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Jabornisky R, Kuppermann N, González-Dambrauskas S. Transitioning From SIRS to Phoenix With the Updated Pediatric Sepsis Criteria-The Difficult Task of Simplifying the Complex. JAMA 2024; 331:650-651. [PMID: 38245901 DOI: 10.1001/jama.2023.27988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Roberto Jabornisky
- Department of Women, Children, and Adolescents, Faculty of Medicine, National University of the Northeast, Corrientes, Argentina
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, UC Davis School of Medicine and UC Davis Health, Sacramento, California
| | - Sebastián González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
- Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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2
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Barajas-Romero JS, Vásquez-Hoyos P, Pardo R, Jaramillo-Bustamante JC, Grigolli R, Monteverde-Fernández N, Gonzalez-Dambrauskas S, Jabornisky R, Cruces P, Wegner A, Díaz F, Pietroboni P. Factors associated with prolonged mechanical ventilation in children with pulmonary failure: Cohort study from the LARed Network registry. Med Intensiva 2024; 48:23-36. [PMID: 37481458 DOI: 10.1016/j.medine.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/15/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). DESIGN Secondary analysis of a prospective cohort. SETTING PICUs in centers that are part of the LARed Network between April 2017 and January 2022. PARTICIPANTS Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. RESULTS 1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21). CONCLUSIONS Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay.
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Affiliation(s)
| | - Pablo Vásquez-Hoyos
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Universidad Nacional de Colombia, Bogotá, Colombia; Sociedad de Cirugía de Bogota Hospital de San José, FUCS, Bogotá, Colombia.
| | - Rosalba Pardo
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Clínica Infantil de Colsubsidio, Bogotá, Colombia
| | - Juan Camilo Jaramillo-Bustamante
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital General de Medellín Luz Castro de Gutiérrez E.S.E., Medellín, Colombia
| | - Regina Grigolli
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital Infantil Sabará, Sao Paulo, Brazil
| | | | - Sebastián Gonzalez-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Departamento de Pediatría y Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Roberto Jabornisky
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital Juan Pablo II, Corrientes, Argentina; Hospital Regional Olga Stucky de Rizzi, Reconquista, Argentina
| | - Pablo Cruces
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Universidad Andres Bello, Facultad de Ciencias de la Vida, Santiago, Chile
| | - Adriana Wegner
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Complejo Asistencial Dr. Sotero del Rio, Santiago, Chile
| | - Franco Díaz
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital El Carmen de Maipú, Dr. Luis Valentín Ferrada, Santiago, Chile; Unidad de Investigación y Epidemiología Clínica, Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Pietro Pietroboni
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network); Hospital Regional de Antofagasta, Antofagasta, Chile
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3
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González G, Arias-López MDP, Bordogna A, Palacio G, Siaba Serrate A, Fernández AL, Jabornisky R, Kissoon N. [Lower socioeconomic conditions are associated with higher rates but similar outcomes in Sepsis in children]. Andes Pediatr 2023; 94:187-199. [PMID: 37358112 DOI: 10.32641/andespediatr.v94i2.4452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/12/2022] [Indexed: 06/27/2023]
Abstract
Sepsis is an important cause of pediatric morbidity and mortality, especially in low-income countries. Data on regional prevalence, mortality trends, and their relationship with socioeconomic variables are scarce. OBJECTIVE to determine the regional prevalence, mortality, and sociodemographic situation of patients diagnosed with severe sepsis (SS) and septic shock (SSh) admitted to Pediatric Intensive Care Units (PICUs). PATIENTS AND METHOD patients aged 1 to 216 months admitted to 47 participating PICUs with a diagnosis of SS or SSh between January 1, 2010, and December 31, 2018, were included. Secondary analysis was performed on the Argentine Society of Intensive Care Benchmarking Quality Program (SATI-Q) database for SS and SSh and a review of the annual reports of the Argentine Ministry of Health and the National Institute of Statistics and Census for the sociodemographic indices of the respective years. RESULTS 45,480 admissions were recorded in 47 PICUs, 3,777 of them with a diagnosis of SS and SSh. The combined prevalence of SS and SSh decreased from 9.9% in 2010 to 6.6% in 2018. The combined mortality decreased from 34.5% to 23.5%. Multivariate analysis showed that the Odds ratio (OR) of the association between SS and SSh mortality was 1.88 (95% CI: 1.46-2.32) and 2.4 (95% CI: 2.16-2.66), respectively, adjusted for malignant disease, PIM2, and mechanical ventilation. The prevalence of SS and SSh in different health regions (HR) was associated with the percentage of poverty and infant mortality rate (p < 0.001). However, there was no association between sepsis mortality and HR adjusted for PIM2. CONCLUSIONS Prevalence and mortality of SS and SSh have decreased over time in the participating PICUs. Lower socioeconomic conditions were associated with higher prevalence but similar sepsis outcomes.
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Affiliation(s)
- Gustavo González
- Hospital de Niños Dr. Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | - Gladys Palacio
- Hospital de Niños Dr. Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
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4
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Argent AC, Ranjit S, Peters MJ, Andre-von Arnim AVS, Chisti MJ, Jabornisky R, Musa NL, Kissoon N. Factors to be Considered in Advancing Pediatric Critical Care Across the World. Crit Care Clin 2022; 38:707-720. [PMID: 36162906 DOI: 10.1016/j.ccc.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article reviews the many factors that have to be taken into account as we consider the advancement of pediatric critical care (PCC) in multiple settings across the world. The extent of PCC and the range of patients who are cared for in this environment are considered. Along with a review of the ongoing treatment and technology advances in the PCC setting, the structures and systems required to support these services are also considered. Finally the question of how PCC can be made sustainable in a volatile world with the impacts of global crises such as climate change is addressed.
