Assuntos
COVID-19 , COVID-19/complicações , Criança , Cuidados Críticos , Progressão da Doença , Hospitalização , Humanos , SARS-CoV-2Assuntos
Estado Terminal , Criança , Seguimentos , Humanos , Estudos Prospectivos , Índice de Gravidade de Doença , UltrassonografiaAssuntos
COVID-19 , SARS-CoV-2 , COVID-19/epidemiologia , Criança , Hospitalização , Humanos , Unidades de Terapia Intensiva Pediátrica , PandemiasRESUMO
PURPOSE: The treatment applied for children admitted to the pediatric intensive care unit (PICU) for severe acute bronchiolitis may differ from general recommendations. The first objective of our study was to describe the treatments offered to these children in a Spanish tertiary PICU. The second objective was to analyse the changes in management derived from the publication of the American Academy of Pediatrics (AAP) bronchiolitis guideline in 2014. METHODS: This was a retrospective-prospective observational study conducted during two epidemic waves (2014-2015 and 2015-2016). The AAP guidelines were distributed and taught to PICU staff between both epidemic waves. RESULTS: A total of 138 children were enrolled (78 male). In the first period, 78 children were enrolled. The median age was 1.8 months (IQR 1.1-3.6). There were no differences between the management in the two periods, except for the use of high-flow oxygen therapy (HFOT); its use increased in the second period. Overall, 83% of patients received non-invasive ventilation or HFOT. Children older than 12 months received HFOT exclusively. In comparison, continuous positive airway pressure and bi-level positive airway pressure were used less during the period 2015-2016 (P=0.036). Regarding pharmacological therapy, 70% of patients received antibiotics, 23% steroids, 33% salbutamol, 31% adrenaline, and 7% hypertonic saline. The mortality rate was zero. CONCLUSIONS: Our PICU did not follow the AAP recommendations. There were no differences between the two periods, except in the use of HFOT. All children older than 12 months received HFOT exclusively. The rate of using invasive mechanical ventilation was also low.
Assuntos
Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Bronquiolite/terapia , Broncodilatadores/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/tendências , Terapia Respiratória/métodos , Doença Aguda , Bronquiolite/diagnóstico , Terapia Combinada , Cuidados Críticos/métodos , Cuidados Críticos/normas , Cuidados Críticos/tendências , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Masculino , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Estudos Prospectivos , Terapia Respiratória/normas , Terapia Respiratória/tendências , Estudos Retrospectivos , Índice de Gravidade de Doença , EspanhaRESUMO
The CD64 receptor has been described as an interesting bacterial infection biomarker. Its expression has not been studied in previously healthy children admitted to pediatric critical care unit (PICU). Our objective was firstly to describe the CD64 expression and secondly study its diagnostic accuracy to discriminate bacterial versus viral infection in this children. We made a prospective double-blind observational study (March 2016-February 2018). A flow cytometry (FC) was done from peripheral blood at PICU admission. We studied the percentage of CD64+ neutrophils and the CD64 mean fluorescence intensity (MFI) on neutrophils (nCD64) and monocytes (mCD64). Statistical analyses were performed with non-parametric tests (p < 0.05). Twenty children in the bacterial infection group (BIG) and 25 in the viral infection group (VIG). Children in BIG showed higher values of CD64+ neutrophils (p = 0.000), nCD64 (p = 0.001), and mCD64 (p = 0.003). In addition, CD64+ neutrophils and nCD64 expression have positive correlation with procalcitonin and C reactive protein. The nCD64 area under the curve (AUC) was 0.83 (p = 0.000). The %CD64+ neutrophils showed an AUC of 0.828 (p = 0.000). The mCD64 AUC was 0.83 (p = 0.003). The nCD64 and %CD64+ neutrophils also showed higher combined values of sensitivity (74%) and specificity (90%) than all classical biomarkers.In our series CD64 expression allows to discriminate between bacterial and viral infection at PICU admission. Future studies should confirm this and be focused in the study of CD64 correlation with clinical data and its utility as an evolution biomarker in critical care children.
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Infecções Bacterianas/diagnóstico , Monócitos/metabolismo , Neutrófilos/metabolismo , Receptores de IgG/sangue , Área Sob a Curva , Infecções Bacterianas/sangue , Biomarcadores/sangue , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Citometria de Fluxo , Humanos , Lactente , Unidades de Terapia Intensiva , Masculino , Estudos Prospectivos , Receptores de IgG/metabolismo , Sensibilidade e Especificidade , Viroses/sangue , Viroses/diagnósticoRESUMO
No disponible
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Humanos , Masculino , Feminino , Criança , Cuidados Críticos/organização & administração , Cuidados Críticos/normas , Cuidados Paliativos na Terminalidade da Vida , Unidades de Terapia Intensiva Pediátrica/organização & administração , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , HemodinâmicaAssuntos
Mortalidade Hospitalar , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Qualidade da Assistência à Saúde , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Grupos Diagnósticos Relacionados , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Assistência Terminal/estatística & dados numéricos , Adulto JovemRESUMO
Anemic syndrome in childhood requires a diagnosis and urgent treatment guided by systematic protocols that can avoid unnecessary additional testing. The case of a 4 year-old girl with fatigue and intermittent fever of 7 days duration, accompanied by abdominal pain is presented. She had regular general health status, with mucocutaneous jaundice, a grade III/VI/iv murmur, and painful abdomen with hepatosplenomegaly. The blood analysis showed a hypo-regenerative anemia with increased LDH and indirect bilirubin. The Coombs Test was negative, with spherocytes being observed in the peripheral blood smear. The IgM and IgG were positive for parvovirus B19 IgM and Epstein Barr virus, leading to the diagnosis of aplastic crisis in a patient with hereditary spherocytosis. No specific treatment was required. Under the suspicion of anemic syndrome in emergencies, the ABCDE sequence must be followed. Through the history, physical examination and basic laboratory tests, an initial diagnostic approach can be made. Specific etiological tests should be based on this first study.