RÉSUMÉ
ABSTRACT Objective: The benefit of atropine in pediatric tracheal intubation is not well established. The objective of this study was to evaluate the effect of atropine on the incidence of hypoxemia and bradycardia during tracheal intubations in the pediatric emergency department. Methods: This is a single-center observational study in a tertiary pediatric emergency department. Data were collected on all tracheal intubations in patients from 31 days to incomplete 20 years old, performed between January 2016 and September 2020. Procedures were divided into two groups according to the use or not of atropine as a premedication during intubation. Records with missing data, patients with cardiorespiratory arrest, cyanotic congenital heart diseases, and those with chronic lung diseases with baseline hypoxemia were excluded. The primary outcome was hypoxemia (peripheral oxygen saturation ≤88%), while the secondary outcomes were bradycardia (decrease in heart rate >20% between the maximum and minimum values) and critical bradycardia (heart rate <60 bpm) during intubation procedure. Results: A total of 151 tracheal intubations were identified during the study period, of which 126 were eligible. Of those, 77% had complex, chronic underlying diseases. Atropine was administered to 43 (34.1%) patients and was associated with greater odds of hypoxemia in univariable analysis (OR: 2.62; 95%CI 1.15-6.16; p=0.027) but not in multivariable analysis (OR: 2.07; 95%CI 0.42-10.32; p=0.37). Critical bradycardia occurred in only three patients, being two in the atropine group (p=0.26). Bradycardia was analyzed in only 42 procedures. Atropine use was associated with higher odds of bradycardia in multivariable analysis (OR: 11.00; 95%CI 1.3-92.8; p=0.028). Conclusions: Atropine as a premedication in tracheal intubation did not prevent the occurrence of hypoxemia or bradycardia during intubation procedures in pediatric emergency.
RESUMO Objetivo: Avaliar o efeito da atropina na incidência de hipoxemia e bradicardia durante a intubação orotraqueal no departamento de emergência pediátrica. Métodos: Estudo observacional, realizado em departamento de emergência pediátrica terciário em que foram analisados os registros de intubações orotraqueais de pacientes com 31 dias a 20 anos incompletos, entre janeiro de 2016 e setembro de 2020. Os procedimentos foram divididos em dois grupos de acordo com o uso ou não da atropina como pré-medicação durante a intubação. Foram excluídos os procedimentos com falhas no preenchimento dos dados, pacientes com parada cardiorrespiratória, cardiopatias congênitas cianóticas, e aqueles com pneumopatias crônicas com hipoxemia basal. O desfecho primário foi hipoxemia (saturação periférica de oxigênio ≤88%), enquanto os desfechos secundários foram bradicardia (queda >20% entre a frequência cardíaca máxima e mínima) e bradicardia crítica (frequência cardíaca <60 bpm) durante o procedimento de intubação Resultados: Foram identificados 151 procedimentos de intubação orotraqueal, sendo 126 elegíveis para o estudo. Desses, 77% tinham doenças subjacentes complexas e crônicas. A atropina foi administrada em 43 (34,1%) pacientes e foi associada a maiores chances de hipoxemia na análise univariada (OR: 2,62; IC95% 1,15-6,16; p=0,027), porém, não na análise multivariada (OR: 2,073; IC95% 0,416-10,32; p=0,373). A bradicardia crítica ocorreu em apenas três pacientes, sendo dois no grupo atropina (p=0,268). A bradicardia foi analisada em apenas 42 procedimentos. O uso de atropina foi associado a maior probabilidade de bradicardia (OR: 11,00; IC95% 1,3-92,8; p=0,028) na análise multivariável. Conclusões: Atropina como pré-medicação na intubação orotraqueal não evitou a ocorrência de hipoxemia ou bradicardia durante os procedimentos de intubação na emergência pediátrica.