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Affiliation(s)
- Andrew C Argent
- Department of Paediatrics and Child Health, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Suchitra Ranjit
- Pediatric ICU, Apollo Children's Hospital, 15, Shafee Mhd Road, Chennai 600006, India
| | - Mark J Peters
- University College London Great Ormond Street Institute of Child Health, London, WC1N 3JH, UK; Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, WC1N 1EH, UK
| | - Amelie von Saint Andre-von Arnim
- Department of Pediatrics, Division of Pediatric Critical Care, University of Washington, Seattle Children's, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA; Department of Global Health, University of Washington, Seattle Children's, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA
| | - Md Jobayer Chisti
- ARI Ward, Dhaka Hospital, Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Roberto Jabornisky
- Universidad Nacional Del Nordeste, Argentina. Pediatric Intensive Care Unit (Hospital Juan Pablo II and Hospital Olga Stuky) Argentina, Sociedad Latinoamericana de Cuidados Intensivos Pediátricos, LARed Network, Universidad Nacional Del Nordeste, 1420 Mariano Moreno, Corrientes 3400, Argentina
| | - Ndidiamaka L Musa
- Paediatric Critical Care, University of Washington, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA
| | - Niranjan Kissoon
- British Columbia Children's Hospital and The University of British Columbia, Vancouver, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
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5
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Morin L, Hall M, de Souza D, Guoping L, Jabornisky R, Shime N, Ranjit S, Gilholm P, Nakagawa S, Zimmerman JJ, Sorce LR, Argent A, Kissoon N, Tissières P, Watson RS, Schlapbach LJ. The Current and Future State of Pediatric Sepsis Definitions: An International Survey. Pediatrics 2022; 149:188114. [PMID: 35611643 DOI: 10.1542/peds.2021-052565] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Definitions for pediatric sepsis were established in 2005 without data-driven criteria. It is unknown whether the more recent adult Sepsis-3 definitions meet the needs of providers caring for children. We aimed to explore the use and applicability of criteria to diagnose sepsis and septic shock in children across the world. METHODS This is an international electronic survey of clinicians distributed across international and national societies representing pediatric intensive care, emergency medicine, pediatrics, and pediatric infectious diseases. Respondents stated their preferences on a 5-point Likert scale. RESULTS There were 2835 survey responses analyzed, of which 48% originated from upper-middle income countries, followed by high income countries (38%) and low or lower-middle income countries (14%). Abnormal vital signs, laboratory evidence of inflammation, and microbiologic diagnoses were the criteria most used for the diagnosis of "sepsis." The 2005 consensus definitions were perceived to be the most useful for sepsis recognition, while Sepsis-3 definitions were stated as more useful for benchmarking, disease classification, enrollment into trials, and prognostication. The World Health Organization definitions were perceived as least useful across all domains. Seventy one percent of respondents agreed that the term sepsis should be restricted to children with infection-associated organ dysfunction. CONCLUSIONS Clinicians around the world apply a myriad of signs, symptoms, laboratory studies, and treatment factors when diagnosing sepsis. The concept of sepsis as infection with associated organ dysfunction is broadly supported. Currently available sepsis definitions fall short of the perceived needs. Future diagnostic algorithms should be pragmatic and sensitive to the clinical settings.
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Affiliation(s)
- Luc Morin
- Université Paris-Saclay, AP-HP, Pediatric Intensive Care, Bicêtre Hospital, DMU 3 Santé de l'Enfant et de l'Adolescent, Le Kremlin-Bicêtre, France
| | - Mark Hall
- Nationwide Children's Hospital, Columbus, Ohio
| | - Daniela de Souza
- Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Lu Guoping
- Children's Hospital of Fudan University, Shanghai, China
| | - Roberto Jabornisky
- Universidad Nacional del Nordeste, Corrientes, Argentina.,Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
| | | | - Patricia Gilholm
- Child Health Research Centre, and Paediatric Intensive Care Unit, The University of Queensland, and Queensland Children`s Hospital, Brisbane, Australia
| | | | - Jerry J Zimmerman
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Lauren R Sorce
- Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,University of Cape Town, Cape Town, South Africa
| | - Niranjan Kissoon
- British Columbia Women and Children's Hospital, Vancouver, British Columbia, Canada.,The University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Tissières
- Université Paris-Saclay, AP-HP, Pediatric Intensive Care, Bicêtre Hospital, DMU 3 Santé de l'Enfant et de l'Adolescent, Le Kremlin-Bicêtre, France.,Institute of Integrative Biology of the Cell, CNRS, CEA, Paris Saclay University, Gif-sur-Yvette, France
| | - R Scott Watson
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Luregn J Schlapbach
- Child Health Research Centre, and Paediatric Intensive Care Unit, The University of Queensland, and Queensland Children`s Hospital, Brisbane, Australia.,Department of Intensive Care and Neonatology, and Children`s Research Center, University Children`s Hospital Zurich, Zurich, Switzerland
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6
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Souza DC, Jaramillo-Bustamante JC, Céspedes-Lesczinsky M, Quintero EMC, Jimenez HJ, Jabornisky R, Piva J, Kissoon N. Challenges and health-care priorities for reducing the burden of paediatric sepsis in Latin America: a call to action. Lancet Child Adolesc Health 2022; 6:129-136. [PMID: 34902315 DOI: 10.1016/s2352-4642(21)00341-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 05/14/2023]
Abstract
Sepsis is a worldwide public health problem due to its high incidence and accompanying mortality, morbidity, and financial burden. It is a major cause of admission to paediatric intensive care units; despite advances in the diagnosis and treatment, both incidence and mortality are high in low-income and middle-income countries. There are several barriers in addressing the enormous burden of paediatric sepsis in these countries, which include: lack of data of incidence and mortality; unfamiliarity of sepsis by the lay public, leading to failure to seek care early, and by health professionals, leading to failure to treat emergently; and insufficient government funding for sepsis care programmes leading to inadequate staffing, material, and financial resources, and therefore, poor health systems. Socioeconomic inequalities, such as inequity and marked variation in income and education, high rates of malnutrition, high percentage of young population, and health systems that do not meet the population's demands also represent barriers in the care of children with sepsis in Latin America. In this Viewpoint, we draw attention to the problem of paediatric sepsis in Latin America and call for action to reduce the disease burden by proposing some solutions.
