Hip fracture registries in low- and middle-income countries: a scoping review.

PURPOSE: The study aims to identify, describe, and organize the currently available evidence regarding hip fracture (HF) registries in low- and middle-income countries (LMICs). METHODS: We conducted a scoping review adhering to PRISMA-ScR guidelines. We searched MEDLINE (PubMed), Google Scholar, Global Index Medicus, websites related to HF, and study references for eligible studies. Two reviewers independently performed the study selection and data extraction, including studies describing the use of individual patient records with the aim to improve the quality of care in older people with HF in LMICs. RESULTS: A total of 222 abstracts were screened, 59 full-text articles were reviewed, and 10 studies regarding 3 registries were included in the analysis. Malaysia and Mexico implemented a HF registry in public hospitals whereas Argentina implemented a registry in the private setting. The Mexican registry, the most recent one, is the only one that publishes annual reports. There was significant variability in data fields between registries, particularly in functional evaluation and follow-up. The Ministry of Health finances the Malaysian registry, while Argentinian and Mexican registries founding was unclear. CONCLUSION: The adoption of HF registries in LMICs is scarce. The few experiences show promising results but higher support is required to develop more registries. Long-term sustainability remains a challenge.

Agreement between diagnostic methods for SARS-CoV-2 infection in children seen at the Emergency Department of a children's hospital. / Concordancia entre métodos diagnósticos de infección por SARS-CoV-2 en niños asistidos en el departamento de urgencias de un hospital pediátrico.

INTRODUCTION: Rapid antigen tests (RAgTs) for SARS-CoV-2 are considered adequate for diagnosis at the point of care. Our objective was to establish the agreement between reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and RAgTs in the pediatric population. POPULATION AND METHODS: All patients aged 1 month to 17 years and 11 months seen at the Emergency Fever Unit of a children's hospital between 6-11-2021 and 10-3-2021 were recruited. The Panbio COVID-19 Ag® test (Abbott Diagnostic) was compared to the reference method RT-qPCR (as per the protocol suggested by the United States Centers for Disease Control and Prevention). RESULTS: A total of 6491 patients were included. The prevalence of COVID-19 was 2.8%. Symptoms were observed in 92.1%. Sensitivity, specificity, and the kappa index of agreement for the RAgT were 71.0%, 99.9%, and 0.813, respectively. The kappa index and the RAgT sensitivity were significantly higher in the group aged 13-17 years (0.89 and 82.4%, respectively) compared to the groups aged 0-5 and 6-12 years. This may be due to the lower viral load observed in patients younger than 12 years. CONCLUSIONS: Although RAgTs shorten the time to result and improve the isolation strategy for COVID-19 patients, their sensitivity in children younger than 12 years or asymptomatic children is not within the recommended ranges, especially during periods of low disease prevalence.

Introducción. Los inmunoensayos de detección rápida de antígenos (TRA) del SARS-CoV-2, son considerados adecuados para el diagnóstico en el punto de atención. El objetivo fue conocer la concordancia entre la reacción en cadena de la polimerasa en tiempo real con transcriptasa inversa (RT-qPCR, por su sigla en inglés) y los TRA en población pediátrica. Población y métodos. Se reclutaron todos los pacientes entre 1 mes y 17 años 11 meses de edad atendidos en la Unidad Febril de Urgencia de un hospital pediátrico entre el 11 de junio y el 3 de octubre de 2021. Se utilizó el TRA Panbio COVID-19 Ag® (Abbott Diagnostic) y, como método de referencia, la RT-qPCR (según el protocolo de los Centros para el Control y la Prevención de Enfermedades). Resultados. Se incluyeron 6491 pacientes. La prevalencia de COVID-19 fue del 2,8 %. El 92,1 % de los sujetos presentaron síntomas. La sensibilidad, la especificidad y el índice kappa de concordancia para el TRA fueron del 71,0 %, 99,9 % y 0,813, respectivamente. El índice kappa y la sensibilidad del TRA fueron significativamente mayores en el grupo de 13 a 17 años (0,89 y 82,4 %, respectivamente) cuando se los comparó con los grupos de 0 a 5 y de 6 a 12 años. Esto podría deberse a la menor carga viral observada en los pacientes menores de 12 años. Conclusión. Si bien los TRA permiten acortar el tiempo de obtención de los resultados y mejorar la estrategia de aislamiento de pacientes con COVID-19, la sensibilidad en niños menores de 12 años o asintomáticos no se encontraría dentro de los rangos recomendados, sobre todo en períodos de baja prevalencia de la enfermedad.

Concordancia entre métodos diagnósticos de infección por SARS-CoV-2 en niños asistidos en el departamento de urgencias de un hospital pediátrico / Agreement between diagnostic methods for SARS-CoV-2 infection in children seen at the Emergency Department of a children's hospital

Introducción. Los inmunoensayos de detección rápida de antígenos (TRA) del SARS-CoV-2, son considerados adecuados para el diagnóstico en el punto de atención. El objetivo fue conocer la concordancia entre la reacción en cadena de la polimerasa en tiempo real con transcriptasa inversa (RT-qPCR, por su sigla en inglés) y los TRA en población pediátrica. Población y métodos. Se reclutaron todos los pacientes entre 1 mes y 17 años 11 meses de edad atendidos en la Unidad Febril de Urgencia de un hospital pediátrico entre el 11 de junio y el 3 de octubre de 2021. Se utilizó el TRA Panbio COVID-19 Ag® (Abbott Diagnostic) y, comométodo de referencia, la RT-qPCR (según el protocolo de los Centros para el Control y la Prevención de Enfermedades). Resultados. Se incluyeron 6491 pacientes. La prevalencia de COVID-19 fue del 2,8 %. El92,1 % de los sujetos presentaron síntomas. La sensibilidad, la especificidad y el índice kappa de concordancia para el TRA fueron del 71,0 %, 99,9 % y 0,813, respectivamente. El índice kappa yla sensibilidad del TRA fueron significativamentemayores en el grupo de 13 a 17 años (0,89 y 82,4 %,respectivamente) cuando se los comparó con los grupos de 0 a 5 y de 6 a 12 años. Esto podría deberse a la menor carga viral observada en los pacientes menores de 12 años. Conclusión. Si bien los TRA permiten acortar el tiempo de obtención de los resultados y mejorar la estrategia de aislamiento de pacientes con COVID-19, la sensibilidad en niños menores de 12 años o asintomáticos no se encontraría dentro de los rangos recomendados, sobre todo enperíodos de baja prevalencia de la enfermedad.