RÉSUMÉ
OBJECTIVE: The benefit of atropine in pediatric tracheal intubation is not well established. The objective of this study was to evaluate the effect of atropine on the incidence of hypoxemia and bradycardia during tracheal intubations in the pediatric emergency department. METHODS: This is a single-center observational study in a tertiary pediatric emergency department. Data were collected on all tracheal intubations in patients from 31 days to incomplete 20 years old, performed between January 2016 and September 2020. Procedures were divided into two groups according to the use or not of atropine as a premedication during intubation. Records with missing data, patients with cardiorespiratory arrest, cyanotic congenital heart diseases, and those with chronic lung diseases with baseline hypoxemia were excluded. The primary outcome was hypoxemia (peripheral oxygen saturation ≤88%), while the secondary outcomes were bradycardia (decrease in heart rate >20% between the maximum and minimum values) and critical bradycardia (heart rate <60 bpm) during intubation procedure. RESULTS: A total of 151 tracheal intubations were identified during the study period, of which 126 were eligible. Of those, 77% had complex, chronic underlying diseases. Atropine was administered to 43 (34.1%) patients and was associated with greater odds of hypoxemia in univariable analysis (OR: 2.62; 95%CI 1.15-6.16; p=0.027) but not in multivariable analysis (OR: 2.07; 95%CI 0.42-10.32; p=0.37). Critical bradycardia occurred in only three patients, being two in the atropine group (p=0.26). Bradycardia was analyzed in only 42 procedures. Atropine use was associated with higher odds of bradycardia in multivariable analysis (OR: 11.00; 95%CI 1.3-92.8; p=0.028). CONCLUSIONS: Atropine as a premedication in tracheal intubation did not prevent the occurrence of hypoxemia or bradycardia during intubation procedures in pediatric emergency.
Sujet(s)
Atropine , Bradycardie , Enfant , Humains , Atropine/usage thérapeutique , Bradycardie/épidémiologie , Bradycardie/prévention et contrôle , Bradycardie/complications , Service hospitalier d'urgences , Hypoxie/étiologie , Hypoxie/prévention et contrôle , Hypoxie/traitement médicamenteux , Intubation trachéale/effets indésirables , Intubation trachéale/méthodes , Nourrisson , Enfant d'âge préscolaire , AdolescentRÉSUMÉ
Abstract Objective Describe the epidemiology of deaths in children not submitted to CPR, compare to a CPR group and evaluate patients' medical records of those not submitted to CPR. Methods Observational cross-sectional study assessing deaths between 2015 and 2018 in a pediatric tertiary hospital, divided into two groups: CPR and no- CPR. The source of data included the cardiorespiratory arrest register, based on Utstein style. Children's medical records in no-CPR group were researched by hand. Results 241 deaths were included, 162 in CPR group and 79 in the no-CPR group. Preexisting diseases were observed in 98.3% of patients and prior advanced intervention in 78%. Of the 241 deaths, 212 (88%) occurred in the PICU, being 138/162 (85.2%) in CPR group and 74/79 (93.7%) in no-CPR group (p= 0.018). Bradycardia as the initial rhythm was five times more frequent in the CPR group (OR 5.06, 95% CI 1.94-13,19). There was no statistically significant difference regarding age, gender, preexisting diseases, and period of the day of the occurrence of death. Medical records revealed factors related to the family decision-making process or the suitability of therapeutic effort. Discrepancies between the practice of CPR and medical records were identified in 9/79 (11,4%) records allocated to the no-CPR group. Conclusion Most deaths with CPR and with the no-CPR occurred in the PICU. Bradycardia as the initial rhythm was five times more frequent in the CPR group. Medical records reflected the complexity of the decision not to perform CPR. Discrepancies were identified between practice and medical records in the no-CPR group.