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Affiliation(s)
- Daniela C Souza
- Pediatric Intensive Care Unit, Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil; Pediatric Intensive Care Unit, Hospital Sírio Libanês, São Paulo, Brazil; Instituto Latino Americano de Sepsis, São Paulo, Brazil.
| | - Juan Camilo Jaramillo-Bustamante
- Pediatric Intensive Care Unit, Hospital General de Medellín, Medellin, Colombia; University of Antioquia, Medellín, Colombia; Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay
| | - Miguel Céspedes-Lesczinsky
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay; Pediatric Intensive Care Unit, Hospital Materno Infantil, Trinidad, Bolivia
| | - Edwin Mauricio Cantillano Quintero
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay; Pediatric Intensive Care Unit, Hospital Regional del Norte, Instituto Hondureño de Suguridaded Social, San Pedro Sula, Honduras
| | | | - Roberto Jabornisky
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay; Pediatric Intensive Care Unit, Hospital Olga Stucky, Reconquista, Santa Fé, Argentina; Hospital Juan Pablo II, Corrientes, Argentina; Universidad Nacional del Nordeste, Corrientes, Argentina; Sociedad Latinoamericana de Cuidados Intensivos Pediátricos, Monterrey, Mexico
| | - Jefferson Piva
- Medical School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Medical Director of Pediatric Intensive Care at Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Niranjan Kissoon
- University of British Columbia and British Columbia Children's Hospital, Vancouver, BC, Canada
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Wooldridge G, O'Brien N, Muttalib F, Abbas Q, Adabie Appiah J, Baker T, Bansal A, Basnet S, Campos-Miño S, de Souza DC, Díaz F, Dramowski A, Fernández-Sarmiento J, Fustiñana A, González G, Jabornisky R, Jaramillo-Bustamante JC, Yek Kee C, Lang HJ, Soares Lanziotti V, Kohn Loncarica G, Mohsenibod H, Ode B, Murthy S, Andre-von Arnim AVS, Hansmann A, González-Dambrauskas S. Challenges of implementing the Paediatric Surviving Sepsis Campaign International Guidelines 2020 in resource-limited settings: A real-world view beyond the academia. Andes Pediatr 2021; 92:954-962. [PMID: 35506809 DOI: 10.32641/andespediatr.v92i6.4030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/28/2021] [Indexed: 06/14/2023]
Abstract
The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children was released in 2020 and is intended for use in all global settings that care for children with sepsis. However, practitioners managing children with sep sis in resource-limited settings (RLS) face several challenges and disease patterns not experienced by those in resource-rich settings. Based upon our collective experience from RLS, we aimed to reflect on the difficulties of implementing the international guidelines. We believe there is an urgent need for more evidence from RLS on feasible, efficacious approaches to the management of sepsis and septic shock that could be included in future context-specific guidelines.
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Affiliation(s)
| | | | - Fiona Muttalib
- Department of Paediatric Critical Care, BC Children's Hospital, Vancouver, Canada
| | - Qalab Abbas
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - John Adabie Appiah
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Tim Baker
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Arun Bansal
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sangita Basnet
- School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | | | | | - Franco Díaz
- Escuela de Postgrado, Universidad Finis Terrae, Santiago, Chile
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | - Ana Fustiñana
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo González
- Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | | | - Hans-Joerg Lang
- Global Child Health Department, University Witten/Herdecke. Witten, Germany
| | - Vanessa Soares Lanziotti
- Paediatric Intensive Care Unit & Research and Education Division/Maternal and Child Health Postgraduate Program, Federal University of Rio De Janeiro. Rio De Janeiro, Brazil
| | - Guillermo Kohn Loncarica
- Paediatric Emergency Department, Hospital Juan P. Garrahan. Buenos Aires, Argentina; Universidad de Buenos Aires (UBA). Argentina; and Sociedad Latinoamericana de Emergencia Pediatrica (SLEPE)
| | - Hadi Mohsenibod
- PICU, The Hospital for Sick Children. Toronto, Canada; and ERU delegate, Canadian Red Cross, Canada
| | - Bunmi Ode
- Pédiatre Reanimatrice volante. NGO ALIMA-The Alliance for International Medical Action, Senegal
| | - Srinivas Murthy
- Department of Paediatric Critical Care, BC Children's Hospital. Vancouver, Canada
| | - Amelie von Saint Andre-von Arnim
- Department of Pediatrics, Division of Paediatric Critical Care, University of Washington, Seattle Children's. Seattle, USA; and Paediatric Emergency and Critical Care, University of Nairobi. Nairobi, Kenya
| | | | - Sebastián González-Dambrauskas
- Cuidados Intensivos Pediátricos Especializados (CIPe), Casa de Galicia. Montevideo, Uruguay; and Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
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8