Introduction. Rapid antigen tests (RAgTs) for SARS-CoV-2 are considered adequate for diagnosis at the point of care. Our objective was to establish the agreement between reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and RAgTs in the pediatric population. Population and methods. All patients aged 1 month to 17 years and 11 months seen at the Emergency Fever Unit of a children's hospital between 6-11-2021 and 10-3-2021 were recruited. The Panbio COVID-19 Ag® test (Abbott Diagnostic) was compared to the reference method RT-qPCR (as per the protocol suggested by the United States Centers for Disease Control and Prevention). Results. A total of 6491 patients were included. The prevalence of COVID-19 was 2.8%. Symptoms were observed in 92.1%. Sensitivity, specificity, and the kappa index of agreement for the RAgT were 71.0%, 99.9%, and 0.813, respectively. The kappa index and the RAgT sensitivity were significantly higher in the group aged 13­17 years (0.89 and 82.4%, respectively) compared to the groups aged 0­5 and 6­12 years. This may be due to the lower viral load observed in patients younger than 12 years. Conclusion. Although RAgTs shorten the time to result and improve the isolation strategy for COVID-19 patients, their sensitivity in children younger than 12 years or asymptomatic children is not within the recommended ranges, especially during periods of low disease prevalence.

Alliance for the development of the Argentinian Hip Fracture Registry.

Age expectancy has significantly increased over the last 50 years, as well as some age-related health conditions such as hip fractures. The development of hip fracture registries has shown enhanced patient outcomes through quality improvement strategies. The development of the Argentinian Hip Fracture Registry is going in the same direction. INTRODUCTION: Age expectancy has increased worldwide in the last 50 years, with the population over 64 growing from 4.9 to 9.1%. As fractures are an important problem in this age group, specific approaches such as hip fracture registries (HFR) are needed. Our aim is to communicate the Argentinian HFR (AHFR) development resulting from an alliance between Fundación Trauma, Fundación Navarro Viola, and the Argentinian Network of Hip Fracture in the elderly. METHODS: Between October 2020 and May 2021, an iterative consensus process involving 5 specialty-focused meetings and 8 general meetings with more than 20 specialists was conducted. This process comprised inclusion criteria definitions, dataset proposals, website deployment with data protection and user validation, the definition of hospital-adjusted registry levels, implementation planning, and sustainability strategies. RESULTS: By June 2021, we were able to (1) outline data fields, including epidemiological, clinical, and functional dimensions for the pre-admission, hospitalization, discharge, and follow-up stages; (2) define three levels: basic (53 fields), intermediate (85), and advanced (99); (3) identify 21 benchmarking indicators; and (4) make a correlation scheme among fracture classifications. Simultaneously, we launched a fundraising campaign to implement the AHFR in 30 centers, having completed 18. CONCLUSION: AHFR development was based on four pillars: (1) representativeness and support, (2) solid definitions from onset, (3) committed teams, and (4) stable funding. This tool may contribute to the design of evidence-based health policies to improve patient outcomes, and we hope this experience will help other LMICs to develop their own tailored-to-their-needs registries.

Consensus of the Respiratory Committee of the Latin American Society for Pediatric Intensive Care: Management of pediatric SARS-CoV-2. (SLACIP): COVID-19 Pediatric / Consenso del Comité Respiratorio Sociedad Latinoamericana Terapia Intensiva Pediátrica: Manejo SARS-CoV-2 pediátrico. (SLACIP): COVID-19 Pediátrico

Introduction The COVID-19 pandemic generated many controversies in the management of critically ill pediatric patients. The main ones were about ventilatory support, phenotypic differences between adults and children, and acute and subacute clinical forms. For this reason, the Respiratory Committee (RC) of the Latin American Society of Pediatric Intensive Care (SLACIP) generated a document to summarize the recommendations with the best evidence. The objective of these recommendations is to provide an update on issues related to pediatric COVID-19. Methods and Materials The Respiratory Committee created a group composed of 19 pediatric kinesiologists/physiotherapists and intensivists from 8 Latin American countries and defined on 3/27/20 the 15 most relevant topics, assigning 3 referents and 2 reviewers for each. The manuscripts went through 4 stages until their final version. The complete document was freely distributed on 22/05/20 and updated twice (07/08/20 and 02/09/21). For the current version there were 3 special collaborators. Result The material consists of a complete 94-page document and an executive summary. The topics included are case definition, epidemiology, clinical classification, subacute inflammatory syndrome, personal protective equipment, aerosolization situations (intubation, extubation, suctioning, sampling, filter replacement, cardiopulmonary resuscitation, early mobilization), high flow cannula support, invasive, non-invasive and high frequency mechanical ventilation, pharmacological treatment, laboratory and imaging. Conclusion The purpose of this document is to serve as a guide for nurses, kinesiologists/physiotherapists and physicians in the management of critically ill pediatric patients with COVID-19.

Introducción La pandemia por COVID-19 generó muchas controversias en el manejo de los pacientes pediátricos críticos. Las principales fueron sobre el soporte ventilatorio, las diferencias fenotípicas entre adultos y niños y las formas clínicas aguda y subaguda.Por esa razón el Comité Respiratorio (CR) de la Sociedad Latinoamericana de Cuidados Intensivos Pediátricos (SLACIP) generó un documento para resumir las recomendaciones con mayor evidencia. El objetivo de estas recomendaciones es brindar una actualización de temas relacionados a COVID-19 pediátrico.Métodos y Materiales El Comité Respiratorio creó un grupo compuesto por 19 kinesiólogos/fisioterapeutas y médicos intensivistas pediátricos de 8 países de Latinoamérica y definió el 27/03/20 los 15 temas más relevantes, asignando 3 referentes y 2 revisores por cada uno. Los manuscritos pasaron por 4 etapas hasta su versión final. El documento completo se distribuyó libremente el 22/05/20, actualizándose en dos oportunidades (07/08/20 y el 02/09/21). Para la versión actual se contó con 3 colaboradores especiales.Resultado El material se compone de un documento completo de 94 páginas y un resumen ejecutivo. Los temas incluidos son definición de caso, epidemiología, clasificación clínica, síndrome inflamatorio subagudo, equipos de protección personal, situaciones de aerosolización (intubación, extubación, aspiración, toma de muestras, recambio de filtros, reanimación cardiopulmonar, movilización temprana), soporte con cánula de alto flujo, ventilación mecánica invasiva, no invasiva y de alta frecuencia, tratamiento farmacológico, laboratorio e imágenes.Conclusión La elaboración de este documento ha tenido como fin servir de guía para enfermeros, kinesiólogos/fisioterapeutas y médicos en el manejo de pacientes pediátricos en estado crítico por COVID-19.