RÉSUMÉ
This study assessed the technical performance of a rapid lateral flow immunochromatographic assay (LFIA) for the detection of anti-SARS-CoV-2 IgG and compared LFIA results with chemiluminescent immunoassay (CLIA) results and an in-house enzyme immunoassay (EIA). To this end, a total of 216 whole blood or serum samples from three groups were analyzed: the first group was composed of 68 true negative cases corresponding to blood bank donors, healthy young volunteers, and eight pediatric patients diagnosed with other coronavirus infections. The serum samples from these participants were obtained and stored in a pre-COVID-19 period, thus they were not expected to have COVID-19. In the second group of true positive cases, we chose to replace natural cases of COVID-19 by 96 participants who were expected to have produced anti-SARS-CoV-2 IgG antibodies 30-60 days after the vaccine booster dose. The serum samples were collected on the same day that LFIA were tested either by EIA or CLIA. The third study group was composed of 52 participants (12 adults and 40 children) who did or did not have anti-SARS-CoV-2 IgG antibodies due to specific clinical scenarios. The 12 adults had been vaccinated more than seven months before LFIA testing, and the 40 children had non-severe COVID-19 diagnosed using RT-PCR during the acute phase of infection. They were referred for outpatient follow-up and during this period the serum samples were collected and tested by CLIA and LFIA. All tests were performed by the same healthcare operator and there was no variation of LFIA results when tests were performed on finger prick whole blood or serum samples, so that results were grouped for analysis. LFIA's sensitivity in detecting anti-SARS-CoV-2 IgG antibodies was 90%, specificity 97.6%, efficiency 93%, PPV 98.3%, NPV 86.6%, and likelihood ratio for a positive or a negative result were 37.5 and 0.01 respectively. There was a good agreement (Kappa index of 0.677) between LFIA results and serological (EIA or CLIA) results. In conclusion, LFIA analyzed in this study showed a good technical performance and agreement with reference serological assays (EIA or CLIA), therefore it can be recommended for use in the outpatient follow-up of non-severe cases of COVID-19 and to assess anti-SARS-CoV-2 IgG antibody production induced by vaccination and the antibodies decrease over time. However, LFIAs should be confirmed by using reference serological assays whenever possible.
Sujet(s)
COVID-19 , Adulte , Anticorps antiviraux , COVID-19/diagnostic , COVID-19/prévention et contrôle , Enfant , Études de suivi , Humains , Dosage immunologique/méthodes , Immunoglobuline G , Immunoglobuline M , Patients en consultation externe , Sensibilité et spécificité , VaccinationRÉSUMÉ
OBJECTIVE: Describe the epidemiology of deaths in children not submitted to CPR, compare to a CPR group and evaluate patients' medical records of those not submitted to CPR. METHODS: Observational cross-sectional study assessing deaths between 2015 and 2018 in a pediatric tertiary hospital, divided into two groups: CPR and no- CPR. The source of data included the cardiorespiratory arrest register, based on Utstein style. Children's medical records in no-CPR group were researched by hand. RESULTS: 241 deaths were included, 162 in CPR group and 79 in the no-CPR group. Preexisting diseases were observed in 98.3% of patients and prior advanced intervention in 78%. Of the 241 deaths, 212 (88%) occurred in the PICU, being 138/162 (85.2%) in CPR group and 74/79 (93.7%) in no-CPR group (p = 0.018). Bradycardia as the initial rhythm was five times more frequent in the CPR group (OR 5.06, 95% CI 1.94-13,19). There was no statistically significant difference regarding age, gender, preexisting diseases, and period of the day of the occurrence of death. Medical records revealed factors related to the family decision-making process or the suitability of therapeutic effort. Discrepancies between the practice of CPR and medical records were identified in 9/79 (11,4%) records allocated to the no-CPR group. CONCLUSION: Most deaths with CPR and with the no-CPR occurred in the PICU. Bradycardia as the initial rhythm was five times more frequent in the CPR group. Medical records reflected the complexity of the decision not to perform CPR. Discrepancies were identified between practice and medical records in the no-CPR group.
Sujet(s)
Réanimation cardiopulmonaire , Arrêt cardiaque , Bradycardie , Enfant , Études transversales , Arrêt cardiaque/épidémiologie , Hôpitaux pédiatriques , HumainsRÉSUMÉ
OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.