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Fernández-Sarmiento J, De Souza DC, Martinez A, Nieto V, López-Herce J, Soares Lanziotti V, Arias López MDP, De Carvalho WB, Oliveira CF, Jaramillo-Bustamante JC, Díaz F, Yock-Corrales A, Ruvinsky S, Munaico M, Pavlicich V, Iramain R, Márquez MP, González G, Yunge M, Tonial C, Cruces P, Palacio G, Grela C, Slöcker-Barrio M, Campos-Miño S, González-Dambrauskas S, Sánchez-Pinto NL, Celiny García P, Jabornisky R. Latin American Consensus on the Management of Sepsis in Children: Sociedad Latinoamericana de Cuidados Intensivos Pediátricos [Latin American Pediatric Intensive Care Society] (SLACIP) Task Force: Executive Summary. J Intensive Care Med 2021; 37:753-763. [PMID: 34812664 DOI: 10.1177/08850666211054444] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to develop evidence-based recommendations for the diagnosis and treatment of sepsis in children in low- and middle-income countries (LMICs), more specifically in Latin America. Design: A panel was formed consisting of 27 experts with experience in the treatment of pediatric sepsis and two methodologists working in Latin American countries. The experts were organized into 10 nominal groups, each coordinated by a member. Methods: A formal consensus was formed based on the modified Delphi method, combining the opinions of nominal groups of experts with the interpretation of available scientific evidence, in a systematic process of consolidating a body of recommendations. The systematic search was performed by a specialized librarian and included specific algorithms for the Cochrane Specialized Register, PubMed, Lilacs, and Scopus, as well as for OpenGrey databases for grey literature. The GRADEpro GDT guide was used to classify each of the selected articles. Special emphasis was placed on search engines that included original research conducted in LMICs. Studies in English, Spanish, and Portuguese were covered. Through virtual meetings held between February 2020 and February 2021, the entire group of experts reviewed the recommendations and suggestions. Result: At the end of the 12 months of work, the consensus provided 62 recommendations for the diagnosis and treatment of pediatric sepsis in LMICs. Overall, 60 were strong recommendations, although 56 of these had a low level of evidence. Conclusions: These are the first consensus recommendations for the diagnosis and management of pediatric sepsis focused on LMICs, more specifically in Latin American countries. The consensus shows that, in these regions, where the burden of pediatric sepsis is greater than in high-income countries, there is little high-level evidence. Despite the limitations, this consensus is an important step forward for the diagnosis and treatment of pediatric sepsis in Latin America.
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Affiliation(s)
- Jaime Fernández-Sarmiento
- Fundación Cardioinfantil - Instituto de Cardiología, Universidad de la Sabana, CES Graduate School, Bogotá, Colombia
| | - Daniela Carla De Souza
- Hospital Universitario da Universidad de São Paulo and Hospital Sírio Libanês, Sao Paulo, Brazil
| | | | - Victor Nieto
- Department of Critical Care Medicine, Cobos Medical Center, Chief Research Group GriBos, Bogotá, Colombia
| | - Jesús López-Herce
- Department of Pediatric Intensive Care, Hospital General Universitario Gregorio Marañón; Department of Public and Maternal-Infant Health, Universidad Complutense de Madrid, Red de Salud Maternoinfantil y del Desarrollo, Madrid, España
| | - Vanessa Soares Lanziotti
- Pediatric Intensive Care Unit & Research and Education Division/Maternal and Child Health Postgraduate Program, Institute of Pediatrics, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - María Del Pilar Arias López
- Pediatric Intensive Care Unit, Hospital de Niños Ricardo Gutierrez, Programa SATI-Q, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Werther Brunow De Carvalho
- Neonatology and Intensive Care Pediatrics, Department of Medical University of São Paulo, São Paulo, Brazil
| | | | - Juan Camilo Jaramillo-Bustamante
- Department of Pediatrics and Intensive Care, Hospital General de Medellín, Universidad de Antioquia, Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Medellín, Colombia
| | - Franco Díaz
- Instituto de Ciencias e Innovacion en Medicina, Universidad del Desarrollo y Hospital El Carmen de Maipu, Santiago, Chile
| | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", CCSS, Pediatric Emergency Physician, San José, Costa Rica
| | - Silvina Ruvinsky
- Department of Infectious Diseases, Hospital de Pediatría Juan P. Garrahan, Latin American Society of Infectious Disease, Buenos Aires, Argentina
| | - Manuel Munaico
- Pediatric Intensive Care Unit, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Viviana Pavlicich
- Hospital General Pediátrico Niños de Acosta Ñu, Universidad Privada del Pacífico, Asunción, Paraguay
| | - Ricardo Iramain
- Pediatric Emergency Department, Hospital de Clínicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Marta Patricia Márquez
- Department of Pediatric Intensive Care, Instituto Nacional de Pediatría, Ciudad de México, México
| | - Gustavo González
- Pediatric Intensive Care Unit, Complejo Médico "CHURUCA VISCA", Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Mauricio Yunge
- Department of Pediatric Intensive Care, Clínica Los Condes, Santiago, Chile
| | - Cristian Tonial
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Porto Alegre, RS, Brazil
| | - Pablo Cruces
- Department of Pediatric Intensive Care, Hospital El Carmen de Maipú, Centro de Investigación de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Chile
| | - Gladys Palacio
- Department of Pediatric Intensive Care Unit Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | - Carolina Grela