Nonintensivist Training to Increase the Staff Capacity of Intensive Care Units During COVID-19 Pandemic Surge in Argentina.

OBJECTIVE: The aim of this study was to report the results of a nationwide critical-care course for non-intensivists to increase staff capacity of intensive care units (ICUs) during the coronavirus disease 2019 (COVID-19) pandemic in Argentina. METHODS: Three academic organizations, with special funding from 55 private companies, developed a short virtual course comprised of Web-based videos, virtual tutorials, and a forum chat. Each state assigned scholarships to non-ICU staff from public hospitals. Students received active follow-up for the completion of the course and took a survey upon course completion. RESULTS: After 4 m, there were 10,123 students registered from 661 hospitals in 328 cities. Of these, 67.8% passed the course, 29.1% were still ongoing, and 3.1% were inactive. Most students were female (74.2%) with a median of 37 y old (IQR 31-44). The group was composed of 56.5% nurses, 36.2% physicians, and 7.4% physiotherapists, of whom 48.3% did not have any experience in critical care. Mean overall satisfaction was 4.4/5 (standard deviation, 0.9), and 90.7% considered they were able to apply the contents to their practice. CONCLUSIONS: This course was effective for rapid training of non-ICU personnel. The assignment strategy, the educational techniques, and the close follow-up led to low dropout and high success rates and satisfaction.

Respeto por la autonomía individual y el beneficio colectivo: argumentación a favor de la vacunación obligatoria contra el SARS-CoV-2 para el personal de la salud / Respect for individual autonomy and a collective benefit: Arguments in favor of compulsory SARS-CoV-2 vaccination among health care professionals

Con la llegada de las vacunas contra el SARS-CoV-2, un nuevo aspecto a tener en cuenta en la pandemia es el rechazo a la vacunación. Como la recepción de la vacuna, es voluntaria, se plantea cómo abordar la situación de los miembros del equipo de salud que la rechazan. Se exponen argumentos bioéticos de diversas corrientes: el deontologismo kantiano y lo conceptos de universalidad, humanidad y autonomía; el utilitarismo de Mill, con la autoprotección como único fin por el cual la humanidad está habilitada para interferir con la libertad de acción de sus miembros; el principismo de Beauchamp y Childress y los conceptos de beneficencia y autonomía; el principio de oportunidad de Varo Baena; y el principio de solidaridad, derivado de la ética de los derechos humanos. Se incluyen aportes de filósofos contemporáneos como Roberto Espósito, Jean-Luc Nancy y Alberto Giubilini. Se exponen dos contrargumentos: el de no maleficencia y el de contraproducencia. Por último, se plantea que, dado que el bien común (la salud pública, en este caso) es el determinante íntimo y último de la libertad individual e igual para todos, está por encima del beneficio individual

With the development of SARS-CoV-2 vaccines, a new aspect to be taken into consideration in the midst of the pandemic is vaccine refusal. Since vaccination is voluntary, it is necessary to deal with the fact that some health care team members refuse to receive it. Here I put forward different bioethical arguments: Kantian deontology and the principles of universalizability, humanity, and autonomy; Mill's utilitarianism, with self-protection as the sole end for which humankind is authorized to interfere with its members' freedom of action; Beauchamp and Childress' principlism and the concepts of beneficence and autonomy; Varo Baena's principle of opportunity; and the principle of solidarity resulting from the ethics of human rights. The contributions of contemporary philosophers like Roberto Espósito, Jean-Luc Nancy, and Alberto Giubilini are also included. Two counter-arguments are presented: nonmaleficence and counter-production. Lastly, I suggest that, since common good (in this case, public health) is the intimate and final determining factor of individual freedom and is the same for all, it is above any individual benefit.

Respect for individual autonomy and a collective benefit: Arguments in favor of compulsory SARS-CoV-2 vaccination among health care professionals. / Respeto por la autonomía individual y el beneficio colectivo: argumentación a favor de la vacunación obligatoria contra el SARS-CoV-2 para el personal de la salud.

With the development of SARS-CoV-2 vaccines, a new aspect to be taken into consideration in the midst of the pandemic is vaccine refusal. Since vaccination is voluntary, it is necessary to deal with the fact that some health care team members refuse to receive it. Here I put forward different bioethical arguments: Kantian deontology and the principles of universalizability, humanity, and autonomy; Mill's utilitarianism, with selfprotection as the sole end for which humankind is authorized to interfere with its members' freedom of action; Beauchamp and Childress' principlism and the concepts of beneficence and autonomy; Varo Baena's principle of opportunity; and the principle of solidarity resulting from the ethics of human rights. The contributions of contemporary philosophers like Roberto Espósito, Jean-Luc Nancy, and Alberto Giubilini are also included. Two counterarguments are presented: nonmaleficence and counter-production. Lastly, I suggest that, since common good (in this case, public health) is the intimate and final determining factor of individual freedom and is the same for all, it is above any individual benefit.

Con la llegada de las vacunas contra el SARSCoV- 2, un nuevo aspecto a tener en cuenta en la pandemia es el rechazo a la vacunación. Como la recepción de la vacuna, es voluntaria, se plantea cómo abordar la situación de los miembros del equipo de salud que la rechazan. Se exponen argumentos bioéticos de diversas corrientes: el deontologismo kantiano y lo conceptos de universalidad, humanidad y autonomía; el utilitarismo de Mill, con la autoprotección como único fin por el cual la humanidad está habilitada para interferir con la libertad de acción de sus miembros; el principismo de Beauchamp y Childress y los conceptos de beneficencia y autonomía; el principio de oportunidad de Varo Baena; y el principio de solidaridad, derivado de la ética de los derechos humanos. Se incluyen aportes de filósofos contemporáneos como Roberto Espósito, Jean-Luc Nancy y Alberto Giubilini. Se exponen dos contrargumentos: el de no maleficencia y el de contraproducencia. Por último, se plantea que, dado que el bien común (la salud pública, en este caso) es el determinante íntimo y último de la libertad individual e igual para todos, está por encima del beneficio individual.

A public-private collaborative model for a trauma program implementation: findings from a prospective trauma registry at 14 hospitals in Buenos Aires, Argentina.