Sujet(s)
COVID-19 , Adolescent , COVID-19/complications , Enfant , Études de cohortes , Études transversales , Humains , Nouveau-né , SARS-CoV-2 , Syndrome de réponse inflammatoire généralisée , Centres de soins tertiairesRÉSUMÉ
OBJECTIVE: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) is a rare and challenging diagnosis requiring early treatment. The diagnostic criteria involve clinical, laboratory, and complementary tests. This review aims to draw pediatrician attention to this diagnosis, suggesting early treatment strategies, and proposing a pediatric emergency care flowchart. SOURCES: The PubMed/MEDLINE/WHO COVID-19 databases were reviewed for original and review articles, systematic reviews, meta-analyses, case series, and recommendations from medical societies and health organizations published through July 3, 2020. The reference lists of the selected articles were manually searched to identify any additional articles. SUMMARY OF THE FINDINGS: COVID-19 infection is less severe in children than in adults, but can present as MIS-C, even in patients without comorbidities. There is evidence of an exacerbated inflammatory response with potential systemic injury, and it may present with aspects similar to those of Kawasaki disease, toxic shock syndrome, and macrophage activation syndrome. MIS-C can develop weeks after COVID-19 infection, suggesting an immunomediated cause. The most frequent clinical manifestations include fever, gastrointestinal symptoms, rash, mucous membrane changes, and cardiac dysfunction. Elevated inflammatory markers, lymphopenia, and coagulopathy are common laboratory findings. Supportive treatment and early immunomodulation can control the intense inflammatory response and reduce complications and mortality. CONCLUSIONS: MIS-C associated with COVID-19 is serious, rare, and potentially fatal. The emergency department pediatrician must recognize and treat it early using immunomodulatory strategies to reduce systemic injury. Further studies are needed to identify the disease pathogenesis and establish the most appropriate treatment.
Sujet(s)
COVID-19 , Coronavirus , Médecins , Adulte , Enfant , Service hospitalier d'urgences , Humains , SARS-CoV-2 , Syndrome de réponse inflammatoire généraliséeRÉSUMÉ
OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.
Sujet(s)
Humains , Nouveau-né , Enfant , Adolescent , COVID-19/complications , Études transversales , Études de cohortes , Syndrome de réponse inflammatoire généralisée , Centres de soins tertiaires , SARS-CoV-2RÉSUMÉ
The aim of this study was to compare the success of first-attempt tracheal intubation in pediatric patients >1-year old performed using video versus direct laryngoscopy and compare the frequency of tracheal intubation-associated events and desaturation among these patients.Prospective observational cohort study conducted in an Academic pediatric tertiary emergency department. We compared 50 children intubated with Mcgrath Mac video laryngoscope (VL group) and an historical series of 141 children intubated with direct laryngoscopy (DL group). All patients were aged 1 to 18 years.The first attempt success rates were 68% (34/50) and 37.6% (53/141) in the VL and DL groups (Pâ<â.01), respectively. There was a lower proportion of tracheal intubation-associated events in the VL group (VL, 31.3% [15/50] vs DL, 67.8% [97/141]; Pâ<â.01) and no significant differences in desaturation (VL, 35% [14/50] vs DL 51.8% [72/141]; Pâ=â.06). The median number of attempts was 1 (range, 1-5) for the VL group and 2 (range, 1-8) for the DL group (Pâ<â.01). Multivariate logistic regression showed that video laryngoscope use was associated with higher chances of first-attempt intubation with an odds ratio of 4.5 (95% confidence interval, 1.9-10.4, Pâ<â0.01).Compared with direct laryngoscopy, VL was associated with higher success rates of first-attempt tracheal intubations and lower rates of tracheal intubation-associated events.
