Comprehensive study of mechanical power in controlled mechanical ventilation: Prevalence of elevated mechanical power and component analysis / Estudio Integral de la Potencia Mecánica en la Ventilación Mecánica Controlada: Prevalencia de Potencia Mecánica Elevada y Análisis de Componentes

Objective To determine the prevalence of elevated mechanical power (MP) values (>17J/min) used in routine clinical practice. Design Observational, descriptive, cross-sectional, analytical, multicenter, international study conducted on November 21, 2019, from 8:00 AM to 3:00 PM. NCT03936231. Setting One hundred thirty-three Critical Care Units. Patients Patients receiving invasive mechanical ventilation for any cause. Interventions None. Main variables of interest Mechanical power. Results A population of 372 patients was analyzed. PM was significantly higher in patients under pressure-controlled ventilation (PC) compared to volume-controlled ventilation (VC) (19.20±8.44J/min vs. 16.01±6.88J/min; p<0.001), but the percentage of patients with PM>17J/min was not different (41% vs. 35%, respectively; p=0.382). The best models according to AICcw expressing PM for patients in VC are described as follows: Surrogate Strain (Driving Pressure) + PEEP+Surrogate Strain Rate (PEEP/Flow Ratio) + Respiratory Rate. For patients in PC, it is defined as: Surrogate Strain (Expiratory Tidal Volume/PEEP) + PEEP+Surrogate Strain Rate (Surrogate Strain/Ti) + Respiratory Rate+Expiratory Tidal Volume+Ti. Conclusions A substantial proportion of mechanically ventilated patients may be at risk of experiencing elevated levels of mechanical power. Despite observed differences in mechanical power values between VC and PC ventilation, they did not result in a significant disparity in the prevalence of high mechanical power values. (AU)

Objetivo Determinar la prevalencia de valores elevados de potencia mecánica (PM) (>17J/min) utilizados en la práctica clínica habitual. Diseño estudio observacional, descriptivo de corte transversal, analítico, multicéntrico e internacional, realizado el 21 de noviembre de 2019 en horario de 8 a 15 horas. NCT03936231. Ámbito Ciento treinta y tres Unidad de Cuidados Críticos. Pacientes pacientes que recibirán ventilación mecánica por cualquier causa. Intervenciones ninguna Variables de interés principales Potencia mecánica. Resultados se analizaron 372 enfermos. La PM fue significativamente mayor en pacientes en ventilación controlada por presión (PC) que en ventilación controlada por volumen (VC) (19,20+8,44J/min frente a 16,01+6,88J/min; p<0,001), pero el porcentaje de pacientes con PM>17J/min no fue diferente (41% frente a 35% respectivamente; p=0,382). Los mejores modelos según AICcw que expresan la PM para los enfermos en VC se decribe como: Strain subrogante (Presión de conducción) + PEEP+Strain Rate subrogante (PEEP/cociente de flujo) + Frecuencia respiratoria. Para los enfermos en PC se define como: Strain subrogante (Volumen tidal expiratorio/PEEP) + PEEP+Strain Rate subrogante (Strain subrogante/Ti) + Frecuencia respiratoria+Expiratory Tidal Volumen+Ti. Conclusiones Gran parte de los pacientes en ventilación mecánica en condiciones de práctica clínica habitual reciben niveles de potencia mecánica peligrosos. A pesar de las diferencias observadas en los valores de potencia mecánica entre la ventilación VC y PC, este porcentaje de riesgo fue similar en PC y VC. (AU)

Comprehensive study of mechanical power in controlled mechanical ventilation: Prevalence of elevated mechanical power and component analysis.