- Universidad de la República, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay
| | | | - Santiago Campos-Miño
- Department of Pediatric Intensive Care Unit, Hospital Metropolitano, Latin American Center for Clinical Research, Quito - Ecuador
| | - Sebastian González-Dambrauskas
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network) - Montevideo, Uruguay. Specialized Pediatric Intensive Care, Casa de Galicia, Montevideo, Uruguay
| | - Nelson L Sánchez-Pinto
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Pedro Celiny García
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Serviço de Medicina Intensiva e Emergência, Porto Alegre, RS, Brazil
| | - Roberto Jabornisky
- Department of Pediatrics, Facultad de Medicina, Universidad Nacional del Nordeste, Argentina
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Vásquez-Hoyos P, Pardo-Carrero R, Jaramillo-Bustamante J, González-Dambrauskas S, Carvajal C, Diaz F, Fernández A, Jabornisky R, Muzzio S, Cidral E, Mansur A, Céspedes Lesczinsky M, Velasco Z, Grigolli Cesar R, Cruces P, Cordova T, Aranguiz Quintanilla D, Sepúlveda J, Padilla I, Donoso A, Núñez Sánchez MJ, Donoso A, Wegner A, Asistencial C, del Río S, Pietroboni Fuster P, Rosales Fernández J, Sanabria S, Ferre A, España M, Iroa A, Navatta R, Benech E, Carro M, Fernández A, Monteverde N, Carbonell M, Alonso B, Serra A, Fátima Varela L, Cristina Courtie L, Martínez J, Cantirán K, Matrai L, Mislej C, Castro L, Menta S, Talasimov C, María José Caggiano L, Pedrozo L, Franco A, Martínez Arroyo L, Dubra S, Inverso A, Mouta N, Parada M, Karina Etulain L. Ingreso en cuidados intensivos debido a bronquiolitis grave en Colombia: ¿dónde nos encontramos en relación con el resto de Latinoamérica? Med Intensiva 2021. [DOI: 10.1016/j.medin.2019.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Serra JA, González-Dambrauskas S, Vásquez Hoyos P, Carvajal C, Donoso A, Cruces P, Fernández A, Martínez Arroyo L, Sarmiento MP, Nuñez MJ, Wegner Araya A, Jaramillo-Bustamante JC, Céspedes-Lesczinsky M, Jabornisky R, Monteverde-Fernández N, Córdova T, Díaz F. Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis. ACTA ACUST UNITED AC 2021; 91:216-225. [PMID: 32730540 DOI: 10.32641/rchped.v91i2.1156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/23/2019] [Indexed: 11/12/2022]
Abstract
The objective of this study was to describe the management of infants with acute bronchiolitis admit ted to 20 pediatric intensive care units (PICU) members of LARed in 5 Latin American countries. Pa tients and Method: Retrospective, multicenter, observational study of data from the Latin American Registry of Acute Pediatric Respiratory Failure. We included children under 2 years of age admitted to the PICU due to community-based acute bronchiolitis between May and September 2017. Demo graphic and clinical data, respiratory support, therapies used, and clinical results were collected. A subgroup analysis was carried out according to geographical location (Atlantic v/s Pacific), type of insurance (Public v/s Private), and Academic v/s non-Academic centers. Results: 1,155 patients were included in the registry which present acute respiratory failure and 6 were excluded due to the lack of information in their record form. Out of the 1,147 patients, 908 were under 2 years of age, and out of those, 467 (51.4%) were diagnosed with acute bronchiolitis, which was the main cause of admission to the PICU due to acute respiratory failure. The demographic and severity characteristics among the centers were similar. The most frequent maximum ventilatory support was the high-flow nasal can nula (47%), followed by non-invasive ventilation (26%) and invasive mechanical ventilation (17%), with a wide coefficient of variation (CV) between centers. There was a great dispersion in the use of treatments, where the use of bronchodilators, antibiotics, and corticosteroids, representing a CV up to 400%. There were significant differences in subgroup analysis regarding respiratory support and treatments used. One patient of this cohort passed away. Conclusion: we detected wide variability in respiratory support and treatments among Latin American PICUs. This variability was not explained by demographic or clinical differences. The heterogeneity of treatments should encourage collabora tive initiatives to reduce the gap between scientific evidence and practice.
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Affiliation(s)
| | | | | | | | - Alejandro Donoso
- Hospital Clínico La Florida Dra. Eloísa Díaz Insunza, Santiago, Chile
| | | | | | | | | | - María José Nuñez
- Hospital Clínico La Florida Dra. Eloísa Díaz Insunza, Santiago, Chile
| | | | | | | | | | | | | | - Franco Díaz
- Hospital Clínico La Florida Dra. Eloísa Díaz Insunza, Santiago, Chile
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11
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Serra JA, Díaz F, Cruces P, Carvajal C, Nuñez MJ, Donoso A, Bravo-Serrano J, Carbonell M, Courtie C, Fernández A, Martínez-Arroyo L, Martínez J, Menta S, Pedrozo-Ortiz L, Wegner A, Monteverde-Fernández N, Jaramillo-Bustamante JC, Jabornisky R, González-Dambrauskas S, Kudchadkar SR, Vásquez-Hoyos P. Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes. J Pediatr Intensive Care 2021; 11:201-208. [DOI: 10.1055/s-0040-1722204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/20/2020] [Indexed: 10/21/2022] Open
Abstract
AbstractSeveral challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4–36.3).
