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Death by community-based methicillin-resistant Staphylococcus aureus: case report. CRITICAL CARE SCIENCE 2023; 35:416-420. [PMID: 38265325 PMCID: PMC10802769 DOI: 10.5935/2965-2774.20230078-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/27/2023] [Indexed: 01/25/2024]
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Epidemiology and outcomes of septic shock in children with complex chronic conditions in a developing country PICU. J Pediatr (Rio J) 2022; 98:614-620. [PMID: 35561755 PMCID: PMC9617278 DOI: 10.1016/j.jped.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To investigate the role of Complex Chronic Conditions (CCCs) on the outcomes of pediatric patients with refractory septic shock, as well as the accuracy of PELOD-2 and Vasoactive Inotropic Score (VIS) to predict mortality in this specific population. METHODS This is a single-center, retrospective cohort study. All patients diagnosed with septic shock requiring vasoactive drugs admitted to a 13-bed PICU in southern Brazil, between January 2016 and July 2018, were included. Clinical and demographic characteristics, presence of CCCs and VIS, and PELOD-2 scores were accessed by reviewing electronic medical records. The main outcome was considered PICU mortality. RESULTS 218 patients with septic shock requiring vasoactive drugs were identified in the 30-month period and 72% of them had at least one CCC. Overall mortality was 22%. Comparing to patients without previous comorbidities, those with CCCs had a higher mortality (26.7% vs 9.8%; OR = 3.4 [1.3-8.4]) and longer hospital length of stay (29.3 vs 14.8; OR 2.39 [1.1- 5.3]). Among the subgroups of CCCs, "Malignancy" was particularly associated with mortality (OR = 2.3 [1.0-5.1]). VIS and PELOD-2 scores in 24 and 48 hours were associated with mortality and a PELOD-2 in 48 hours > 8 had the best performance in predicting mortality in patients with CCC (AUROC = 0.89). CONCLUSION Patients with CCCs accounted for the majority of those admitted to the PICU with septic shock and related to poor outcomes. The high prevalence of hospitalizations, use of resources, and significant mortality determine that patients with CCCs should be considered a priority in the healthcare system.
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Continuous clonidine infusion: an alternative for children on mechanical ventilation. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:xxx. [PMID: 35830018 PMCID: PMC9574962 DOI: 10.1590/1806-9282.20220166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to assess the clonidine infusion rate in the first 6 h, as maintenance dose (first 24 h), and in the pre-extubation period (last 24 h), as well as the cumulative dose of other sedatives and the hemodynamic response. METHODS This is a retrospective cohort study. RESULTS Children up to the age of 2 years who were admitted to the pediatric intensive care unit of a tertiary referral hospital in the south region of Brazil, between January 2017 and December 2018, were submitted to mechanical ventilation, and received continuous clonidine infusions were included in the study. The initial, maintenance, and pre-extubation doses of clonidine; the vasoactive-inotropic score; heart rate; and systolic and diastolic blood pressure of the study participants were assessed. A total of 66 patients with a median age of 4 months who were receiving clonidine infusions were included. The main indications for mechanical ventilation were acute viral bronchiolitis (56%) and pneumonia associated with acute respiratory distress syndrome (15%). The median of clonidine infusion in the first 6 h (66 patients) was 0.53 μg/kg/h (IQR 0.49-0.88), followed by 0.85 μg/kg/h (IQR 0.53-1.03) during maintenance (57 patients) and 0.63 μg/kg/h (IQR 0.54-1.01) during extubation period (42 patients) (p=0.03). No differences were observed in the doses regarding the indication for mechanical ventilation. Clonidine infusion was not associated with hemodynamic changes and showed no differences when associated with adjuvants. CONCLUSION Clonidine demonstrated to be a well-tolerated sedation option in pediatric patients submitted to mechanical ventilation, without relevant influence in hemodynamic variables.