OBJECTIVE: To determine the prevalence of elevated mechanical power (MP) values (>17J/min) used in routine clinical practice. DESIGN: Observational, descriptive, cross-sectional, analytical, multicenter, international study conducted on November 21, 2019, from 8:00 AM to 3:00 PM. NCT03936231. SETTING: One hundred thirty-three Critical Care Units. PATIENTS: Patients receiving invasive mechanical ventilation for any cause. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Mechanical power. RESULTS: A population of 372 patients was analyzed. PM was significantly higher in patients under pressure-controlled ventilation (PC) compared to volume-controlled ventilation (VC) (19.20±8.44J/min vs. 16.01±6.88J/min; p<0.001), but the percentage of patients with PM>17J/min was not different (41% vs. 35%, respectively; p=0.382). The best models according to AICcw expressing PM for patients in VC are described as follows: Surrogate Strain (Driving Pressure) + PEEP+Surrogate Strain Rate (PEEP/Flow Ratio) + Respiratory Rate. For patients in PC, it is defined as: Surrogate Strain (Expiratory Tidal Volume/PEEP) + PEEP+Surrogate Strain Rate (Surrogate Strain/Ti) + Respiratory Rate+Expiratory Tidal Volume+Ti. CONCLUSIONS: A substantial proportion of mechanically ventilated patients may be at risk of experiencing elevated levels of mechanical power. Despite observed differences in mechanical power values between VC and PC ventilation, they did not result in a significant disparity in the prevalence of high mechanical power values.

CPAP vs oxigenoterapia convencional en lactantes trasladados por insuficiencia respiratoria / CPAP vs oxygen therapy in infants being transported due to acute respiratory failure

OBJETIVOS: Evaluar la efectividad y la seguridad de la presión continua en la vía aérea (CPAP) en lactantes trasladados por insuficiencia respiratoria aguda (IRA) y comparar el curso clínico y la evolución en la unidad de cuidados intensivos pediátricos (UCIP) de los pacientes trasladados con dicha terapia vs la oxigenoterapia convencional. MATERIAL Y MÉTODOS: Estudio observacional y analítico de una cohorte retrospectiva. Se revisaron las historias de los lactantes de 0 a 12meses con IRA que precisaron traslado interhospitalario a la UCIP. RESULTADOS: Se incluyeron 110 pacientes: 71 trasladados con CPAP y 39 con oxigenoterapia. La causa principal de IRA fue la bronquiolitis (81,8%). La mediana del nivel de CPAP fue de 7cmH2O (rango intercuartílico, 6-7). Controlando en análisis multivariables específicos por los valores previos, se obtuvo que la CPAP durante el traslado produjo una disminución significativa en el score de Wood-Downes (beta=−1,08; IC95%: −1,76 a 0,40; p = 0,002) y en la frecuencia cardiaca (beta=−19,64, IC95%: −28,46 a −10,81; p < 0,001). Ningún paciente precisó intubación endotraqueal durante el transporte. En la UCIP, la tasa de intubación fue similar en el grupo CPAP (7%) y en el de oxigenoterapia (5,1%) (p = 0,689). El porcentaje de pacientes que precisaron ventilación no invasiva con dos niveles de presión en las primeras 6h de ingreso en la UCIP fue mayor en el grupo de oxigenoterapia: 100% (11/11) vs 69,2% (18/26), p = 0,04. CONCLUSIONES: La administración precoz de CPAP en lactantes es segura durante el traslado interhospitalario. Durante el transporte, la CPAP comparada con la oxigenoterapia disminuye el score de Wood-Downes y la frecuencia cardiaca

OBJECTIVE: The aims of our study are to evaluate the effectiveness and security of CPAP (continuous positive airway pressure) in infants transferred with acute respiratory failure (ARF) and to compare their evolution in PICU between CPAP vs oxygen therapy. MATERIALS AND METHODS: We conducted a retrospective observational and analytical study by reviewing the health records of infants with ARF aged 0 to 12months that required interhospital transfer to the PICU. RESULTS: We included 110 patients: 71 transported with CPAP and 39 with oxygen therapy. The main cause of ARF was acute bronchiolitis (81.8%). The median level of CPAP was 7cmH2O (interquartile range, 6-7). Controlling by the previous values in specific multivariable models, CPAP produced a significant decrease in the Wood-Downes score (beta = −1.08; 95% CI = −1.76 to −0.40; P = .002) and the heart rate (beta = −19.64, 95% CI = −28.46 to −10.81; P < .001). No patients required endotracheal intubation during transport. During the PICU stay, the intubation rate was similar in the CPAP group (7%) and the oxygen therapy group (5.1%) (P=.689). The proportion of patients that required bilevel positive airway pressure within 6hours of admission to the PICU was higher in the oxygen therapy group: 100% (11/11) vs 69.2% (18/26), P=.04. CONCLUSIONS: Early administration of CPAP to infants with ARF was a safe respiratory support intervention during interhospital transport. During patient transport, the use of CPAP achieved greater decreases in the Wood-Downes score and heart rate compared to oxygen therapy

[CPAP vs oxygen therapy in infants being transported due to acute respiratory failure]. / CPAP vs oxigenoterapia convencional en lactantes trasladados por insuficiencia respiratoria.