INTRODUCTION: Trauma is a leading cause of mortality and comprises an important cause of functional impairment among young people worldwide. The trauma registry (TR) is an integral component of modern comprehensive trauma care systems. Nevertheless, TRs have not been yet established in most developing countries. The objective of this study was to summarize the challenges, results, and lessons learned from a trauma program including initial results from a TR at tertiary-care public hospitals of Buenos Aires, Argentina. MATERIAL AND METHODS: This is a descriptive study of the implementation of a trauma program in 14 hospitals and analysis of the initial results in the period between January 2010 and December 2018, using data from Fundación Trauma TR. Patients fitting injury definition that remained in hospital for more than 23 h were included. Injured patients were divided by age groups. Data on patients' demographics, mechanism of injury and severity, complications, treatments, and in-hospital mortality were analyzed between groups. A descriptive analysis is presented. RESULTS: There were 29,970 trauma cases during the study period. Median age was 23 years (RIC 12, 39) with a 2.4:1 male-to-female ratio. Road traffic injuries (RTI) were the leading mechanism (30.8%) of admission and head was the most frequently injured body region (33.2%). Two-thirds of RTIs were motorcycle-related. Overall in-hospital mortality was 6.1%. Intentional self-harm in adult males and burns in adult females had the highest mortality rates (17.6% and 17.9%, respectively). CONCLUSIONS AND DISCUSSION: The implementation of a trauma program within a public-private collaborative program in a resource-limited environment is feasible. The hospital-based TR can be used as a tool for injury surveillance, monitoring of the quality of trauma care, development of a trauma system, and to guide public health policies.

Fluid restriction versus volume expansion in children with diarrhea-associated HUS: a retrospective observational study.

BACKGROUND: Fifty percent of patients with typical diarrhea-associated hemolytic uremic syndrome (D+HUS) require kidney replacement therapy (KRT). In these patients, dehydration worsens disease prognosis. We evaluated dialysis requirement, presence of seizures, and mortality rate among patients diagnosed with D+HUS treated with volume expansion (VE) versus fluid restriction (FR). METHODS: Thirty-five patients with D+HUS were enrolled; 16 received VE and 19 were historical patients who received conventional FR. RESULTS: Upon admission or during treatment, neither group presented evidence of fluid overload. The VE group received higher volumes of saline (VE 27 ml/kg [10-30] over a 3-h period vs. FR 0 ml), had higher urine output after 12 h (VE vs. FR: OR 6.2 [1.2-41.6], P = 0.03), and required less dialysis (VE 2 [12.5%, CI 95% 0-29] vs. FR 9 [47.4%, CI 95% 24-70], P = 0.035). The VE group had an absolute risk reduction of 0.34 (CI 95% 0.07-0.63); hence, three patients treated with VE were required to avoid one KRT. VE also corrected initial hyponatremia and maintained serum sodium within normal ranges. No statistical differences were observed regarding number of patients with seizures (P = 0.08) or mortality (P = 1.0). CONCLUSIONS: VE markedly reduces the number of patients requiring KRT and keeps serum sodium within a normal range. We propose to initially hydrate every patient with D+HUS and without signs of fluid overload, with 10 ml/kg/h 0.9% saline solution IV, over a 3-h period. Afterwards, if urine output is ≥ 0.5 ml/kg/h, it is recommended to not dialyze and continue IV hydration schedule with isotonic (D5) saline solution, according to their needs.

Relevamiento de drogas en carros de emergencia de un hospital pediátrico. Estudio antes-después de una intervención educativa / Assessment of emergency trolley drugs in a children's hospital. Before and after study on an educational intervention

Introducción. El abordaje de las emergencias pediátricas requiere recursos especializados y son frecuentes los errores relacionados con la medicación.Objetivos. Describir el contenido de los carros de emergencia (CE) en un hospital pediátrico y compararlo luego de una intervención educativa.Métodos. Se incluyeron CE de 9 salas de internación. Se elaboró una lista de cotejo con 30 drogas. Se relevaron los CE determinando presencia o ausencia de drogas y si las cantidades eran suficientes. Luego se realizó una intervención educativa y relevamientos 30 y 90 días posintervención.Resultados. La medición basal arrojó una proporción global de drogas adecuadas del 43,9 % (intervalo de confianza ­IC­ del 95 %: 38,4-49,4) con una variación entre CE del 29 % al 54,8 % y del 15 % al 85 % en los grupos de drogas. A los 30 días, la proporción correcta alcanzó el 70,3 % (IC 95 %: 65,2-75,4), con amplia variación entre los diferentes CE y grupos de drogas (del 51,6 % al 93,5 % y del 50 % al 95 %, respectivamente). A los 90 días, los porcentajes fueron similares. La comparación entre la primera y segunda medición mostró mejoría en todos los CE (rango: del 3,2 % al 45,1 %), odds ratio 3,73 (IC 95 %: 2,5-5,6), p < 0,001. Los resultados fueron similares entre la segunda y tercera medición.Conclusiones. En la medición inicial, se evidenció bajo nivel de adecuación de drogas de los CE. Luego de la intervención, mejoró significativamente y se mantuvo durante el período evaluado.

Introduction. The approach to pediatric emergencies requires specialized resources, and medication errors are common.Objectives. To describe the contents of emergency trolleys (ETs) in a children's hospital and compare them after an educational intervention.Methods. The ETs from 9 hospitalization wards were included. A checklist of 30 drugs was developed. ETs were assessed by determining whether drugs were present or absent and their amount. An educational intervention was conducted and assessments were repeated 30 and 90 days after the intervention.Results. The baseline measurement indicated an overall ratio of adequate drugs of 43.9 % (95 % confidence interval [CI]: 38.4-49.4) with a variation among ETs from 29 % to 54.8 %, and from 15 % to 85 % among drug groups. At 30 days, the adequate ratio reached 70.3 % (95 % CI: 65.2-75.4), with a wide variation among the different ETs and drug groups (from 51.6 % to 93.5 % and from 50 % to 95 %, respectively). At 90 days, the percentages were similar. The comparison between the first and second measurementshowed an improvement in all ETs (range: 3.2 %-45.1 %), odds ratio: 3.73 (95 % CI: 2.5-5.6), p < 0.001. Results were similar between the second and third measurement.Conclusions. The baseline measurement showed a low level of adequate ET drugs. After the intervention, this improved significantly and was maintained during the studied period

Assessment of emergency trolley drugs in a children's hospital. Before and after study on an educational intervention. / Relevamiento de drogas en carros de emergencia de un hospital pediátrico. Estudio antes-después de una intervención educativa.

