Prevalence of Children With Complex Chronic Conditions in PICUs of Argentina: A Prospective Multicenter Study.

OBJECTIVES: To determine the prevalence of children with complex chronic conditions in PICUs in Argentina. To describe the demographic profile, clinical course and outcomes in PICU of children with complex chronic condition in comparison to previously healthy children. DESIGN: Prospective, observational multicenter study. SETTING: Nineteen PICUs located in Argentina belonging to public and private institutions. PATIENTS: All children admitted to the participating PICUs between March 1, 2015, and February 28, 2016. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: We analyzed 3,483 PICU admissions. The prevalence of complex chronic condition was 48.06% (95% CI, 46.39-49.72). Cardiovascular complex chronic condition was predominant (22.24% [421/1,893]), followed by neuromuscular complex chronic condition (18.75% [355/1,893]) and malignant disease 17.7% (335/1,893). Technologic dependence was present in 22.22% of the patients (372 of 1,674). Predominant admission diagnosis was postoperative (36.6%) and respiratory disease (28.32%). Children with complex chronic condition had higher mortality than previously healthy patients (odds ratio, 2.74; 95% CI, 2.01-3.73). The risk of prolonged stay (≥ 26 d) was also higher (odds ratio, 1.44; 95% CI, 1.10-1.89). Rate utilization of the following devices was higher in patients with complex chronic condition: mechanical ventilation (odds ratio, 1.35; 95% CI, 1.12-1.63), central venous catheter (odds ratio, 1.24; 95% CI, 1.04-1.48), and arterial monitoring (odds ratio, 1.33; 95% CI, 1.09-1.63). CONCLUSIONS: We observed a high prevalence of patients with complex chronic condition in this sample of argentine PICUs. These patients presented higher mortality and resource use than previously healthy children. This information is valuable to understand the impact that patients with complex chronic condition have on PICU performance and enables proper planning of care.

¿Quién traslada los pacientes a la unidad de cuidados intensivos pediátricos del Hospital El Cruce? / Who transfers patients to the pediatric intensive care unit of El Cruce Hospital?

INTRODUCCION: La demanda de atención de situaciones críticas no se da habitualmente cerca del centro terciario, por lo que es imprescindible una coordinación entre los centros asistenciales y un adecuado traslado de estos pacientes. Las condiciones de traslado de pacientes críticos influirán en la sobrevida y calidad de vida. OBJETIVO: El presente estudio tiene como objetivo describir las características generales de los traslados de pacientes admitidos en la UCIP del HEC. METODOS: Se ha realizado un estudio prospectivo, observacional en el que fueron evaluados de manera consecutiva todos los pacientes que ingresaron a la UCIP del HEC desde el 1° de noviembre de 2008 hasta el 31 de marzo de 2009. Se registraron datos demográficos e inherentes al traslado (tipo de transporte, tiempos de traslado, médico que realiza el traslado, presencia de enfermero en ambulancia, consentimiento informado). RESULTADOS: Dentro de los resultado obtenidos ochenta pacientes (72,7%) completaron los datos al ingreso. Los pacientes fueron trasladados en su mayoría por médicos en formación (68,4%). Las ambulancias no contaban con enfermero en 72,5% de los traslados. Dos pacientes (2,5%) fueron trasladados con el consentimiento informado correspondiente. Se identifica que el traslado de pacientes críticos a la UCIP del HEC fue realizado en un alto porcentaje por médicos en formación, sin enfermero acompañante y sin el consentimiento informado correspondiente.

INTRODUCTION: Because of critical care is not usually near the tertiary Center, coordination between centers and an adequate transfer of these patients is essential. The conditions for transfer critical patients influence on survival and quality of life. OBJECTIVE: Describe the General characteristics of transport of patients admitted to the Hospital El Cruce from November the 1st 2008 up to march 31st. METHODS: Prospective, observational study. All patients admitted the Hospital El Cruce´s UCIP from November the 1st 2008 up to march 31st 2009 were assessed consecutively. Demographic and inherent to transport (transport type, time of transfer, the physician who performed the transport, presence of nurse in ambulance, informed consent) data were recorded. RESULT: Eighty patients (72,7%) completed the data entry. Professionals responsible for transports were majority training doctors (68.4%).