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Affiliation(s)
- Jesus A. Serra
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Casa de Galicia, Montevideo, Uruguay
| | - Franco Díaz
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
- Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Pablo Cruces
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital El Carmen de Maipú, Santiago, Chile
- Departamento de Pediatría, Facultad de Ciencias de la Vida, Universidad Andrés Bello, Santiago, Chile
| | - Cristobal Carvajal
- Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo, Santiago, Chile
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Facultad de Medicina, Clínica Alemana, Santiago, Chile
| | - Maria J. Nuñez
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Clínico La Florida Dra. Eloísa Díaz Insunza, Santiago, Chile
| | - A Donoso
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Clínico La Florida Dra. Eloísa Díaz Insunza, Santiago, Chile
| | - J.A Bravo-Serrano
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Caja Nacional de Salud, La Paz, Bolivia
| | - M Carbonell
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Médica Uruguaya, Montevideo, Uruguay
| | - C Courtie
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital de Sanidad Militar, Montevideo, Uruguay
| | - A Fernández
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Asociación Española, Montevideo, Uruguay
| | - L Martínez-Arroyo
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, COMEPA, Paysandú, Uruguay
| | - J Martínez
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital de Sanidad Militar, Montevideo, Uruguay
| | - S Menta
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Regional de Tacuarembó, Tacuarembó, Uruguay
| | - Luis Pedrozo-Ortiz
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Regional de Salto, Salto, Uruguay
| | - A Wegner
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | | | - Juan C. Jaramillo-Bustamante
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital General de Medellín, Colombia
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquía, Colombia
| | - Roberto Jabornisky
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Juan Pablo II, Corrientes, Argentina
| | | | - Sapna R. Kudchadkar
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Pablo Vásquez-Hoyos
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Departamento de Pediatría, Sociedad de Cirugía Hospital de San José, Bogotá, Colombia
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
- División de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Universidad Nacional de Colombia, Bogotá, Colombia
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12
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Fernández-Sarmiento J, De Souza D, Jabornisky R, Gonzalez GA, Arias López MDP, Palacio G. Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): a narrative review and the viewpoint of the Latin American Society of Pediatric Intensive Care (SLACIP) Sepsis Committee. BMJ Paediatr Open 2021; 5:e000894. [PMID: 34192188 PMCID: PMC7868133 DOI: 10.1136/bmjpo-2020-000894] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/29/2020] [Accepted: 01/07/2021] [Indexed: 01/15/2023] Open
Abstract
Background In this review, we discuss some important aspects of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), a new syndrome that is temporally related to previous exposure to SARS-CoV-2 infection. This virus has a broad spectrum of presentation that may overlap with Kawasaki disease in terms of presenting symptoms and laboratory and cardiac findings. Our objective was to review and summarise published evidence regarding the most important aspects of PIMS-TS, with special emphasis on the treatment strategies suggested for middle-income and low-income countries. Methods A systematic review of the literature was performed in the principal medical databases including PubMed, Embase (OVID) and Google Scholar between December 2019 and August 2020. Results A total of 69 articles were identified in the described databases. Altogether, 13 articles met the inclusion criteria and were eligible. The most frequently described symptoms of PIMS-TS include fever (82%), shock (67%) and gastrointestinal (87%), skin (71%) and cardiac disorders (75%). In most series, it has been observed between 4 and 6 weeks after the pandemic appears in the general population. Multisystem inflammatory syndrome in children is presented as a great systemic inflammatory response syndrome, which sometimes presents as shock requiring fluid resuscitation and vasoactive drug support (26%). Several treatment strategies have been used, including immunoglobulin, steroids, aspirin, anakinra and anticoagulation among others. These general and specific interventions should be guided by an interdisciplinary and multidisciplinary team, especially in settings with limited resources. Conclusions PIMS-TS COVID-19 is a new type of presentation of SARS-CoV-2 infection, with an exaggerated inflammatory response and frequent-but not exclusive-digestive and myocardial involvement. It is important to describe the clinical course and outcomes in countries with limited resources as well as establish the role of biomarkers for early diagnosis, effective therapeutic strategies and outpatient follow-up schemes.
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Affiliation(s)
- Jaime Fernández-Sarmiento
- Department of Critical Care Medicine and Pediatrics Fundación Cardioinfantil - Instituto de Cardiología, Universidad de la Sabana, CES Graduate School, Sepsis Committee Latin American Society of Pediatric Intensive Care (SLACIP), Bogotá, Colombia
| | - Daniela De Souza
- Pediatric Intensive Care Unit and Department of Pediatrics, Hospital Universitario da Universidad de São Paulo and Hospital Sírio Libanês, Sepsis Committee Latin American Society of Pediatric Intensive Care (SLACIP), Sao Paulo, Brazil
| | - Roberto Jabornisky
- Department of Pediatrics Facultad de Medicina Universidad Nacional del Nordeste, Sepsis Committee Latin American Society of Pediatric Intensive Care (SLACIP), Corrientes, Argentina
| | - Gustavo Ariel Gonzalez
- Pediatric Intensive Care Unit. Hospital Churruca - Visca Medical Complex, Ricardo Gutiérrez Children’s Hospital, Sepsis Committee. Latin American Society of Pediatric Intensive Care (SLACIP), Buenos Aires, Argentina
| | - Maria del Pilar Arias López
- Pediatric Intensive Care Unit Ricardo Gutiérrez Children's Hospital, Sepsis Committee Latin American Society of Pediatric Intensive Care (SLACIP), Buenos Aires, Argentina
| | - Gladys Palacio
- Pediatric Intensive Care Unit Ricardo Gutiérrez Children's Hospital, Sepsis Committee. Latin American Society of Pediatric Intensive Care (SLACIP), Buenos Aires, Argentina
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13
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Kohn-Loncarica G, Fustiñana A, Díaz-Rubio F, Jaramillo-Bustamante JC, González-Dambrauskas S, Vásquez-Hoyos P, Fernández-Sarmiento J, González G, Mansur A, Ponce J, Jabornisky R. Recommendations for the initial management of multisystem inflammatory syndrome temporally related to COVID-19, in children and adolescents. ARCH ARGENT PEDIATR 2020; 118:e514-e526. [PMID: 33231054 DOI: 10.5546/aap.2020.eng.e514] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 11/12/2022]
Abstract
Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that proposed for septic shock. This review analyzes such approach based on the characteristics typical of multisystem inflammatory syndrome related to COVID-19 in accordance with the paradigm of an "institutional practice guideline" and suggests therapeutic approach strategies, including early detection, stabilization, referral, specific treatment, and process analysis.