INTRODUCTION: The approach to pediatric emergencies requires specialized resources, and medication errors are common. OBJECTIVES: To describe the contents of emergency trolleys (ETs) in a children's hospital and compare them after an educational intervention. METHODS: The ETs from 9 hospitalization wards were included. A checklist of 30 drugs was developed. ETs were assessed by determining whether drugs were present or absent and their amount. An educational intervention was conducted and assessments were repeated 30 and 90 days after the intervention. RESULTS: The baseline measurement indicated an overall ratio of adequate drugs of 43.9 % (95 % confidence interval [Cl]: 38.4-49.4) with a variation among ETs from 29 % to 54.8 %, and from 15 % to 85 % among drug groups. At 30 days, the adequate ratio reached 70.3 % (95 % CI: 65.275.4), with a wide variation among the different ETs and drug groups (from 51.6 % to 93.5 % and from 50 % to 95 %, respectively). At 90 days, the percentages were similar. The comparison between the first and second measurement showed an improvement in all ETs (range: 3.2 %-45.1 %), odds ratio: 3.73 (95 % CI: 2.5-5.6), p < 0.001. Results were similar between the second and third measurement. CONCLUSIONS: The baseline measurement showed a low level of adequate ET drugs. After the intervention, this improved significantly and was maintained during the studied period.

Introducción. El abordaje de las emergencias pediátricas requiere recursos especializados y son frecuentes los errores relacionados con la medicación. Objetivos. Describir el contenido de los carros de emergencia (CE) en un hospital pediátrico y compararlo luego de una intervención educativa. Métodos. Se incluyeron CE de 9 salas de internación. Se elaboró una lista de cotejo con 30 drogas. Se relevaron los CE determinando presencia o ausencia de drogas y si las cantidades eran suficientes. Luego se realizó una intervención educativa y relevamientos 30 y 90 días posintervención. Resultados. La medición basal arrojó una proporción global de drogas adecuadas del 43,9 % (intervalo de confianza -IC- del 95 %: 38,449,4) con una variación entre CE del 29 % al 54,8 % y del 15 % al 85 % en los grupos de drogas. A los 30 días, la proporción correcta alcanzó el 70,3 % (IC 95 %: 65,2-75,4), con amplia variación entre los diferentes CE y grupos de drogas (del 51,6 % al 93,5 % y del 50 % al 95 %, respectivamente). A los 90 días, los porcentajes fueron similares. La comparación entre la primera y segunda medición mostró mejoría en todos los CE (rango: del 3,2 % al 45,1 %), odds ratio 3,73 (IC 95 %: 2,55,6), p < 0,001. Los resultados fueron similares entre la segunda y tercera medición. Conclusiones. En la medición inicial, se evidenció bajo nivel de adecuación de drogas de los CE. Luego de la intervención, mejoró significativamente y se mantuvo durante el período evaluado.

Estado actual del soporte neurológico crítico en pediatría en la Argentina / Current status of pediatric neurocritical care in Argentina

Introducción. Los pacientes con lesiones neurocríticas representan el 10-16 % de los ingresos a unidades de cuidados intensivos pediátricas (UCIP) y, frecuentemente, requieren neuromonitoreo. Objetivo. Describir el estado actual del neuromonitoreo en la Argentina. Métodos. Encuesta con 37 preguntas sobre neuromonitoreo sin incluir datos de pacientes. Período: abril-junio, 2017. Resultados. Se recibieron 38 respuestas a 71 solicitudes (14 distritos con 11498 egresos anuales). La relación camas de UCIP/hospitalarias fue 21,9 (rango: 4,2-66,7). El 74 % fueron públicas; el 61 %, universitarias, y el 71 %, nivel 1. La disponibilidad fue similar entre públicas y privadas (porcentajes): presión intracraneana (95), electroencefalografía (92), doppler transcraneano (53), potenciales evocados (50), saturación yugular (47) e índice bispectral (11). El principal motivo de monitoreo fue trauma. Conclusión. Excepto la presión intracraneana y la electroencefalografía, los recursos de neuromonitoreo son escasos y la disponibilidad de neurocirugía activa es mínima. Se necesita un registro nacional de UCIP.

Introduction. Patients with neurocritical injuries account for 10-16 % of pediatric intensive care unit (PICU) admissions and frequently require neuromonitoring. Objective. To describe the current status of neuromonitoring in Argentina. Methods. Survey with 37 questions about neuromonitoring without including patients' data. Period: April-June 2017. Results. Thirty-eight responses were received out of 71requests (14districts with 11498annual discharges). The PICU/hospital bed ratio was 21.9 (range: 4.2-66.7). Seventy-four percent of PICUs were public; 61%, university-affiliated; and 71%, levelI. The availability of monitoring techniques was similar between public and private (percentages): intracranial pressure (95), electroencephalography (92), transcranial Doppler (53), evoked potentials (50), jugular saturation (47), and bispectral index(11). Trauma was the main reason for monitoring. Conclusion. Except for intracranial pressure and electroencephalography, neuromonitoring resources are scarce and active neurosurgery availability is minimal. A PICU national registry is required.

Current status of pediatric neurocritical care in Argentina. / Estado actual del soporte neurológico crítico en pediatría en la Argentina.

INTRODUCTION: Patients with neurocritical injuries account for 10-16 % of pediatric intensive care unit (PICU) admissions and frequently require neuromonitoring. OBJECTIVE: To describe the current status of neuromonitoring in Argentina. METHODS: Survey with 37 questions about neuromonitoring without including patients' data. Period: April-June 2017. RESULTS: Thirty-eight responses were received out of 71 requests (14 districts with 11 498 annual discharges). The PICU/hospital bed ratio was 21.9 (range: 4.2-66.7). Seventy-four percent of PICUs were public; 61 %, university-affiliated; and 71 %, level I. The availability of monitoring techniques was similar between public and private (percentages): intracranial pressure (95), electroencephalography (92), transcranial Doppler (53), evoked potentials (50), jugular saturation (47), and bispectral index (11). Trauma was the main reason for monitoring. CONCLUSION: Except for intracranial pressure and electroencephalography, neuromonitoring resources are scarce and active neurosurgery availability is minimal. A PICU national registry is required.