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The epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): an observational study. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:873-881. [PMID: 34756191 DOI: 10.1016/s2352-4642(21)00286-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality. METHODS We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates. FINDINGS Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25·0% (95% CI 21·6-28·8), with a mortality rate of 19·8% (15·4-25·2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1·21, 95% CI 1·14-1·29, p<0·0001), unknown vaccination status (2·57, 1·26-5·24; p=0·011), incomplete vaccination status (2·16, 1·19-3·92; p=0·012), health care-associated infection (2·12, 1·23-3·64, p=0·0073), and compliance with antibiotics (2·38, 1·46-3·86, p=0·0007). The estimated incidence of PICU-treated sepsis was 74·6 cases per 100 000 paediatric population (95% CI 61·5-90·5), which translates to 42 374 cases per year (34 940-51 443) in Brazil, with an estimated mortality of 8305 (6848-10 083). INTERPRETATION In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality. FUNDING Fundação de Amparo à Pesquisa do Estado de São Paulo and Conselho Nacional de Desenvolvimento Científico e Tecnológico. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Risk factors for severe COVID-19 infection in Brazilian children. Braz J Infect Dis 2021; 25:101650. [PMID: 34774486 PMCID: PMC8578000 DOI: 10.1016/j.bjid.2021.101650] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/29/2021] [Accepted: 10/17/2021] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to describe the epidemiological characteristics and clinical outcome of children hospitalized with COVID-19 and identify the risk factors for severe disease. All hospital admissions of pediatric patients between March and December 2020 in the southern region of Brazil were reviewed and the patients positive for RT-PCR for SARS-CoV-2 were identified. This region encompasses a population of over 2.8 million children and adolescents. Data were extracted from a national database that includes all cases of severe acute respiratory syndrome requiring hospitalization in Brazil. A total of 288 hospitalizations (51.3% female) with a median age of 3 years (interquartile range 0-12 years) were identified. Of these, 38.9% had chronic medical conditions, 55.6% required some form of supplementary oxygen, and 30.2% were admitted to an intensive care unit. There were 17 deaths (5.9%) related to COVID-19. Age less than 30 days was significantly associated with increased odds of critical illness (OR 9.52, 95% CI 3.01-30.08), as well as the presence of one chronic condition (OR 5.08 95%CI 2.78-9.33) or two or more chronic conditions (OR 6.60, 95% CI 3.17-13.74). Conclusion: Age under 30 days old and presence of chronic conditions were strongly associated with unfavorable outcomes in Brazilian children with SARS-CoV-2 infection. These findings could help local public health authorities to develop specific policies to protect this more vulnerable group of children.
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Two-Thumb Technique Is Superior to Two-Finger Technique in Cardiopulmonary Resuscitation of Simulated Out-of-Hospital Cardiac Arrest in Infants. J Am Heart Assoc 2021; 10:e018050. [PMID: 34612083 PMCID: PMC8751903 DOI: 10.1161/jaha.120.018050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background To compare the 2‐finger and 2‐thumb chest compression techniques on infant manikins in an out‐of‐hospital setting regarding efficiency of compressions, ventilation, and rescuer pain and fatigue. Methods and Results In a randomized crossover design, 78 medical students performed 2 minutes of cardiopulmonary resuscitation with mouth‐to‐nose ventilation at a 30:2 rate on a Resusci Baby QCPR infant manikin (Laerdal, Stavanger, Norway), using a barrier device and the 2‐finger and 2‐thumb compression techniques. Frequency and depth of chest compressions, proper hand position, complete chest recoil at each compression, hands‐off time, tidal volume, and number of ventilations were evaluated through manikin‐embedded SkillReporting software. After the interventions, standard Likert questionnaires and analog scales for pain and fatigue were applied. The variables were compared by a paired t‐test or Wilcoxon test as suitable. Seventy‐eight students participated in the study and performed 156 complete interventions. The 2‐thumb technique resulted in a greater depth of chest compressions (42 versus 39.7 mm; P<0.01), and a higher percentage of chest compressions with adequate depth (89.5% versus 77%; P<0.01). There were no differences in ventilatory parameters or hands‐off time between techniques. Pain and fatigue scores were higher for the 2‐finger technique (5.2 versus 1.8 and 3.8 versus 2.6, respectively; P<0.01). Conclusions In a simulation of out‐of‐hospital, single‐rescuer infant cardiopulmonary resuscitation, the 2‐thumb technique achieves better quality of chest compressions without interfering with ventilation and causes less rescuer pain and fatigue.