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Affiliation(s)
- Guillermo Kohn-Loncarica
- Unidad Emergencias, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina. Sociedad Latinoamericana de Emergencias Pediátricas (SLEPE).
| | - Ana Fustiñana
- Unidad Emergencias, Hospital "Prof. Dr. Juan P. Garrahan", Buenos Aires, Argentina. Sociedad Latinoamericana de Emergencias Pediátricas (SLEPE)
| | - Franco Díaz-Rubio
- Instituto de Ciencias e Innovación en Medicina, Universidad del Desarrollo y Hospital El Carmen de Maipú, Santiago, Chile. Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
| | - Juan C Jaramillo-Bustamante
- Unidad de Cuidados Intensivos Pediátricos, Hospital General de Medellín. Docente de cátedra, Universidad de Antioquía, Colombia. Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
| | - Sebastián González-Dambrauskas
- Cuidados Intensivos Pediátricos Especializados (CIPe), Casa de Galicia, Montevideo, Uruguay. Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
| | - Pablo Vásquez-Hoyos
- Universidad Nacional de Colombia y Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia. Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
| | - Jaime Fernández-Sarmiento
- Departamento de Pediatría y Cuidados Críticos, Universidad de la Sabana. Fundación Cardioinfantil, Instituto de Cardiología, Bogotá, Colombia. Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
| | - Gustavo González
- Unidad de Cuidados Intensivos Pediátricos, Complejo Médico Policial "Churruca Visca", Buenos Aires, Argentina. Comité de Shock, Sociedad Argentina de Terapia Intensiva
| | - Alejandro Mansur
- Servicio de Cuidados Intensivos, Hospital Regional de Reconquista, Santa Fe, Argentina. Red Colaborativa Pediátrica de Latinoamérica (LARed Network) Universidad Católica de Santa Fe
| | - Javier Ponce
- Unidad de Cuidados Intensivos Pediátricos, Hospital Doctor Guillermo Rawson, San Juan, Argentina. Comité de Shock, Sociedad Argentina de Terapia Intensiva
| | - Roberto Jabornisky
- Facultad de Medicina, Universidad Nacional del Nordeste, Corrientes, Argentina. Red Colaborativa Pediátrica de Latinoamérica (LARed Network)
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14
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Sanchez-Pinto LN, González-Dambrauskas S, Jabornisky R, Naidoo K, Schlapbach LJ, Kissoon N. Sepsis hysteria? Not for children. Lancet 2020; 396:1332-1333. [PMID: 34338208 DOI: 10.1016/s0140-6736(20)32148-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 09/14/2020] [Indexed: 11/16/2022]
Affiliation(s)
- L Nelson Sanchez-Pinto
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Sebastián González-Dambrauskas
- Cuidados Intensivos Pediátricos Especializados y Red Colaborativa Pediátrica de Latinoamérica, Casa de Galicia, Montevideo, Uruguay
| | - Roberto Jabornisky
- Unidad de Cuidados Intensivos Pediátricos y Red Colaborativa Pediátrica de Latinoamérica, Hospital Juan Pablo II, Universidad Nacional del Nordeste, Corrientes, Argentina
| | - Kuban Naidoo
- Division of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Niranjan Kissoon
- Department of Pediatrics and Emergency Medicine, School of Population and Public Health, University of British Columbia, British Columbia Children's Hospital, Vancouver, BC, Canada
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15
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Jabornisky R, Sáenz SS, Capocasa P, Jaen R, Moreno RP, Landry L, Rufach D, Santos SN, Berrueta M, Carcillo J, Vassallo JC. Epidemiological study of pediatric severe sepsis in Argentina. ARCH ARGENT PEDIATR 2020; 117:S135-S156. [PMID: 31833341 DOI: 10.5546/aap.2019.eng.s135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/26/2018] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Severe sepsis (SS) is one of the leading causes of pediatric mortality in Argentina. The objective was to describe the epidemiological characteristics and to analyze risk factors associated with mortality from SS among patients hospitalized in pediatric intensive care units (PICU) in Argentina. POPULATION AND METHODS Observational, prospective cohort study among patients with SS hospitalized in PICUs in Argentina from 8/1/2008 to 9/30/2008. RESULTS Two thousand five hundred and fifty nine patients were admitted at 59 PICUs. A total of 315 patients (335 events) were included. Patients' median age was 8 months (1-182). The frequency was 13.8 %, and 28-day mortality was 31.6 %. Patients with a higher mortality were those who were coming from rural areas, had comorbidities at the time of admission or a history of cancer, had shock or acute respiratory distress syndrome (ARDS), were administered low-dose corticosteroids or vasoactive drugs or more than 60 ml/kg of fluid in the first hour and in the first 6hours, and had severe malnutrition. Following adjustment by severity using a multivariate logistic regression model, only coming from a rural area, having shock or ARDS remained associated with 28-day mortality. Forty per cent of patients received antibiotics 60 minutes after diagnosis. CONCLUSIONS SS is an event with a high frequency and mortality in Argentina. In the severity adjusted multivariate analysis, only coming from a rural area, having ARDS and/or shock were associated with higher mortality.
