were identified by a clinical record, data tabulation and result comparison review.