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Abstract
OBJECTIVE To evaluate the prognostic performance of the Pediatric Index of Mortality 2 (PIM2), ferritin, lactate, C-reactive protein (CRP), and leukocytes, alone and in combination, in pediatric patients with sepsis admitted to the pediatric intensive care unit (PICU). METHODS A retrospective study was conducted in a PICU in Brazil. All patients aged 6 months to 18 years admitted with a diagnosis of sepsis were eligible for inclusion. Those with ferritin and C-reactive protein measured within 48h and lactate and leukocytes within 24h of admission were included in the prognostic performance analysis. RESULTS Of 350 eligible patients with sepsis, 294 had undergone all measurements required for analysis and were included in the study. PIM2, ferritin, lactate, and CRP had good discriminatory power for mortality, with PIM2 and ferritin being superior to CRP. The cutoff values for PIM2 (> 14%), ferritin (> 135ng/mL), lactate (> 1.7mmol/L), and CRP (> 6.7mg/mL) were associated with mortality. The combination of ferritin, lactate, and CRP had a positive predictive value of 43% for mortality, similar to that of PIM2 alone (38.6%). The combined use of the three biomarkers plus PIM2 increased the positive predictive value to 76% and accuracy to 0.945. CONCLUSIONS PIM2, ferritin, lactate, and CRP alone showed good prognostic performance for mortality in pediatric patients older than 6 months with sepsis. When combined, they were able to predict death in three-fourths of the patients with sepsis. Total leukocyte count was not useful as a prognostic marker.
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Early fluid overload was associated with prolonged mechanical ventilation and more aggressive parameters in critically ill paediatric patients. Acta Paediatr 2020; 109:557-564. [PMID: 31532841 DOI: 10.1111/apa.15021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/17/2019] [Accepted: 09/16/2019] [Indexed: 12/13/2022]
Abstract
AIM We evaluated the influence of early fluid overload on critically ill children admitted to a paediatric intensive care unit by examining mechanical ventilation (MV), mortality, length of stay and renal replacement therapy. METHODS This retrospective cohort study covered January 2015 to December 2016 and focused on all episodes of MV support that exceeded 24 hours. The fluid overload percentage (FO%) was calculated daily for the first 72 hours and we estimated its effect on outcomes. RESULTS We included 186 MV episodes in 154 patients. The median age was 13.8 months, with an interquartile range (IQR) of 3.8-34.0 months, and the mortality rate was 12.4%. The median FO% in the first 72 hours was 8.0% (IQR 3.6%-11.2%). An FO% of ≥10% was associated with higher ventilatory parameters, namely peak inspiratory pressure (P = .023) and positive end expiratory pressure (P = .003), and renal replacement therapy (P = .02) and higher mortality (8.8% vs 19.7%). In a multivariate Cox regression model, FO ≥ 10% at 72 hours was independently associated with longer MV support, but not mortality (P = .001). CONCLUSION In a heterogeneous paediatric population given MV, an early cumulative FO of ≥10% was associated with more aggressive ventilatory parameters and prolonged length of MV, but not mortality.
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Septic shock in pediatrics: the state‐of‐the‐art. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
OBJECTIVE Review the main aspects of the definition, diagnosis, and management of pediatric patients with sepsis and septic shock. SOURCE OF DATA A search was carried out in the MEDLINE and Embase databases. The articles were chosen according to the authors' interest, prioritizing those published in the last five years. SYNTHESIS OF DATA Sepsis remains a major cause of mortality in pediatric patients. The variability of clinical presentations makes it difficult to attain a precise definition in pediatrics. Airway stabilization with adequate oxygenation and ventilation if necessary, initial volume resuscitation, antibiotic administration, and cardiovascular support are the basis of sepsis treatment. In resource-poor settings, attention should be paid to the risks of fluid overload when administrating fluids. Administration of vasoactive drugs such as epinephrine or norepinephrine is necessary in the absence of volume response within the first hour. Follow-up of shock treatment should adhere to targets such as restoring vital and clinical signs of shock and controlling the focus of infection. A multimodal evaluation with bedside ultrasound for management after the first hours is recommended. In refractory shock, attention should be given to situations such as cardiac tamponade, hypothyroidism, adrenal insufficiency, abdominal catastrophe, and focus of uncontrolled infection. CONCLUSIONS The implementation of protocols and advanced technologies have reduced sepsis mortality. In resource-poor settings, good practices such as early sepsis identification, antibiotic administration, and careful fluid infusion are the cornerstones of sepsis management.
