Effectiveness of Two Targeted Temperature Management Methods After Pediatric Postcardiac Arrest: A Multicenter International Study.

OBJECTIVES: It is currently recommended that after return of spontaneous circulation following cardiac arrest, fever should be prevented using TTM through a servo-controlled system. This technology is not yet available in many global settings, where manual physical measures without servo-control is the only option. Our aim was to compare feasibility, safety and quality assurance of servo-controlled system versus no servo-controlled system cooling, TTM protocols for cooling, maintenance and rewarming following return of spontaneous circulation after cardiac arrest in children. DESIGN: Prospective, multicenter, nonrandomized, study. SETTING: PICUs of 20 hospitals in South America, Spain, and Italy, 2012-2014. PATIENTS: Under 18 years old with a cardiac arrest longer than 2 minutes, in coma and surviving to PICU admission requiring mechanical ventilation were included. METHODS: TTM to 32-34°C was performed by prospectively designed protocol across 20 centers, with either servo-controlled system or no servo-controlled system methods, depending on servo-controlled system availability. We analyzed clinical data, cardiac arrest, temperature, mechanical ventilation duration, length of hospitalization, complications, survival, and neurologic outcomes at 6 months. PRIMARY OUTCOME: feasibility, safety and quality assurance of the cooling technique and secondary outcome: survival and Pediatric Cerebral Performance Category at 6 months. MEASUREMENTS AND MAIN RESULTS: Seventy patients were recruited, 51 of 70 TTM (72.8%) with servo-controlled system. TTM induction, maintenance, and rewarming were feasible in both groups. Servo-controlled system was more effective than no servo-controlled system in maintaining TTM (69 vs 60%; p = 0.004). Servo-controlled system had fewer temperatures above 38.1°C during the 5 days of TTM (0.1% vs 2.9%; p < 0.001). No differences in mortality, complications, length of mechanical ventilation and of stay, or neurologic sequelae were found between the two groups. CONCLUSIONS: TTM protocol (for cooling, maintenance and rewarming) following return of spontaneous circulation after cardiac arrest in children was feasible and safe with both servo-controlled system and no servo-controlled system techniques. Achieving, maintaining, and rewarming within protocol targets were more effective with servo-controlled system versus no servo-controlled system techniques.

[Viral respiratory co-infections in pediatric patients admitted for acute respiratory infection and their impact on clinical severity]. / Co-infección viral respiratoria en niños hospitalizados por infección respiratoria aguda y su impacto en la gravedad clínica.

INTRODUCTION: Respiratory viruses are the leading cause of acute respiratory tract infection (ARI) in children. It has been reported that viral respiratory co-infection could be associated with severe clinical course. OBJECTIVES: To describe the frequency of viral co-infection in children admitted for AlRI and evaluate whether this co-infection was associated with more severe clinical course. PATIENTS AND METHODS: Prospective, descriptive study in pediatric patients who were hospitalized for ARI, with molecular detection of at least 1 respiratory virus in nasopharyngeal sample studied by PCR-Microarray for 17 respiratory viruses. RESULTS: 110 out of 147 patients with detection of > 1 respiratory virus were included. Viral co-infection was detected in 41/110 (37%). 22/110 children (20%) were classified as moderate to severe clinical course and 88/110 (80%) were classified as mild clinical course. In the group of moderate to severe clinical course, viral respiratory co-infection was detected in 6/22 (27.3%), compared to 35/88 (39.8 %) in the mild clinical course group. No statistically significant difference was found regarding the presence of co-infection between groups (p = 0.33). CONCLUSIONS: We detected high rates of viral co-infection in children with ARI. It was not possible to demonstrate that viral co-infections were related with severe clinical course in hospitalized children.