OBJECTIVE: The aims of our study are to evaluate the effectiveness and security of CPAP (continuous positive airway pressure) in infants transferred with acute respiratory failure (ARF) and to compare their evolution in PICU between CPAP vs oxygen therapy. MATERIALS AND METHODS: We conducted a retrospective observational and analytical study by reviewing the health records of infants with ARF aged 0 to 12months that required interhospital transfer to the PICU. RESULTS: We included 110 patients: 71 transported with CPAP and 39 with oxygen therapy. The main cause of ARF was acute bronchiolitis (81.8%). The median level of CPAP was 7cmH2O (interquartile range, 6-7). Controlling by the previous values in specific multivariable models, CPAP produced a significant decrease in the Wood-Downes score (beta = -1.08; 95% CI = -1.76 to -0.40; P = .002) and the heart rate (beta = -19.64, 95% CI = -28.46 to -10.81; P < .001). No patients required endotracheal intubation during transport. During the PICU stay, the intubation rate was similar in the CPAP group (7%) and the oxygen therapy group (5.1%) (P=.689). The proportion of patients that required bilevel positive airway pressure within 6hours of admission to the PICU was higher in the oxygen therapy group: 100% (11/11) vs 69.2% (18/26), P=.04. CONCLUSIONS: Early administration of CPAP to infants with ARF was a safe respiratory support intervention during interhospital transport. During patient transport, the use of CPAP achieved greater decreases in the Wood-Downes score and heart rate compared to oxygen therapy.

[Organ donation after brain death due to child abuse]. / Donación de órganos tras muerte encefálica debida a maltrato infantil.

More than 40 percent of deaths from child abuse occur among children younger than 5 years. The injury pattern in child abuse is block abuse head trauma which in the most severe cases produces brain death. Organ donation is uncommon in children younger than five years. We describe two cases of child abuse that caused brain death; subsequently they were subsidiary for organ donation. It is very important to establish a good coordination between health, social care and legal assistance teams to obtain organ donation.

Donación de órganos tras muerte encefálica debida a maltrato infantil / Organ donation after brain death due to child abuse

Más del 40 por ciento de las muertes por maltrato infantil se producen entre los niños menores de 5 años. El patrón de lesión es el traumatismo encefalocraneano abusivo, que, en los casos más graves, conduce a la muerte cerebral. La donación de órganos en menores de 5 años es poco frecuente. Se describen dos casos de maltrato infantil que causó la muerte encefálica en un niño de un mes y otro de cuatro años de edad, quienes posteriormente fueron candidatos para la donación de órganos. Es crucial la existencia de una buena coordinación entre los equipos sanitarios, de asistencia social y jurídica para intentar obtener la donación de órganos en los casos de muerte encefálica secundaria a maltrato.

More than 40 percent of deaths from child abuse occur among children younger than 5 years. The injury pattern in child abuse is block abuse head trauma which in the most severe cases produces brain death. Organ donation is uncommon in children younger than five years. We describe two cases of child abuse that caused brain death; subsequently they were subsidiary for organ donation. It is very important to establish a good coordination between health, social care and legal assistance teams to obtain organ donation.

Donación de órganos tras muerte encefálica debida a maltrato infantil / Organ donation after brain death due to child abuse

Más del 40 por ciento de las muertes por maltrato infantil se producen entre los niños menores de 5 años. El patrón de lesión es el traumatismo encefalocraneano abusivo, que, en los casos más graves, conduce a la muerte cerebral. La donación de órganos en menores de 5 años es poco frecuente. Se describen dos casos de maltrato infantil que causó la muerte encefálica en un niño de un mes y otro de cuatro años de edad, quienes posteriormente fueron candidatos para la donación de órganos. Es crucial la existencia de una buena coordinación entre los equipos sanitarios, de asistencia social y jurídica para intentar obtener la donación de órganos en los casos de muerte encefálica secundaria a maltrato.(AU)