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From the International Pediatric Sepsis Conference 2005 to the Sepsis-3 Consensus. Rev Bras Ter Intensiva 2019; 30:1-5. [PMID: 29742230 PMCID: PMC5885223 DOI: 10.5935/0103-507x.20180005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/14/2017] [Indexed: 01/11/2023] Open
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Accidental strangulation in children by the automatic closing of a car window. Rev Bras Ter Intensiva 2018; 30:112-115. [PMID: 29742212 PMCID: PMC5885238 DOI: 10.5935/0103-507x.20180017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 04/13/2017] [Indexed: 11/21/2022] Open
Abstract
Among the main causes of death in our country are car accidents, drowning and
accidental burns. Strangulation is a potentially fatal injury and an important
cause of homicide and suicide among adults and adolescents. In children, its
occurrence is usually accidental. However, in recent years, several cases of
accidental strangulation in children around the world have been reported. A
2-year-old male patient was strangled in a car window. The patient was admitted
to the pediatric intensive care unit with a Glasgow Coma Scale score of 8 and
presented with progressive worsening of respiratory dysfunction and torpor. The
patient also presented acute respiratory distress syndrome, acute pulmonary
edema and shock. He was managed with protective mechanical ventilation,
vasoactive drugs and antibiotic therapy. He was discharged from the intensive
care unit without neurological or pulmonary sequelae. After 12 days of
hospitalization, he was discharged from the hospital, and his state was very
good. The incidence of automobile window strangulation is rare but of high
morbidity and mortality due to the resulting choking mechanism. Fortunately,
newer cars have devices that stop the automatic closing of the windows if
resistance is encountered. However, considering the severity of complications
strangulated patients experience, the intensive neuro-ventilatory and
hemodynamic management of the pathologies involved is important to reduce
morbidity and mortality, as is the need to implement new campaigns for the
education of parents and caregivers of children, aiming to avoid easily
preventable accidents and to optimize safety mechanisms in cars with electric
windows.
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Translation and cross-cultural adaptation of the Pediatric Confusion Assessment Method for the Intensive Care Unit into Brazilian Portuguese for the detection of delirium in pediatric intensive care units. Rev Bras Ter Intensiva 2018; 30:71-79. [PMID: 29742225 PMCID: PMC5885234 DOI: 10.5935/0103-507x.20180013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/24/2017] [Indexed: 12/03/2022] Open
Abstract
Objective To undertake the translation and cross-cultural adaption into Brazilian
Portuguese of the Pediatric Confusion Assessment Method for the Intensive
Care Unit for the detection of delirium in pediatric
intensive care units, including the algorithm and instructions. Methods A universalist approach for the translation and cross-cultural adaptation of
health measurement instruments was used. A group of pediatric critical care
specialists assessed conceptual and item equivalences. Semantic equivalence
was evaluated by means of a translation from English to Portuguese by two
independent translators; reconciliation into a single version;
back-translation by a native English speaker; and consensus among six
experts with respect to language and content understanding by means of
Likert scale responses and the Content Validity Index. Finally, operational
equivalence was assessed by applying a pre-test to 30 patients. Results The back-translation was approved by the original authors. The medians of the
expert consensus responses varied between good and excellent, except for the
feature "acute onset" of the instructions. Items with a low Content Validity
Index for the features "acute onset" and "disorganized thinking" were
adapted. In the pre-test, the expression "signal with your head" was
modified into "nod your head" for better understanding. No further
adjustments were necessary, resulting in the final version for Brazilian
Portuguese. Conclusion The Brazilian version of the Pediatric Confusion Assessment Method for the
Intensive Care Unit was generated in agreement with the international
recommendations and can be used in Brazil for the diagnosis of
delirium in critically ill children 5 years of age or
above and with no developmental cognitive disabilities.
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Characteristics and outcome of burned children admitted to a pediatric intensive care unit. Rev Bras Ter Intensiva 2018; 30:333-337. [PMID: 30304085 PMCID: PMC6180472 DOI: 10.5935/0103-507x.20180045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/10/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To analyze the characteristics and outcomes of children hospitalized for
burns in a pediatric trauma intensive care unit for burn patients. Methods An observational study was conducted through the retrospective analysis of
children (< 16 years) admitted to the pediatric trauma intensive care
unit for burn victims between January 2013 and December 2015.
Sociodemographic and clinical variables were analyzed including the causal
agent, burned body surface, presence of inhalation injury, length of
hospital stay and mortality. Results The study analyzed a sum of 140 patients; 61.8% were male, with a median age
of 24 months and an overall mortality of 5%. The main cause of burns was
scalding (51.4%), followed by accidents involving fire (38.6%) and electric
shock (6.4%). Mechanical ventilation was used in 20.7% of the cases.