Co-infección viral respiratoria en niños hospitalizados por infección respiratoria aguda y su impacto en la gravedad clínica / Viral respiratory co-infections in pediatric patients admitted for acute respiratory infection and their impact on clinical severity

Introduction: Respiratory viruses are the leading cause of acute respiratory tract infection (ARI) in children. It has been reported that viral respiratory co-infection could be associated with severe clinical course. Objectives: To describe the frequency of viral co-infection in children admitted for AlRI and evaluate whether this co-infection was associated with more severe clinical course. Patients and Methods: Prospective, descriptive study in pediatric patients who were hospitalized for ARI, with molecular detection of at least 1 respiratory virus in nasopharyngeal sample studied by PCR-Microarray for 17 respiratory viruses. Results: 110 out of 147 patients with detection of > 1 respiratory virus were included. Viral co-infection was detected in 41/110 (37%). 22/110 children (20%) were classified as moderate to severe clinical course and 88/110 (80%) were classified as mild clinical course. In the group of moderate to severe clinical course, viral respiratory co-infection was detected in 6/22 (27.3%), compared to 35/88 (39.8 %) in the mild clinical course group. No statistically significant difference was found regarding the presence of co-infection between groups (p = 0.33). Conclusions: We detected high rates of viral co-infection in children with ARI. It was not possible to demonstrate that viral co-infections were related with severe clinical course in hospitalized children.

Introducción: Los virus respiratorios son la principal causa de infección aguda del tracto respiratorio (IRA) en pediatría. Se ha descrito que la co-infección viral podría relacionarse con infecciones virales respiratorias de curso más grave. Objetivo: Describir la frecuencia de co-infección viral en niños hospitalizados por IRA y determinar si esta co-infección se relacionó con una evolución clínica más grave. Pacientes y Métodos: Estudio descriptivo, prospectivo, en pacientes pediátricos hospitalizados por IRA entre junio y agosto 2010, que tuvieron detección molecular de al menos un virus respiratorio en muestra nasofaríngea estudiada por RPC-microarreglo para 17 virus respiratorios. Resultados: Se incluyeron 110 de 147 pacientes con detección de > 1 virus respiratorio. Se detectó co-infección viral en 41/110 (37%). En cuanto a evolución clínica, 22/110 niños (20%) se clasificaron como evolución moderada a grave (MG) y 88/110 (80%) se clasificaron como evolución leve (L). En el grupo MG se detectó co-infección viral respiratoria en 6/22 (27,3%), mientras que en el grupo L se detectó co-infección en 35/88 (39,8%). No se encontró diferencia significativa en relación a la presencia de co-infección entre ambos grupos (p = 0,33). Conclusión: Se demostró la presencia de co-infección viral en un alto porcentaje de niños con IRA. No fue posible demostrar que la presencia de coinfección viral tenga relación con una evolución clínica más grave en estos niños hospitalizados.

First Pediatric Intensive Care Congress in Chile.

OBJECTIVE: To summarize the First Chilean Congress on Pediatric Critical Care Medicine. DATA SOURCE/EXTRACTION: Program schedule, presentations, abstracts. STUDY SELECTION: Descriptive summary of the congress. CONCLUSIONS: The Chilean Society of Pediatric Critical Care organized the First Pediatric Intensive Care Congress in Chile, having a registration of 217 delegates. All the pediatric intensive care units of the country had a representative in the Congress either as a delegate or a faculty member, which provided an excellent opportunity for interactions between them. The international faculty addressed state-of-the-art issues, with a charge of highlighting basic science relevant to clinical practice, which motivated long interactive question-and-answer sessions with the audience. Strong evidence was presented by Chilean faculty debaters who discussed controversial topics, making these sessions very attractive. An entire day was scheduled with a simultaneous nursing session. More than 80 intensive care nurses benefited from a very interactive day with five symposia and short oral presentations. A randomized multi-institutional research protocol studying reintubation rate using three methods for weaning from mechanical ventilation was discussed during the meeting. Thirteen units committed to participate. Twenty-three posters were displayed in the congress. Posters describing the activity of pediatric intensive care units were also presented. The mean for intensive care unit beds was 6.8 and for intermediate care beds was 7.1. Annual admissions showed a mean of 640 patients, and mortality rate ranged from 4.1% to 12%, with a mean of 6.7%