More than 40 percent of deaths from child abuse occur among children younger than 5 years. The injury pattern in child abuse is block abuse head trauma which in the most severe cases produces brain death. Organ donation is uncommon in children younger than five years. We describe two cases of child abuse that caused brain death; subsequently they were subsidiary for organ donation. It is very important to establish a good coordination between health, social care and legal assistance teams to obtain organ donation.(AU)

Donación de órganos tras muerte encefálica debida a maltrato infantil / Organ donation after brain death due to child abuse

Más del 40 por ciento de las muertes por maltrato infantil se producen entre los niños menores de 5 años. El patrón de lesión es el traumatismo encefalocraneano abusivo, que, en los casos más graves, conduce a la muerte cerebral. La donación de órganos en menores de 5 años es poco frecuente. Se describen dos casos de maltrato infantil que causó la muerte encefálica en un niño de un mes y otro de cuatro años de edad, quienes posteriormente fueron candidatos para la donación de órganos. Es crucial la existencia de una buena coordinación entre los equipos sanitarios, de asistencia social y jurídica para intentar obtener la donación de órganos en los casos de muerte encefálica secundaria a maltrato.(AU)

More than 40 percent of deaths from child abuse occur among children younger than 5 years. The injury pattern in child abuse is block abuse head trauma which in the most severe cases produces brain death. Organ donation is uncommon in children younger than five years. We describe two cases of child abuse that caused brain death; subsequently they were subsidiary for organ donation. It is very important to establish a good coordination between health, social care and legal assistance teams to obtain organ donation.(AU)

Donación de órganos tras muerte encefálica debida a maltrato infantil. / [Organ donation after brain death due to child abuse].

More than 40 percent of deaths from child abuse occur among children younger than 5 years. The injury pattern in child abuse is block abuse head trauma which in the most severe cases produces brain death. Organ donation is uncommon in children younger than five years. We describe two cases of child abuse that caused brain death; subsequently they were subsidiary for organ donation. It is very important to establish a good coordination between health, social care and legal assistance teams to obtain organ donation.

The use of the Berlin definition for acute respiratory distress syndrome during infancy and early childhood: multicenter evaluation and expert consensus.

PURPOSE: A new acute respiratory distress syndrome (ARDS) definition has been recently issued: the so-called Berlin definition (BD) has some characteristics that could make it suitable for pediatrics. The European Society for Pediatric Neonatal Intensive Care (ESPNIC) Respiratory Section started a project to evaluate BD validity in early childhood. A secondary aim was reaching a consensus on clinical tools (risk factors list and illustrative radiographs) to help the application of BD. METHODS: This was an international, multicenter, retrospective study enrolling 221 children [aged greater than 30 days and less than 18 months; median age 6 (range 2-13) months], admitted to seven European pediatric intensive care units (PICU) with acute lung injury (ALI) or ARDS diagnosed with the earlier definition. RESULTS: Patients were categorized according to the two definitions, as follows: ALI, 36; ARDS, 185 (for the American-European Consensus Conference (AECC) definition); mild, 36; moderate, 97; severe ARDS, 88 (for BD). Mortality (13.9 % for mild ARDS; 11.3 % for moderate ARDS; 25 % for severe ARDS, p = 0.04) and the composite outcome extracorporeal membrane oxygenation (ECMO)/mortality (13.9 % for mild ARDS; 11.3 % for moderate ARDS; 28.4 % for severe ARDS, p < 0.01) were different across the BD classes, whereas they were similar using the previous definition. Mortality [HR 2.7 (95 % CI 1.1-7.1)] and ECMO/mortality [HR 3 (95 % CI 1.1-7.9)] were increased only for the severe ARDS class and remained significant after adjustment for confounding factors. PICU stay was not different across severity classes, irrespective of the definition used. There was significant concordance between raters evaluating radiographs [ICC 0.6 (95 % CI 0.2-0.8)] and risk factors [ICC 0.92 (95 % CI 0.8-0.97)]. CONCLUSIONS: BD validity for children is similar to that already reported in adults and mainly due to the introduction of a "severe ARDS" category. We provided clinical tools to use BD for clinical practice, research, and health services planning in pediatric critical care.

Las complicaciones de la varicela, rara vez consultadas al dermatólogo, un argumento más a favor de la vacunación sistemática / Complications of varicella for which dermatologists are rarely consulted, another argument in favor of systematic immunization

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