Introducción. Los pacientes con lesiones neurocríticas representan el 10-16 % de los ingresos a unidades de cuidados intensivos pediátricas (UCIP) y, frecuentemente, requieren neuromonitoreo. Objetivo. Describir el estado actual del neuromonitoreo en la Argentina. Métodos. Encuesta con 37 preguntas sobre neuromonitoreo sin incluir datos de pacientes. Período: abril-junio, 2017. Resultados. Se recibieron 38 respuestas a 71 solicitudes (14 distritos con 11 498 egresos anuales). La relación camas de UCIP/hospitalarias fue 21,9 (rango: 4,2-66,7). El 74 % fueron públicas; el 61 %, universitarias, y el 71 %, nivel 1. La disponibilidad fue similar entre públicas y privadas (porcentajes): presión intracraneana (95), electroencefalografía (92), doppler transcraneano (53), potenciales evocados (50), saturación yugular (47) e índice bispectral (11). El principal motivo de monitoreo fue trauma. Conclusión. Excepto la presión intracraneana y la electroencefalografía, los recursos de neuromonitoreo son escasos y la disponibilidad de neurocirugía activa es mínima. Se necesita un registro nacional de UCIP.

Impacto del uso de oxigenoterapia de alto flujo en el Hospital de Niños Dr. Ricardo Gutiérrez / Impact of high-flow oxygen therapy in Ricardo Gutiérrez Children's Hospital

Introducción. En la Ciudad Autónoma de Buenos Aires 35 000 niños con infección respiratoria aguda baja (IRAB) son asistidos por el sistema de salud pública cada año, 8-10% requieren internación en unidades de clínica (UC) y de ellos 5-12% ingresa a unidades de terapia intensiva pediátrica (UTIP). La oxigenoterapia a través de cánulas nasales de alto flujo (CNAF) surge como alternativa terapéutica en la escalada de tratamiento. Objetivos. Describir la implementación de un protocolo de asistencia progresiva incluyendo CNAF a pacientes con IRAB internados en UC del Hospital de Niños "Dr. Ricardo Gutiérrez" desde junio a septiembre del bienio 2017/2018. Analizar el impacto de la implementación comparando los resultados con el mismo periodo del bienio anterior (2015/2016) considerando la tasa de admisión a UTIP como punto final. Métodos. Cohorte prospectiva con controles históricos. Los datos 2017/2018 se recolectaron en un formulario diseñado para tal fin y los de 2015/2016 se obtuvieron de registros del servicio de Epidemiología. Se incluyeron pacientes de 1 a 18 meses internados por IRAB. Los resultados se expresan como cantidad, porcentaje e intervalo de confianza de 95% (IC95%) y las medidas de asociación como riesgo relativo (RR), reducción de riesgo absoluto (RRA) y número necesario a tratar (NNT). Resultados. En el bienio 2015/2016 se internaron en UC 547 pacientes (266 y 281, respectivamente) con una tasa de admisión a UTIP de 5,7% (IC95% 3,7-7,6; n=31) y una mortalidad de 0.7% (IC95% 0.2-1.4; n=4). En el bienio 2017/2018 se internaron 391 pacientes (219 y 172 respectivamente), 203 de los cuales recibieron CNAF (51,9%). La tasa de admisión a UTIP fue 4,6% (IC95% 2,5-6,7%; n=18) y requirieron ventilación mecánica invasiva (VMI) 2,8% (IC95% 1,2-4,5; n=11 de 391) con una mortalidad de 0%. La comparación de ambos grupos con respecto al ingreso a UTIP mostró: RR=0,81 (IC95% 0,46-1,43), RRA=1,1%, NNT=94. Entre 2015/2016 y 2017/2018 no se observaron diferencias significativas en edad: 7 meses (4-11) vs. 8 (4-12) ni en prevalencia de gérmenes en IFI: negativo 54.2%, VSR 35.1% vs. negativo 48.3% y VSR 43.9%, respectivamente; con una estadía hospitalaria discretamente menor: 6 días (4-9) vs 5 (3-7). No se observaron complicaciones asociadas al uso de CNAF. Conclusión. La implementación estandarizada de CNAF en UC fue una medida segura y bien tolerada

Introduction. In Buenos Aires city 35 000 children with acute lower respiratory infection (LRTI) are assisted by the public health system every year. 8 to 10% of them require hospitalization in general wards (GW) while 5 to 12% of those are admitted to pediatric intensive care units (PICU). Oxygen therapy through high flow nasal cannulas (HFNC) rises as a therapeutic option during treatment. Objectives. To describe the implementation of a progressive assistance protocol including HFNC for LRTI patients in GW at "Dr. Ricardo Gutiérrez" children hospital between June and September, 2017 and 2018. To compare these results with the equivalent period from the previous biennium (2015/2016), considering PICU admission as the outcome. Methods. Prospective cohort study with historical controls. Records from 2015/2016 were provided by the Epidemiology service and those from 2017/2018 were collected prospectively in a specifically designed form. Hospitalized LRTI patients ranging from 1 to 18 months of age were included. Results are expressed as Relative Risk (RR), Absolute Risk Reduction (RRA) and number needed to treat (NNT). Results. In 2015/2016 biennium, 547 patients were hospitalized in GW (266 and 281, respectively) with a PICU admission rate of 5,7% (95%CI 3,7-7,6; n=31) and a mortality of 0.7% (95%CI 0.2-1.4; n=4). In 2017/2018 biennium, 391 patients were hospitalized (219 and 172, respectively), 203 of which received HFNC (51,9%). PICU admission rate was 4,6% (95%CI 2,5-6,7%; n=18) and invasive mechanical ventilation (IMV) was required in 2,8% of the cases (95%CI 1,2-4,5; n=11 out of 391) with 0% mortality. Comparing both groups in terms of PICU admission, the following was observed: RR=0,81, RRA=1,1%, NNT=94. Between 2015/2016 and 2017/2018 no differences were observed in age: 7 (4-11) vs. 8 months (4-12), length of stay: 6 (4-9) vs. 5 days (3-7), or germ prevalence in IFA-test: 54.2% negative and 35.1% RSV vs. 48.3% negative and 43.9% RSV 43.9%, respectively. No complications associated with the new protocol were observed. Conclusion. Standardized HFNC use in UC was shown as a safe and well-tolerated measure

Oxigenoterapia con cánula nasal de alto flujo en lactantes con infección respiratoria baja aguda: Experiencia en hospitales de la Ciudad de Buenos Aires / High-flow nasal cannula oxygen therapy in infants with acute lower respiratory tract infection: An experience in hospitals of the City of Buenos Aires