Sujet(s)
Intubation trachéale/instrumentation , Laryngoscopie/instrumentation , Chirurgie vidéoassistée/instrumentation , Adolescent , Études cas-témoins , Enfant , Enfant d'âge préscolaire , Service hospitalier d'urgences/statistiques et données numériques , Femelle , Humains , Nourrisson , Intubation trachéale/statistiques et données numériques , Laryngoscopie/statistiques et données numériques , Mâle , Études prospectives , Enregistrements , Chirurgie vidéoassistée/statistiques et données numériquesRÉSUMÉ
Abstract Objective: To analyze the main epidemiological aspects of prehospital and hospital pediatric cardiopulmonary resuscitation and the impact of scientific evidence on survival. Source of data: This was a narrative review of the literature published at PubMed/MEDLINE until January 2019 including original and review articles, systematic reviews, meta-analyses, annals of congresses, and manual search of selected articles. Synthesis of data: The prehospital and hospital settings have different characteristics and prognoses. Pediatric prehospital cardiopulmonary arrest has a three-fold lower survival rate than cardiopulmonary arrest in the hospital setting, occurring mostly at home and in children under 1 year. Higher survival appears to be associated with age progression, shockable rhythm, emergency medical care, use of automatic external defibrillator, high-quality early life support, telephone dispatcher-assisted cardiopulmonary resuscitation, and is strongly associated with witnessed cardiopulmonary arrest. In the hospital setting, a higher incidence was observed in children under 1 year of age, and mortality increased with age. Higher survival was observed with shorter cardiopulmonary resuscitation duration, occurrence on weekdays and during daytime, initial shockable rhythm, and previous monitoring. Despite the poor prognosis of pediatric cardiopulmonary resuscitation, an increase in survival has been observed in recent years, with good neurological prognosis in the hospital setting. Conclusions: A great progress in the science of pediatric cardiopulmonary resuscitation has been observed, especially in developed countries. The recognition of the epidemiological aspects that influence cardiopulmonary resuscitation survival may direct efforts towards more effective actions; thus, studies in emerging and less favored countries remains a priority regarding the knowledge of local factors.
Resumo Objetivo: Analisar os principais aspectos epidemiológicos da ressuscitação cardiopulmonar pediátrica pré-hospitalar e hospitalar e o impacto das evidências científicas na sobrevida. Fonte de dados: Revisão narrativa da literatura publicada em Pubmed/Medline até janeiro de 2019, inclusive artigos originais e de revisão, revisões sistemáticas, metanálises, anais de Congresso, além de busca manual dos artigos selecionados. Síntese dos dados: Os cenários pré-hospitalar e hospitalar apresentam características e prognósticos distintos. A parada cardiorrespiratória pré-hospitalar pediátrica apresenta sobrevida três vezes menor do que a hospitalar, ocorre em sua maioria nas residências e nos menores de um ano. A maior sobrevida parece estar associada a progressão da idade, ritmo chocável, atendimento por serviço médico de emergência, uso de desfibrilador externo automático, suporte básico de vida precoce de alta qualidade e orientação de ressuscitação cardiopulmonar via telefônica por atendente e está fortemente associada com parada cardiorrespiratória presenciada. No cenário hospitalar, observou-se maior incidência em menores de um ano e mortalidade crescente com a idade. Maior sobrevida foi observada quanto a menor duração da ressuscitação cardiopulmonar, ocorrência em dias da semana e período diurno, ritmo chocável inicial e monitoração prévia. Apesar do prognóstico reservado da ressuscitação cardiopulmonar pediátrica, observou-se nos últimos anos incremento da sobrevida com bom prognóstico neurológico no cenário hospitalar. Conclusões: Houve grande avanço na ciência da ressuscitação cardiopulmonar pediátrica, especialmente em países desenvolvidos. O reconhecimento dos aspectos epidemiológicos que influenciam a sobrevida da ressuscitação cardiopulmonar pode direcionar esforços para ações mais efetivas. Assim, a pesquisa em países emergentes e menos favorecidos persiste como prioridade no conhecimento de fatores locais.