Associated inhalation injury presented a relative risk of 6.1 (3.5 - 10.7)
of needing ventilatory support and a relative risk of mortality of 14.1 (2.9
- 68.3) compared to patients without this associated injury. A significant
connection was found between burned body surface and mortality (p <
0.002), reaching 80% in patients with a burned area greater than 50%.
Patients who died had a significantly higher Tobiasen Abbreviated Burn
Severity Index than survivors (9.6 ± 2.2 versus 4.4
± 1.1; p < 0.001). A Tobiasen Abbreviated Burn Severity Index
≥ 7 represented a relative risk of death of 68.4 (95%CI 9.1 -
513.5). Conclusion Scalding burns are quite frequent and are associated with high morbidity.
Mortality is associated with the amount of burned body surface and the
presence of inhalation injury. Special emphasis should be given to accidents
involving fire, reinforcing proper diagnosis and treatment of inhalation
injury.
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Scores TISS-28 versus NEMS to size the nursing team in a pediatric intensive care unit. EINSTEIN-SAO PAULO 2017; 15:470-475. [PMID: 29267426 PMCID: PMC5875162 DOI: 10.1590/s1679-45082017ao4028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/13/2017] [Indexed: 12/03/2022] Open
Abstract
Objective To estimate the workload and size the nursing team using the scales TISS-28 and NEMS in a pediatric intensive care unit. Methods An observational prospective study with a quantitative approach was conducted at the pediatric intensive care unit of a university hospital from Jan 1st, 2009 to Dec 31st, 2009. All children who remained hospitalized for more than 8 hours were included, with length of stay of 4 hours in case of death. Clinical data were collected and the Paediatric Index of Mortality 2 and the scores TISS-28 and NEMS were determined. The TISS-28 and NEMS were converted into working hours of the nursing team and sizing complied with the parameters of the Brazilian Federal Nursing Council. Pearson's correlation and the Bland-Altman model were used to verify the association and agreement between the instruments. Results A total of 459 children were included, totaling 3,409 observations. The average values for the TISS-28 and NEMS were 20.8±8 and 25.2±8.7 points, respectively. The nursing workload was 11 hours by TISS-28 and 13.3 hours by NEMS. The estimated number of professionals by TISS-28 and NEMS was 29.6 and 35.8 professionals, respectively. The TISS-28 and NEMS showed adequate correlation and agreement. Conclusion Time spent in nursing activities and team sizing reflected by the NEMS were significantly greater when compared to the TISS-28.
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Influence of the weight on the lung properties in children submitted to mechanical ventilation. J Crit Care 2017. [DOI: 10.1016/j.jcrc.2017.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Intranasal ketamine for peripheral venous access in pediatric patients: A randomized double blind and placebo controlled study. J Crit Care 2017. [DOI: 10.1016/j.jcrc.2017.09.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Prevalence and outcomes of complex chronic conditions in a tertiary pediatric intensive care unit in over a decade. J Crit Care 2017. [DOI: 10.1016/j.jcrc.2017.09.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Effect of early fluid overload in children submitted to mechanical ventilation. J Crit Care 2017. [DOI: 10.1016/j.jcrc.2017.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fluid overload in children undergoing mechanical ventilation. Rev Bras Ter Intensiva 2017; 29:346-353. [PMID: 28977099 PMCID: PMC5632978 DOI: 10.5935/0103-507x.20170045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/03/2016] [Indexed: 12/14/2022] Open
Abstract
Patients admitted to an intensive care unit are prone to cumulated fluid overload and receive intravenous volumes through the aggressive resuscitation recommended for septic shock treatment, as well as other fluid sources related to medications and nutritional support. The liberal liquid supply strategy has been associated with higher morbidity and mortality. Although there are few prospective pediatric studies, new strategies are being proposed. This non-systematic review discusses the pathophysiology of fluid overload, its consequences, and the available therapeutic strategies. During systemic inflammatory response syndrome, the endothelial glycocalyx is damaged, favoring fluid extravasation and resulting in interstitial edema. Extravasation to the third space results in longer mechanical ventilation, a greater need for renal replacement therapy, and longer intensive care unit and hospital stays, among other changes. Proper hemodynamic monitoring, as well as cautious infusion of fluids, can minimize these damages. Once cumulative fluid overload is established, treatment with long-term use of loop diuretics may lead to resistance to these medications. Strategies that can reduce intensive care unit morbidity and mortality include the early use of vasopressors (norepinephrine) to improve cardiac output and renal perfusion, the use of a combination of diuretics and aminophylline to induce diuresis, and the use of sedation and early mobilization protocols.