Introducción. Durante el invierno, los lactantes con infecciones respiratorias agudas bajas (IRAB) sobrecargan los recursos sanitarios. En la Ciudad Autónoma de Buenos Aires, 35 000 niños son asistidos anualmente en hospitales; se interna el 8-10 % en unidades generales, y el 5-12 % de ellos, en unidades de terapia intensiva. En 2017, el Departamento de Salud Materno-Infantil de dicha ciudad incluyó la oxigenoterapia por cánula nasal de alto flujo (CNAF) en el protocolo IRAB en unidades generales de tres hospitales. El objetivo de este trabajo es describir los resultados y explorar potenciales factores relacionados con el fracaso terapéutico. Métodos. Estudio prospectivo descriptivo que incluyó a lactantes < 18 meses hospitalizados por IRAB en 3 hospitales (Durand, Elizalde, Gutiérrez), de junio a septiembre de 2017. Todos los niños incapaces de cumplir los objetivos terapéuticos con bajo flujo recibieron CNAF, y se consideró fracaso de soporte el ingreso a Terapia Intensiva. Resultados. De 522 pacientes hospitalizados por IRAB, el 39,7 % requirieron CNAF. No se observaron diferencias basales significativas entre pacientes con CNAF y con oxigenoterapia convencional. Solo el 8,7 % de los pacientes con CNAF presentaron fracaso. Los pacientes con éxito del soporte mostraron un descenso de la frecuencia respiratoria significativamente mayor y más sostenido en el tiempo que aquellos con fracaso (p < 0,01). No se registraron complicaciones. Conclusión. La implementación protocolizada de CNAF en unidades generales fue una medida segura. Los pacientes con fracaso del soporte mostraron una menor disminución en la frecuencia respiratoria a lo largo del tratamiento.

Introduction. During the winter, infants with acute lower respiratory tract infection (ALRTI) overburden health resources. In the Autonomous City of Buenos Aires, 35 000 children are seen at the hospitals every year; 8-10 % of them are admitted to the general hospitalization ward and 5-12 % of these, to the intensive care unit (ICU). In 2017, the Department of Maternal and Child Health of the Autonomous City of Buenos Aires included high flow nasal cannula (HNFC) oxygen therapy in the ALRTI protocol in the general ward of 3 hospitals. The objective of this study was to describe its outcomes and explore the potential factors related to therapeutic failure. Methods. Prospective, descriptive study with infants < 18 months old hospitalized due to ALRTI in 3 hospitals (Durand, Elizalde, Gutiérrez) between June and September 2017. All children unable to comply with low-flow therapeutic targets received HNFC oxygen therapy; admission to the ICU was considered a failure. Results. Out of 522 patients hospitalized due to ALRTI, 39.7% required HNFC oxygen therapy. No significant baseline differences were observed between patients receiving HNFC and conventional oxygen therapy. Failure was observed in only 8.7% of patients with HNFC oxygen therapy. The decrease in respiratory rate was significantly greater and longer in patients with support success versus those with failure (p < 0.01). No complications were recorded. Conclusion. The implementation of HNFC oxygen therapy under a protocol in the general wards was a safe measure. Patients with therapeutic failure showed a smaller reduction in respiratory rate during treatment.

High-flow nasal cannula oxygen therapy in infants with acute lower respiratory tract infection. An experience in hospitals of the City of Buenos Aires.

INTRODUCTION: During the winter, infants with acute lower respiratory tract infection (ALRTI) overburden health resources. In the Autonomous City of Buenos Aires, 35 000 children are seen at the hospitals every year; 8-10 % of them are admitted to the general hospitalization ward and 5-12 % of these, to the intensive care unit (ICU). In 2017, the Department of Maternal and Child Health of the Autonomous City of Buenos Aires included high flow nasal cannula (HNFC) oxygen therapy in the ALRTI protocol in the general ward of 3 hospitals. The objective of this study was to describe its outcomes and explore the potential factors related to therapeutic failure. METHODS: Prospective, descriptive study with infants < 18 months old hospitalized due to ALRTI in 3 hospitals (Durand, Elizalde, Gutiérrez) between June and September 2017. All children unable to comply with low-flow therapeutic targets received HNFC oxygen therapy; admission to the ICU was considered a failure. RESULTS: Out of 522 patients hospitalized due to ALRTI, 39.7% required HNFC oxygen therapy. No significant baseline differences were observed between patients receiving HNFC and conventional oxygen therapy. Failure was observed in only 8.7% of patients with HNFC oxygen therapy. The decrease in respiratory rate was significantly greater and longer in patients with support success versus those with failure (p < 0.01). No complications were recorded. CONCLUSIONS: The implementation of HNFC oxygen therapy under a protocol in the general wards was a safe measure. Patients with therapeutic failure showed a smaller reduction in respiratory rate during treatment.

Introducción. Durante el invierno, los lactantes con infecciones respiratorias agudas bajas (IRAB) sobrecargan los recursos sanitarios. En la Ciudad Autónoma de Buenos Aires, 35 000 niños son asistidos anualmente en hospitales; se interna el 8-10 % en unidades generales, y el 5-12 % de ellos, en unidades de terapia intensiva. En 2017, el Departamento de Salud Materno-Infantil de dicha ciudad incluyó la oxigenoterapia por cánula nasal de alto flujo (CNAF) en el protocolo IRAB en unidades generales de tres hospitales. El objetivo de este trabajo es describir los resultados y explorar potenciales factores relacionados con el fracaso terapéutico. Métodos. Estudio prospectivo descriptivo que incluyó a lactantes < 18 meses hospitalizados por IRAB en 3 hospitales (Durand, Elizalde, Gutiérrez), de junio a septiembre de 2017. Todos los niños incapaces de cumplir los objetivos terapéuticos con bajo flujo recibieron CNAF, y se consideró fracaso de soporte el ingreso a Terapia Intensiva. Resultados. De 522 pacientes hospitalizados por IRAB, el 39,7 % requirieron CNAF. No se observaron diferencias basales significativas entre pacientes con CNAF y con oxigenoterapia convencional. Solo el 8,7 % de los pacientes con CNAF presentaron fracaso. Los pacientes con éxito del soporte mostraron un descenso de la frecuencia respiratoria significativamente mayor y más sostenido en el tiempo que aquellos con fracaso (p < 0,01). No se registraron complicaciones. Conclusión. La implementación protocolizada de CNAF en unidades generales fue una medida segura. Los pacientes con fracaso del soporte mostraron una menor disminución en la frecuencia respiratoria a lo largo del tratamiento.