Sujet(s)
Humains , Enfant , Réanimation cardiopulmonaire , Services des urgences médicales , Arrêt cardiaque/thérapie , Arrêt cardiaque/épidémiologie , Facteurs temps , Taux de survieRÉSUMÉ
OBJECTIVE: To analyze the main epidemiological aspects of prehospital and hospital pediatric cardiopulmonary resuscitation and the impact of scientific evidence on survival. SOURCE OF DATA: This was a narrative review of the literature published at PubMed/MEDLINE until January 2019 including original and review articles, systematic reviews, meta-analyses, annals of congresses, and manual search of selected articles. SYNTHESIS OF DATA: The prehospital and hospital settings have different characteristics and prognoses. Pediatric prehospital cardiopulmonary arrest has a three-fold lower survival rate than cardiopulmonary arrest in the hospital setting, occurring mostly at home and in children under 1year. Higher survival appears to be associated with age progression, shockable rhythm, emergency medical care, use of automatic external defibrillator, high-quality early life support, telephone dispatcher-assisted cardiopulmonary resuscitation, and is strongly associated with witnessed cardiopulmonary arrest. In the hospital setting, a higher incidence was observed in children under 1year of age, and mortality increased with age. Higher survival was observed with shorter cardiopulmonary resuscitation duration, occurrence on weekdays and during daytime, initial shockable rhythm, and previous monitoring. Despite the poor prognosis of pediatric cardiopulmonary resuscitation, an increase in survival has been observed in recent years, with good neurological prognosis in the hospital setting. CONCLUSIONS: A great progress in the science of pediatric cardiopulmonary resuscitation has been observed, especially in developed countries. The recognition of the epidemiological aspects that influence cardiopulmonary resuscitation survival may direct efforts towards more effective actions; thus, studies in emerging and less favored countries remains a priority regarding the knowledge of local factors.
Sujet(s)
Réanimation cardiopulmonaire , Services des urgences médicales , Arrêt cardiaque , Enfant , Arrêt cardiaque/épidémiologie , Arrêt cardiaque/thérapie , Humains , Taux de survie , Facteurs tempsRÉSUMÉ
OBJECTIVE: Children and adolescents often require sedation and analgesia in emergency situations. With the emergence of new therapeutic options, the obsolescence of others, and recent discoveries regarding already known drugs, it became necessary to review the literature in this area. DATA SOURCES: Non-systematic review in the PubMed database of studies published up to December 2016, including original articles, review articles, systematic reviews, and meta-analyses. References from textbooks, publications from regulatory agencies, and articles cited in reviews and meta-analyses through active search were also included. DATA SYNTHESIS: Based on current literature, the concepts of sedation and analgesia, the necessary care with the patient before, during, and after sedoanalgesia, and indications related to the appropriate choice of drugs according to the procedure to be performed and their safety profiles are presented. CONCLUSIONS: The use of sedoanalgesia protocols in procedures in the pediatric emergency room should guide the professional in the choice of medication, the appropriate material, and in the evaluation of discharge criteria, thus assuring quality in care.
Sujet(s)
Analgésie/méthodes , Analgésiques/administration et posologie , Service hospitalier d'urgences , Gestion de la douleur/méthodes , Adolescent , Enfant , Humains , Hypnotiques et sédatifs/administration et posologieRÉSUMÉ
Abstract Objective: Children and adolescents often require sedation and analgesia in emergency situations. With the emergence of new therapeutic options, the obsolescence of others, and recent discoveries regarding already known drugs, it became necessary to review the literature in this area. Data sources: Non-systematic review in the PubMed database of studies published up to December 2016, including original articles, review articles, systematic reviews, and meta-analyses. References from textbooks, publications from regulatory agencies, and articles cited in reviews and meta-analyses through active search were also included. Data synthesis: Based on current literature, the concepts of sedation and analgesia, the necessary care with the patient before, during, and after sedoanalgesia, and indications related to the appropriate choice of drugs according to the procedure to be performed and their safety profiles are presented. Conclusions: The use of sedoanalgesia protocols in procedures in the pediatric emergency room should guide the professional in the choice of medication, the appropriate material, and in the evaluation of discharge criteria, thus assuring quality in care.