Recuperación cardiovascular pediátrica: relevamiento estadístico 2009 - 2012 / Pediatric cardiovascular recovery: statistical survey 2009 - 2012

INTRODUCCION: Las cardiopatías congénitas son una patología prevalente en nuestra comunidad generando una importante demanda que requiere una respuesta rápida y efectiva para lograr mejores resultados en los tratamientos. Esta necesidad ha sido cubierta en gran medida desde la implementación del Plan Nacer (Cardiopatías Congénitas), con un gran impacto en la disminución de la mortalidad infantil. En el siguiente trabajo se comunican los resultados de las cirugías cardiovasculares en cardiopatías congénitas en el Hospital de Alta Complejidad El Cruce. Dr. Néstor Carlos Kirchner. MATERIALES Y METODOS: Los datos se identificaron por medio de la revisión de la Historia Clínica Digital en el Sistema SIGHEOS. RESULTADOS: los resultados obtenidos durante el período julio 2009 - octubre 2012 se realizaron 64 cirugías cardiovasculares. Diez cirugías fueron en neonatos, treinta y seis en pacientes de 31 días a 1 año y dieciocho en mayores de 1 año. Se concluye con que el crecimiento de los Servicios de Cirugía Cardiovascular Pediátrica y Recuperación Cardiovascular Pediátrica, ha sido exponencial desde el inicio de la realización de la primera cirugía en el año 2009. Desde el inicio de las actividades del servicio de Cirugía Cardiovascular Pediátrica y de Recuperación Cardiovascular Pediátrica en UCIP (Unidad Cuidados Intensivos Pediátricos), tanto el número, como la complejidad de las patologías operadas han ido en aumento.

INTRODUCTION: Congenital heart disease is a disease prevalent in our community generating significant demand that requires a rapid and effective response to achieve better results in treatment. This need has been met largely from the implementation of the Plan nacer (congenital heart disease), with a great impact on reducing child mortality. In this paper, we report the results of cardiovascular surgery in congenital heart disease in the High Complexity Hospital El Cruce. Dr. néstor Carlos Kirchner. MATERIAL AND METHODS: review of Medical records. SIGHEOS System. RESULTS: During the period July 2009 - 64 October 2012 cardiovascular surgeries were performed. Ten surgeries were in neonates, thirty-six patients under one year and eighteen in over 1 year.

Critically ill infants and children with influenza A (H1N1) in pediatric intensive care units in Argentina.

OBJECTIVE: To determine the epidemiological features, course, and outcomes of critically ill pediatric patients with Influenza A (H1N1) virus. DESIGN: Prospective cohort of children in pediatric intensive care units (PICUs) due to Influenza A (H1N1) virus infection. SETTING: Seventeen medical-surgical PICUs in tertiary care hospital in Argentina. PATIENTS: All consecutive patients admitted to the PICUs with influenza A (H1N1) viral infection from 15 June to 31 July 2009. MEASUREMENTS AND MAIN RESULTS: Of 437 patients with acute lower respiratory infection in PICUs, 147 (34%) were diagnosed with influenza A (H1N1) related to critical illness. The median age of these patients was 10 months (IQR 3-59). Invasive mechanical ventilation was used in 117 (84%) on admission. The rate of acute respiratory distress syndrome (ARDS) was 80% (118 of 147 patients). Initial non-invasive ventilation failed in 19 of 22 attempts (86%). Mortality at 28 days was 39% (n = 57). Chronic complex conditions (CCCs), acute renal dysfunction (ARD) and ratio PaO(2)/FiO(2) at day 3 on MV were independently associated with a higher risk of mortality. The odds ratio (OR) for CCCs was 3.06, (CI 95% 1.36-6.84); OR for ARD, 3.38, (CI 95% 1.45-10.33); OR for PaO(2)/FiO(2), 4 (CI 95% 1.57-9.59). The administration of oseltamivir within 24 h after admission had a protective effect: OR 0.2 (CI 95% 0.07-0.54). CONCLUSIONS: In children with ARDS, H1N1 as an etiologic agent confers high mortality, and the presence of CCCs in such patients increases the risk of death.

Sistema de registro informático en una unidad de cuidados intensivos pediátricos en tiempo real y sin papeles / Computer registration system in a pediatric intensive care unit in real time and without papers

Las bases de datos constituyen una importante herramienta en la gestión de un servicio. Para ello es indispensable que el registro se realice en tiempo real, permitiendo un monitoreo efectivo de la situación, con intervenciones oportunas que admitan modificar situaciones que compremeten la calidad de atención de un servicio.