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Affiliation(s)
- Roberto Jabornisky
- Comité Nacional de Emergencias y Cuidados Críticos, Sociedad Argentina de Pediatría.
| | - Silvia S Sáenz
- Comité Nacional de Emergencias y Cuidados Críticos, Sociedad Argentina de Pediatría
| | - Patricia Capocasa
- Comité Nacional de Emergencias y Cuidados Críticos, Sociedad Argentina de Pediatría
| | - Roxana Jaen
- Comité Nacional de Emergencias y Cuidados Críticos, Sociedad Argentina de Pediatría
| | - Rodolfo P Moreno
- Comité Nacional de Emergencias y Cuidados Críticos, Sociedad Argentina de Pediatría
| | - Luis Landry
- Comité Nacional de Emergencias y Cuidados Críticos, Sociedad Argentina de Pediatría
| | - Daniel Rufach
- Comité Nacional de Emergencias y Cuidados Críticos, Sociedad Argentina de Pediatría
| | - Silvia N Santos
- Comité Nacional de Emergencias y Cuidados Críticos, Sociedad Argentina de Pediatría
| | - Mabel Berrueta
- Comité Nacional de Emergencias y Cuidados Críticos, Sociedad Argentina de Pediatría
| | | | - Juan Carlos Vassallo
- Comité Nacional de Emergencias y Cuidados Críticos, Sociedad Argentina de Pediatría
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16
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Kohn Loncarica G, Fustiñana A, Jabornisky R. Recommendations for the management of pediatric septic shock in the first hour (part one). ARCH ARGENT PEDIATR 2020; 117:e14-e23. [PMID: 30652450 DOI: 10.5546/aap.2019.eng.e14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 06/04/2018] [Indexed: 11/12/2022]
Abstract
In the past two years, different organizations have updated their clinical practice guidelines for hemodynamic support in pediatric septic shock. The studies conducted in adults have questioned the initial management of sepsis in accordance to protocols based on achieving various goals. However, the usefulness of these protocols in children has been demonstrated. The possibility of adhering to guidelines may vary depending on patients and facilities, so it is necessary to update the general aspects of initial care for children with sepsis. The proposal is to shift the paradigm from an "individual practice guideline," which is universal for all, to an "institutional practice guideline" and to assess the factors that should be improved at each facility. This manuscript is divided into two parts. The first part analyzes the bundles for the early detection of septic shock. Part two addresses treatment, stabilization, referral, and process analysis.
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Affiliation(s)
| | - Ana Fustiñana
- Unidad de Emergencias, Hospital "Prof. Dr. J. P. Garrahan", Buenos Aires, Argentina
| | - Roberto Jabornisky
- Facultad de Medicina, Universidad Nacional del Nordeste, Corrientes, Argentina
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17
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Kohn Loncarica G, Fustiñana A, Jabornisky R. [Recommendations for the management of pediatric septic shock in the first hour (part two)]. ARCH ARGENT PEDIATR 2020. [PMID: 30652451 DOI: 10.5546/aap.2019.e24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In 2016, the Surviving Sepsis Campaign and the National Institute for Health and Care Excellence (NICE) developed clinical practice guidelines for the management of pediatric septic shock. In 2017, the American College of Critical Care Medicine (ACCM) updated its recommendations for hemodynamic support of pediatric shock. Recognizing septic shock is critical, as well as an optimal, time-sensitive treatment. An adequate consultation with a pediatric specialist and/or a timely referral to a facility with a higher level of care are also critical for an appropriate outcome in the management of this condition. Here we analyze the bundles used in the management of these patients, which are essential to improve the quality of care.
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Affiliation(s)
| | - Ana Fustiñana
- Unidad de Emergencias, Hospital "Prof. Dr. J. P. Garrahan", Buenos Aires, Argentina
| | - Roberto Jabornisky
- Facultad de Medicina, Universidad Nacional del Nordeste, Corrientes, Argentina
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18
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Althabe M, Cardigni G, Vassallo JC, Allende D, Berrueta M, Codermatz M, Córdoba J, Castellano S, Jabornisky R, Marrone Y, Orsi MC, Rodriguez G, Varón J, Schnitzler E, Tamusch H, Torres JM, Vega L. Dying in the intensive care unit: collaborative multicenter study about forgoing life-sustaining treatment in Argentine pediatric intensive care units. Pediatr Crit Care Med 2003; 4:164-9. [PMID: 12749646 DOI: 10.1097/01.pcc.0000059428.08927.a9] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Describe modes of death and factors involved in decision-making together with life support limitation (LSL) procedures. DESIGN Prospective, descriptive, longitudinal, and noninterventional study. SETTING Sixteen pediatric intensive care units in Argentina. PATIENTS Every patient who died during a 1-yr period was included. MEASUREMENTS AND MAIN RESULTS Age, sex, length of stay (LOS), primary and admission diagnosis, underlying chronic disease (CD), postoperative condition (PO). Deaths were classified in four groups: a) failed cardiopulmonary resuscitation (CPR); b) do-not-resuscitate (DNR) status; c) withholding or withdrawing life-sustaining treatment (WH/WD); and d) brain death (BD). Justifications were classified as a) imminent death; b) poor long-term prognosis; c) poor quality of life; and d) family request. Data were collected from medical records and interviews with the attending physicians. Descriptive statistics were performed. Differences among groups were analyzed through contingency tables and analysis of variance when required. Relative risks and confidence intervals of variables potentially related to LSL were analyzed, and logistic regression was performed. There were 6358 admissions and 457 deaths. CPR was performed in 52%, DNR in 16%, WH/WD in 20%, and BD in 11% of dead patients. BD patients were older, LOS and CD prevalence were higher in the WH/WD group. Inotropic drugs were the most frequently limited treatment in 110 patients (55%), CPR in 72 (35.6%), and mechanical ventilation in 63 (31%). Imminent death was the most frequently reported justification for LSL. CD and more staff were associated with a higher probability of LSL. CONCLUSIONS Most of the patients in Argentina underwent CPR before their death. We have a high proportion of patients with CD (65%) and low BD diagnosis. PO condition decreased LSL probability in chronically ill patients. Do-not-resuscitate orders and withholding new treatments were the most common LSL. Active withdrawal was exceptional. The Ethics Committee was consulted in 5% of the LSL population.
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Affiliation(s)
- María Althabe
- Hospital de Pediatría "J. P. Garrahan," Buenos Aires, Argentina
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