Clinical practices related to liberation from mechanical ventilation in Latin American pediatric intensive care units: survey of the Sociedad Latino-Americana de Cuidados Intensivos Pediátricos Mechanical Ventilation Liberation Group.

OBJECTIVE: To address the current practice of liberating patients from invasive mechanical ventilation in pediatric intensive care units, with a focus on the use of standardized protocols, criteria, parameters, and indications for noninvasive respiratory support postextubation. METHODS: Electronic research was carried out from November 2021 to May 2022 in Ibero-American pediatric intensive care units. Physicians and respiratory therapists participated, with a single representative for each pediatric intensive care unit included. There were no interventions. RESULTS: The response rate was 48.9% (138/282), representing 10 Ibero-American countries. Written invasive mechanical ventilation liberation protocols were available in only 34.1% (47/138) of the pediatric intensive care units, and their use was associated with the presence of respiratory therapists (OR 3.85; 95%CI 1.79 - 8.33; p = 0.0008). The most common method of liberation involved a gradual reduction in ventilatory support plus a spontaneous breathing trial (47.1%). The mean spontaneous breathing trial duration was 60 - 120 minutes in 64.8% of the responses. The presence of a respiratory therapist in the pediatric intensive care unit was the only variable associated with the use of a spontaneous breathing trial as the primary method of liberation from invasive mechanical ventilation (OR 5.1; 95%CI 2.1 - 12.5). Noninvasive respiratory support protocols were not frequently used postextubation (40.4%). Nearly half of the respondents (43.5%) reported a preference for using bilevel positive airway pressure as the mode of noninvasive ventilation postextubation. CONCLUSION: A high proportion of Ibero-American pediatric intensive care units lack liberation protocols. Our study highlights substantial variability in extubation readiness practices, underscoring the need for standardization in this process. However, the presence of a respiratory therapist was associated with increased adherence to guidelines.

MUC5AC: A potential biomarker of severity in pediatric patients infected with influenza.

Numerous factors can increase the risk of severe influenza; however, a majority of severe cases occur in previously healthy children. Identification of high-risk children is important for targeted preventive interventions and prompt treatment. The aim of this study was to evaluate MUC5AC as a biomarker for influenza disease severity in children. For this, a prospective cohort study was conducted in 2019. Children hospitalized with acute respiratory infection (ARI) with confirmed positive influenza infection were enrolled. Influenza cases were identified by reverse transcriptase-polymerase chain reaction. Life-threatening disease (LTD) was defined by the need for intensive care and ventilatory support. MUC5AC, epidemiologic, and clinical risk factors were assessed. Three hundred and forty-two patients were hospitalized with ARI, of which 49 (14%) had confirmed influenza infection and 6 (12%) of them developed LTD. MUC5AC levels were higher in those patients with mild disease compared to cases with poorer outcomes. Our results show that the severity of influenza infection in children is significantly associated with low levels of MUC5AC. These findings suggest its potential as a suitable biomarker for predicting disease severity.

Ventilación no invasiva posextubación en cuidados intensivos pediátricos: estudio multicéntrico / Post-extubation non-invasive ventilation in the pediatric intensive care unit: a multicenter study

Introducción. El fracaso de extubación es una complicación que aumenta la morbimortalidad. La ventilación no invasiva (VNI) demostró ser efectiva como tratamiento de soporte ventilatorio. Objetivo. Determinar la tasa de éxito de la VNI posextubación y los factores asociados al éxito o fracaso del procedimiento. Población y métodos. Diseño: observacional, retrospectivo, analítico y multicéntrico. Ingresaron todos los pacientes que requirieron VNI posextubación durante 2014 y 2015. Se denominó VNI de rescate la implementación por falla respiratoria aguda y VNI electiva, su aplicación en forma profiláctica. Se definió fracaso de la VNI la necesidad de intubación orotraqueal en las primeras 48 horas. Se compararon las características entre éxitos y fracasos, los tipos de VNI y se realizó un relevamiento del equipamiento utilizado. Resultados. Precisaron VNI de rescate 112 niños y VNI electiva, 143. Las tasas de éxitos fueron de 68,8% y 72,7%, respectivamente. Aquellos que fracasaron la VNI de rescate tuvieron una mortalidad mayor que aquellos con VNI exitosa. Se observaron más días de internación y de ventilación mécanica invasiva previa a la extubación en el grupo de VNI electiva. El diagnóstico más frecuente fue la infección respiratoria aguda baja en el niño sano. Conclusiones. La utilización de VNI posterior a la extubación puede ser una herramienta útil para evitar el reingreso a ventilación mecánica invasiva. Los pacientes inmunocomprometidos y con antecedentes neurológicos tuvieron mayor fracaso. Los pacientes que fracasaron toleraron menos horas de VNI y presentaron mayor estadía en la Unidad de Cuidados Intensivos Pediátricos.