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Undersedation is a risk factor for the development of subglottic stenosis in intubated children. J Pediatr (Rio J) 2017; 93:351-355. [PMID: 28130966 DOI: 10.1016/j.jped.2016.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/25/2016] [Accepted: 10/24/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis. METHODS All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for subglottic stenosis. RESULTS The study included 36 children. Incidence of subglottic stenosis was 11.1%. Children with subglottic stenosis had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated) than those who did not develop subglottic stenosis (15.8% vs. 3.65%, p=0.004). CONCLUSION Children who developed subglottic stenosis were less sedated than children who did not develop subglottic stenosis.
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Abstract
OBJECTIVE To describe main indications, doses, length of infusion and side effects related to dexmedetomidine infusion. METHODS Observational and retrospective study evaluating dexmedetomidine use in pediatric intensive care unit. RESULTS 77 children received dexmedetomidine infusion longer than 6 hours for mechanical ventilation weaning (32.5%), post- neurosurgery and post-upper airway surgery (24.7%), non-invasive ventilation (13%), refractory tachycardia (6.5%) and other causes (23.3%). After 6 hours of infusion, significant decrease in mean arterial pressure and heart rate was observed in all groups. Six children (8%) required withdrawal of drug because of possible side effects: hypotension, bradycardia and somnolence. CONCLUSION Dexmedetomidine may be used as sedative in critically ill children without much side effects.
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Cardiac dysfunction and ferritin as early markers of severity in pediatric sepsis. J Pediatr (Rio J) 2017; 93:301-307. [PMID: 28126563 DOI: 10.1016/j.jped.2016.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/03/2016] [Accepted: 08/09/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to verify the association of echocardiogram, ferritin, C-reactive protein, and leukocyte count with unfavorable outcomes in pediatric sepsis. METHODS A prospective cohort study was carried out from March to December 2014, with pediatric critical care patients aged between 28 days and 18 years. Inclusion criteria were diagnosis of sepsis, need for mechanical ventilation for more than 48h, and vasoactive drugs. Serum levels of C-reactive protein, ferritin, and leukocyte count were collected on the first day (D0), 24h (D1), and 72h (D3) after recruitment. Patients underwent transthoracic echocardiography to determine the ejection fraction of the left ventricle on D1 and D3. The outcomes measured were length of hospital stay and in the pediatric intensive care unit, mechanical ventilation duration, free hours of VM, duration of use of inotropic agents, maximum inotropic score, and mortality. RESULTS Twenty patients completed the study. Patients with elevated ferritin levels on D0 had also fewer ventilator-free hours (p=0.046) and higher maximum inotropic score (p=0.009). Patients with cardiac dysfunction by echocardiogram on D1 had longer hospital stay (p=0.047), pediatric intensive care unit stay (p=0.020), duration of mechanical ventilation (p=0.011), maximum inotropic score (p=0.001), and fewer ventilator-free hours (p=0.020). CONCLUSION Cardiac dysfunction by echocardiography and serum ferritin value was significantly associated with unfavorable outcomes in pediatric patients with sepsis.