Resumo Objetivo: Crianças e adolescentes necessitam frequentemente de sedação e analgesia em situações de emergência. Com o surgimento de novas opções terapêuticas, a obsolescência de outras e descobertas recentes das drogas já conhecidas, fez-se necessário uma nova revisão da literatura nessa área. Fontes dos dados: Revisão não sistemática na base de dados PubMed de estudos publicados até dezembro de 2016, inclusive artigos originais, artigos de revisão, revisões sistemáticas e metanálises. Também foram incluídos referências de livros-texto, publicações de agências reguladoras, além de artigos citados nas revisões e metanálises através de busca ativa. Síntese dos dados: Com base na literatura atual, são apresentados os conceitos de sedação e analgesia, os cuidados necessários com o paciente antes, durante e após a sedoanalgesia, além de indicações quanto à escolha apropriada dos fármacos de acordo com o procedimento a ser feito e o perfil de segurança desses. Conclusões: O emprego de protocolos de sedoanalgesia em procedimentos no pronto-socorro pediátrico deve orientar o profissional na escolha da medicação, do material adequado e na avaliação dos critérios de alta e garantir, assim, qualidade na assistência.
Sujet(s)
Humains , Enfant , Adolescent , Service hospitalier d'urgences , Gestion de la douleur/méthodes , Analgésie/méthodes , Analgésiques/administration et posologie , Hypnotiques et sédatifs/administration et posologieRÉSUMÉ
OBJETIVO: Descrever uma apresentação atípica de abscesso hepático em paciente pediátrico e realizar uma revisão da literatura no que diz respeito às diferenças observadas na etiopatogenia do quadro, quando considerados os países desenvolvidos e aqueles em desenvolvimento. DESCRIÇÃO DO CASO: Paciente de 13 anos, do sexo masculino, foi trazido ao pronto-socorro pediátrico devido à febre diária e à perda de peso, sem alterações ao exame físico. Na investigação realizada, o ultrassom abdominal evidenciou área heterogênea nodulariforme relativamente definida, compatível com abscesso hepático. Foi realizada drenagem cirúrgica e antibioticoterapia. No material da drenagem houve crescimento de Staphylococcus aureus sensível à oxacilina. COMENTÁRIOS: O caso demonstra a importância de o pediatra conhecer as principais causas da febre de origem indeterminada, saber desenvolver a abordagem investigativa e, frente ao diagnóstico de abscesso hepático, aferir a possibilidade de o agente etiológico ser o Staphylococcus aureus, principalmente quando houver relato de rotura da pele.
OBJECTIVE: To describe the clinical presentation of an atypical liver abscess in the pediatric setting and to conduct a review of the literature concerning ethiopathogenic differences between developed and developing countries. CASE DESCRIPTION: A 13-year-old male patient was admitted to the emergency room due to daily fever and weight loss, without abnormalities in his physical examination. After undergoing an investigation, the patient was found to have a well-defined heterogeneous nodular area in the abdominal ultrasonography exam, which was compatible with liver abscess. He was subsequently submitted to surgical drainage and started on antibiotics. The drainage material culture turned positive to methicillin-sensible Staphylococcus aureus. COMMENTS: The present case report shows that the pediatrician needs to be aware of the common causes of fever of unknown origin in order to systematically develop an investigative approach. In face of the diagnosis of a liver abscess, the possibility of Staphylococcus aureus, especially with a previous history of skin rupture, should be considered.