Oxigenoterapia por Cánula Nasal de Alto Flujo / Oxygen therapy with High-Flow Nasal Cannula

Las infecciones respiratorias agudas bajas (IRAB) son una de las principales causas de consulta en los servicios de atención ambulatoria, pudiendo representar hasta el 36% de las consultas a servicios de Emergencias, 25% de los ingresos hospitalarios y 55 % de los requerimientos de asistencia ventilatoria mecánica (AVM), siendo la bronquiolitis la principal entidad clínica. El pilar fundamental del tratamiento de pacientes con IRAB e insuficiencia respiratoria aguda es la oxigenoterapia. De acuerdo al flujo entregado, la misma se divide en bajo y alto flujo. Cabe destacar que los sistemas de bajo flujo presentan algunas desventajas, como la imprecisión para entregar una FiO2 constante y cuantificable, insuficiente humidificación y calentamiento, inadecuada relación entre el flujo entregado y la demanda inspiratoria del paciente y riesgo de re-inhalación de CO2 con el uso de máscaras. En este contexto surge la oxigenoterapia por medio de cánulas nasales de alto flujo, que son sistemas abiertos y de fácil utilización, en el cual se basará la revisión del presente artículo.

Acute lower respiratory infections are one of the most common causes of ambulatory visits, accounting for up to 36% of the emergency department consults, 25% of hospital admissions and 55% of the requirement of invasive ventilation. The main responsible clinical entity is acute viral bronchiolitis. a. Médico de Planta Unidad 8. HNRG b. Médico de Planta Unidad de Terapia Intensiva- HNRG c. Jefe de Residentes Clínica Médica. HNRG d. Instructor de Residentes Clínica Médica. HNRG Correspondencia: Cristian Barbaro: drcristianbarbaro@gmail.com Conflicto de interés: ninguno que declarar. Oxigenoterapia por Cánula Nasal de Alto Flujo. Una revisión Oxygen therapy with High-Flow Nasal Cannula. A review Cristian Barbaroa , Ezequiel Monteverdeb , Julian Rodriguez Kibrikc , Guillermo Schvartzc y Gonzalo Guiñazúd The basic treatment for patients with acute respiratory insufficiency is oxygen therapy. According to the flow rate of the oxygen delivery, this therapy can be divided into high or low flow. The later has some disadvantages, like the lack of precision in delivered FiO2 , insufficient humidity and warmth of gas mixture, inadequate matching between oxygen delivery and the patient's inspiratory effort, and the risk of CO2 rebreathing. In this context, the High-Flow Nasal Cannula appears as a non-invasive and easy to use method, which will be reviewed in this article.

Mechanical ventilation in pediatric intensive care units during the season for acute lower respiratory infection: a multicenter study.

OBJECTIVE: To describe the characteristics and outcomes of mechanical ventilation in pediatric intensive care units during the season of acute lower respiratory infections. DESIGN: Prospective cohort of infants and children receiving mechanical ventilation for at least 12 hrs. SETTING: Sixty medical-surgical pediatric intensive care units. PATIENTS: All consecutive patients admitted to participating pediatric intensive care units during a 28-day period. MEASUREMENTS AND MAIN RESULTS: Of 2,156 patients admitted to pediatric intensive care units, 1185 (55%) received mechanical ventilation for a median of 5 days (interquartile range 2-8). Median age was 7 months (interquartile range 2-25). Main indications for mechanical ventilation were acute respiratory failure in 78% of the patients, altered mental status in 15%, and acute on chronic pulmonary disease in 6%. Median length of stay in the pediatric intensive care units was 10 days (interquartile range 6-18). Overall mortality rate in pediatric intensive care units was 13% (95% confidence interval: 11-15) for the entire population, and 39% (95% confidence interval: 23 - 58) in patients with acute respiratory distress syndrome. Of 1150 attempts at liberation from mechanical ventilation, 62% (95% confidence interval: 60-65) used the spontaneous breathing trial, and 37% (95% confidence interval: 35-40) used gradual reduction of ventilatory support. Noninvasive mechanical ventilation was used initially in 173 patients (15%, 95% confidence interval: 13-17). CONCLUSION: In the season of acute lower respiratory infections, one of every two children admitted to pediatric intensive care units requires mechanical ventilation. Acute respiratory failure was the most common reason for mechanical ventilation. The spontaneous breathing trial was the most commonly used method for liberation from mechanical ventilation.

Characterization of pediatric patients receiving prolonged mechanical ventilation.

OBJECTIVE: To describe the characteristics and risk factors of pediatric patients who receive prolonged mechanical ventilation, defined as ventilatory support for >21 days. DESIGN: Prospective cohort. SETTING: Four medical-surgical pediatric intensive care units in four university-affiliated hospitals in Argentina. PATIENTS: All consecutive patients from 1 month to 15 yrs old admitted to participating pediatric intensive care units from June 1, 2007, to August 31, 2007, who received mechanical ventilation (invasive or noninvasive) for >12 hrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic and physiologic data on admission to the pediatric intensive care units, drugs and events during the study period, and outcomes were prospectively recorded. A total of 256 patients were included. Of these, 23 (9%) required mechanical ventilation for >21 days and were assigned to the prolonged mechanical ventilation group. Patients requiring prolonged mechanical ventilation had higher mortality (43% vs. 21%, p < .05) and longer pediatric intensive care unit stay: 35 days [28-64 days] vs. 10 days [6-14]). There was no difference between the groups in age and gender distribution, reasons for admission, incidence of immunodeficiencies, or Paediatric Index of Mortality 2 score. The only difference at admission was a higher rate of genetic diseases in prolonged mechanical ventilation patients (26% vs. 9%, p < .05). There was a higher incidence of septic shock (87% vs. 34%, p < .01), acute respiratory distress syndrome (43% vs. 20%, p < .01), and ventilator-associated pneumonia (35% vs. 8%, p < .01) and higher utilization of dopamine (78% vs. 42%, p < .01), norepinephrine (61% vs. 15%, p < .01), multiple antibiotics (83% vs. 20%, p < .01), and blood transfusions (52% vs. 14%, p < .01). The proportion of extubation failure was higher in the prolonged mechanical ventilation group with similar rates of unplanned extubations in both groups. Variables remaining significantly associated with prolonged mechanical ventilation after multivariate analysis were treatment with multiple antibiotics, septic shock, ventilator-associated pneumonia, and use of norepinephrine. CONCLUSIONS: Patients with prolonged mechanical ventilation have more complications and require more pediatric intensive care unit resources. Mortality in these patients duplicates that from those requiring shorter support.