Characteristics of Transport of Ill Pediatric Patients in the Emergency Department: A Latin America Multicenter Prospective Study.

OBJECTIVE: The aim was to describe the characteristics of the transport system of critically ill pediatric patients in the emergency departments (EDs) in Latin America (LA). METHODOLOGY: This is a prospective cross-sectional study in a 1-year period. Patients were recruited on days 1, 7, 14, 21, and 28 of each month in the EDs in LA. We included ill-pediatric patients aged 1 month to 18 years. Patients who needed transfer for a diagnostic study, with arrival mode not by ambulance, or with the impossibility of interviewing the transfer team were excluded from the study. RESULTS: A total of 389 patients were included in the study. The majority were males (57%) with a median age of 49 months (interquartile range, 10-116). Thirty-three percent (129) of transfers had the participation of a coordinating center; 97.1% (375) were carried out by road ambulance, and 84.3% (323) were interhospital transfers, with a mean distance traveled of 83.2 km (SD, 105 km). The main reason for transfer in 88.17% (343) was the need for a more complex health center. The main diagnosis was respiratory distress (71; 18.2%), acute abdomen (70; 18%), Traumatic Brain Injury (33; 8.48%), multiple trauma (32; 8.23%), septic shock (31; 7.9%), and COVID-19-related illness (19; 4.8%). A total of 296 (76.5%) patients had peripheral vascular access, and 171 (44%) patients had oxygen support with 49 (28.6%) having invasive ventilation; the most frequent monitoring method (67.8%) was pulse oximetry, and 83.4% (313) did not record adverse events. Regarding the transfer team, 88% (342) had no specialized personnel, and only 62.4% (243) had a physician on their teams. CONCLUSIONS: In LA, there is great variability in personnel training, equipment for pediatric transport, team composition, and characterization of critical care transport systems. Continued efforts to improve conditions in our countries may help reduce patient morbidity and mortality.

Modelo experimental en cerdo recién nacido para el estudio y entrenamiento en ultrasonografía pulmonar del niño crítico / Experimental newborn piglet model for studying and training lung ultrasound in critically ill children

Introducción: la ultrasonografía pulmonar en el paciente crítico (LUCI) ha generado creciente interés en el escenario de los cuidados intensivos. Los modelos animales son herramientas útiles para facilitar el aprendizaje y entrenamiento de los profesionales que la practican. Presentamos el desarrollo de un modelo animal para el estudio y entrenamiento de LUCI en niños críticos. Material y métodos: se utilizó un cerdo recién nacido al que se realizó anestesia, traqueostomía, intubación traqueal y ventilación mecánica (VM) con monitorización convencional. Se aplicaron diferentes niveles de presión telespiratoria (PEEP), se produjo neumotórax y derrame pleural mediante colocación de drenaje en tórax e introducción de aire y suero respectivamente. Se realizó ultrasonografía con transductor lineal de 4-8 MHz. Previo al experimento 12 profesionales recibieron un curso introductorio sobre LUCI dictado por un radiólogo, para luego observar las diferentes secuencias y practicar LUCI con el animal. Resultados: se obtuvieron imágenes de secuencias pulmonares básicas y sus signos característicos: aireación pulmonar normal en VM basal, confirmación de intubación, sobredistensión y colapso pulmonar, neumotórax y derrame pleural. Todos los participantes encontraron a la experiencia positiva y pudieron identificar las diferentes secuencias ultrasonográficas programadas. Conclusiones: el modelo animal que se presenta permitiría el entrenamiento en LUCI de los profesionales que atienden niños críticos. Asimismo, esto posibilitaría el desarrollo de investigación en patología respiratoria pediátrica.

Background: lung ultrasound in the critically ill (LUCI) has generated growing interest in the intensive care scenario. Animal models are useful tools for training professionals in its practice. We present an animal model designed for studying and training in LUCI for critically ill children. Method: a newborn piglet was anesthetized, traqueostomized, intubated and mechanically ventilated (MV) with conventional monitoring. Different levels of PEEP were applied, and pneumothorax and pleural effusion were produced by the insertion of a thoracic drainage and instillation of air and a saline solution. Lung ultrasound was performed by using a 4-8 MHz linear probe. Prior to the experiment, 12 trainees with no previous experience attended a theoretical course on basic LUCI delivered by a radiologist. Subsequently, they visualized and practiced LUCI in the animal model. Results: basic lung ultrasound sequences were obtained, where their typical signs could be seen: normal lung ventilation during standard MV, confirmation of endotracheal tube position, lung overdistension and collapse, pneumothorax and pleural effusion. All trainees found the experience was positive and could identify every sonographic sequence. Conclusions: the animal model presented in the study could allow professionals caring for critically ill children to receive training in LUCI. Likewise, it could allow the development of research in pediatric respiratory pathology.