OBJETIVOS: Describir una presentación atípica de absceso hepático en pacientes pediátricos y realizar una revisión de la literatura en lo que se refiere a las diferencias observadas en la etiopatogenia del cuadro, cuando considerados los países desarrollados y en desarrollo. DESCRIPCIÓN DEL CASO: Paciente de 13 años, varón, fue traído a la emergencia pediátrica debido a la fiebre diaria y pérdida de peso, sin alteraciones al examen físico. En la investigación realizada, el ultrasonido abdominal evidenció área heterogénea nodulariforme relativamente definida, compatible con absceso hepático. Se realizó drenaje quirúrgico y antibioticoterapia. En el material drenado hubo crecimiento de Staphylococcus aureus sensible a la oxacilina. COMENTARIOS: El caso demuestra la importancia del pediatra en conocer las principales causas de fiebre de origen indeterminado, en saber desarrollar un acercamiento investigativo y, frente al diagnóstico de absceso hepático, estimar la posibilidad de que el agente etiológico sea el Staphylococcus aureus, principalmente cuando haya relato de rotura de la piel.
Sujet(s)
Humains , Mâle , Adolescent , Abcès du foie/étiologie , Fièvre d'origine inconnue , Staphylococcus aureusRÉSUMÉ
OBJECTIVE: To evaluate the accuracy of pediatric patients' death records of a tertiary care center, comparing these records with data from a previous study. METHODS: Death records entered on the medical charts of non-resuscitated patients between 1999 and 2001 were compared with the medical procedure during cardiac arrest, which was described based on the Utstein-style guidelines. Our results were compared (using the chi-square test for equality of distributions) with the results of a previous study, which revealed a significant discrepancy between the medical procedure and the death record entered on the medical chart. RESULTS: The data analysis revealed agreement between the medical procedure and the medical record notes in 86.5% of the cases. The agreement rate in the previous study was only 27.5%. CONCLUSIONS: There was a significant reduction of discrepancy between the medical procedure during a cardiac arrest and the death record entered on the medical chart.
Sujet(s)
Certificats de décès , Dossiers médicaux/normes , Types de pratiques des médecins , Ordres de réanimation , Réanimation cardiopulmonaire/statistiques et données numériques , Loi du khi-deux , Enfant , Femelle , Humains , Mâle , Études rétrospectives , Soins terminauxRÉSUMÉ
OBJETIVO: Avaliar a veracidade do registro do óbito de pacientes pediátricos de um hospital terciário e comparar esse dado com o de um estudo anterior. MÉTODOS: O registro do óbito apresentado nos prontuários dos pacientes não ressuscitados entre os anos de 1999 e 2001 foi confrontado com o ato médico realizado durante as paradas cardiorrespiratórias, cuja descrição se deu através da padronização Utstein. Esse resultado foi comparado (através do teste de qui-quadrado, com proporções de concordância) com os resultados de um estudo anterior, que havia encontrado uma discrepância expressiva entre o ato médico e o registro de óbito em prontuário. RESULTADOS: Observamos uma concordância entre a prática médica e o registro no prontuário em 86,5 por cento dos casos. No estudo anterior essa taxa foi de apenas 27,5 por cento. CONCLUSÕES: Houve uma redução significativa na discrepância entre o ato médico e o registro de óbito no prontuário.
OBJECTIVE: To evaluate the accuracy of pediatric patients' death records of a tertiary care center, comparing these records with data from a previous study. METHODS: Death records entered on the medical charts of non-resuscitated patients between 1999 and 2001 were compared with the medical procedure during cardiac arrest, which was described based on the Utstein-style guidelines. Our results were compared (using the chi-square test for equality of distributions) with the results of a previous study, which revealed a significant discrepancy between the medical procedure and the death record entered on the medical chart. RESULTS: The data analysis revealed agreement between the medical procedure and the medical record notes in 86.5 percent of the cases. The agreement rate in the previous study was only 27.5 percent. CONCLUSIONS: There was a significant reduction of discrepancy between the medical procedure during a cardiac arrest and the death record entered on the medical chart.