Introduction. Extubation failure is a complication that increases morbidity and mortality. Noninvasive ventilation (NIV) has demonstrated to be effective as ventilatory support therapy. Objective. To determine the rate of postextubation NIV success and the factors associated with procedural failure or success. Population and methods. Design: observational, retrospective, analytical, and multicenter study. All patients who required post-extubation NIV during 2014 and 2015 were included. Rescue NIV was defined as the implementation of NIV for acute respiratory failure; elective NIV was described as its implementation for prophylaxis. NIV failure was defined as the need for orotracheal intubation within the first 48 hours. The characteristics of failure and success and the types of NIV were compared, and the equipment used was assessed. Results. Rescue NIV was required in 112 children; elective NIV, in 143. The rates of success were 68.8% and 72.7%, respectively. Mortality was higher among patients in whom rescue NIV failed compared to those with successful NIV. A longer length of stay and more days of invasive mechanical ventilation prior to extubation were observed in the elective NIV group. The most common diagnosis was acute lower respiratory tract infection in previously healthy children. Conclusions. The use of post-extubation NIV may be a useful tool to prevent reintubation with invasive mechanical ventilation. Immunocompromised patients and those with neurological history had a higher rate of failure. Patients with failure tolerated less hours of NIV and had a longer length of stay in the pediatric intensive care unit.

Post-extubation non-invasive ventilation in the pediatric intensive care unit: a multicenter study. / Ventilación no invasiva posextubación en cuidados intensivos pediátricos: estudio multicéntrico.

INTRODUCTION: Extubation failure is a complication that increases morbidity and mortality. Noninvasive ventilation (NIV) has demonstrated to be effective as ventilatory support therapy. OBJECTIVE: To determine the rate of postextubation NIV success and the factors associated with procedural failure or success. POPULATION AND METHODS: Design: observational, retrospective, analytical, and multicenter study. All patients who required post-extubation NIV during 2014 and 2015 were included. Rescue NIV was defined as the implementation of NIV for acute respiratory failure; elective NIV was described as its implementation for prophylaxis. NIV failure was defined as the need for orotracheal intubation within the first 48 hours. The characteristics of failure and success and the types of NIV were compared, and the equipment used was assessed. RESULTS: Rescue NIV was required in 112 children; elective NIV, in 143. The rates of success were 68.8% and 72.7%, respectively. Mortality was higher among patients in whom rescue NIV failed compared to those with successful NIV. A longer length of stay and more days of invasive mechanical ventilation prior to extubation were observed in the elective NIV group. The most common diagnosis was acute lower respiratory tract infection in previously healthy children. CONCLUSIONS: The use of post-extubation NIV may be a useful tool to prevent reintubation with invasive mechanical ventilation. Immunocompromised patients and those with neurological history had a higher rate of failure. Patients with failure tolerated less hours of NIV and had a longer length of stay in the pediatric intensive care unit.

Introducción. El fracaso de extubación es una complicación que aumenta la morbimortalidad. La ventilación no invasiva (VNI) demostró ser efectiva como tratamiento de soporte ventilatorio. Objetivo. Determinar la tasa de éxito de la VNI posextubación y los factores asociados al éxito o fracaso del procedimiento. Población y métodos. Diseño: observacional, retrospectivo, analítico y multicéntrico. Ingresaron todos los pacientes que requirieron VNI posextubación durante 2014 y 2015. Se denominó VNI de rescate la implementación por falla respiratoria aguda y VNI electiva, su aplicación en forma profiláctica. Se definió fracaso de la VNI la necesidad de intubación orotraqueal en las primeras 48 horas. Se compararon las características entre éxitos y fracasos, los tipos de VNI y se realizó un relevamiento del equipamiento utilizado. Resultados. Precisaron VNI de rescate 112 niños y VNI electiva, 143. Las tasas de éxitos fueron de 68,8% y 72,7%, respectivamente. Aquellos que fracasaron la VNI de rescate tuvieron una mortalidad mayor que aquellos con VNI exitosa. Se observaron más días de internación y de ventilación mécanica invasiva previa a la extubación en el grupo de VNI electiva. El diagnóstico más frecuente fue la infección respiratoria aguda baja en el niño sano. Conclusiones. La utilización de VNI posterior a la extubación puede ser una herramienta útil para evitar el reingreso a ventilación mecánica invasiva. Los pacientes inmunocomprometidos y con antecedentes neurológicos tuvieron mayor fracaso. Los pacientes que fracasaron toleraron menos horas de VNI y presentaron mayor estadía en la Unidad de Cuidados Intensivos Pediátricos.