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Meropenem-induced low valproate levels in a cerebral palsy child. Braz J Infect Dis 2017; 21:491. [PMID: 28343819 PMCID: PMC9427987 DOI: 10.1016/j.bjid.2017.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/20/2022] Open
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Characteristics and progression of children with acute viral bronchiolitis subjected to mechanical ventilation. Rev Bras Ter Intensiva 2017; 28:55-61. [PMID: 27096677 PMCID: PMC4828092 DOI: 10.5935/0103-507x.20160003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/05/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To analyze the characteristics of children with acute viral bronchiolitis subjected to mechanical ventilation for three consecutive years and to correlate their progression with mechanical ventilation parameters and fluid balance. METHODS Longitudinal study of a series of infants (< one year old) subjected to mechanical ventilation for acute viral bronchitis from January 2012 to September 2014 in the pediatric intensive care unit. The children's clinical records were reviewed, and their anthropometric data, mechanical ventilation parameters, fluid balance, clinical progression, and major complications were recorded. RESULTS Sixty-six infants (3.0 ± 2.0 months old and with an average weight of 4.7 ± 1.4kg) were included, of whom 62% were boys; a virus was identified in 86%. The average duration of mechanical ventilation was 6.5 ± 2.9 days, and the average length of stay in the pediatric intensive care unit was 9.1 ± 3.5 days; the mortality rate was 1.5% (1/66). The peak inspiratory pressure remained at 30cmH2O during the first four days of mechanical ventilation and then decreased before extubation (25 cmH2O; p < 0.05). Pneumothorax occurred in 10% of the sample and extubation failure in 9%, which was due to upper airway obstruction in half of the cases. The cumulative fluid balance on mechanical ventilation day four was 402 ± 254mL, which corresponds to an increase of 9.0 ± 5.9% in body weight. Thirty-seven patients (56%) exhibited a weight gain of 10% or more, which was not significantly associated with the ventilation parameters on mechanical ventilation day four, extubation failure, duration of mechanical ventilation or length of stay in the pediatric intensive care unit. CONCLUSION The rate of mechanical ventilation for acute viral bronchiolitis remains constant, being associated with low mortality, few adverse effects, and positive cumulative fluid balance during the first days. Better fluid control might reduce the duration of mechanical ventilation.
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Neurally adjusted ventilatory assist in pediatrics: why, when, and how? Rev Bras Ter Intensiva 2017; 29:408-413. [PMID: 29211188 PMCID: PMC5764551 DOI: 10.5935/0103-507x.20170064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/20/2017] [Indexed: 11/20/2022] Open
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[Use of scores to calculate the nursing workload in a pediatric intensive care unit]. Rev Bras Ter Intensiva 2015; 26:36-43. [PMID: 24770687 PMCID: PMC4031889 DOI: 10.5935/0103-507x.20140006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 01/14/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess the performance of the Nursing Activities Score in a pediatric intensive care unit, compare its scores expressed as time spent on nursing activities to the corresponding ones calculated using the Simplified Therapeutic Intervention Scoring System, and correlate the results obtained by both instruments with severity, morbidity and mortality. METHODS Prospective, observational, and analytical cohort study conducted at a type III general pediatric intensive care unit. The study participants were all the children aged 29 days to 12 years admitted to the investigated pediatric intensive care unit from August 2008 to February 2009. RESULTS A total of 545 patients were studied, which corresponded to 2,951 assessments. The average score of the Simplified Therapeutic Intervention Scoring System was 28.79±10.37 (915±330 minutes), and that of the Nursing Activities Score was 55.6±11.82 (802±161 minutes). The number of minutes that resulted from the conversion of the Simplified Therapeutic Intervention Scoring System score was higher compared to that resulting from the Nursing Activities Score for all the assessments (p<0.001). The correlation between the instruments was significant, direct, positive, and moderate (R=0.564). CONCLUSIONS The agreement between the investigated instruments was satisfactory, and both instruments also exhibited satisfactory discrimination of mortality; for that purpose, the best cutoff point was 16 nursing hours/patient day.
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Supplemented vs. unsupplemented human milk on bone mineralization in very low birth weight preterm infants: a randomized clinical trial. Osteoporos Int 2015; 26:2265-71. [PMID: 25971686 DOI: 10.1007/s00198-015-3144-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 04/20/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED Very low birth weight preterm newborns weighing less than 1500 g were randomized to receive human milk supplemented with FM 85® or not. They have similar bone mineral content (BMC) at baseline, but, at the end of study, BMC was increasingly higher in the FM 85® group. INTRODUCTION The purpose of this study is to evaluate the effectiveness of a human milk supplement (FM 85®; Nestlé, Vevey, Switzerland) developed for the purpose of improving nutrition, including bone mineralization, in very low birth weight preterm newborns. METHODS Preterm infants weighing less than 1500 g at birth admitted to the neonatal intensive care unit of a university hospital were studied. During hospitalization, they were fed at least 50 % of human milk. Newborns with ≥20 days of age were randomly assigned to the intervention group (n = 19) to receive human milk supplemented with FM 85® or to a control group (n = 19) to receive human milk only. Anthropometric measurements, whole-body bone densitometry (DXA), and biochemical tests were performed at study entry and at the end of the study (shortly before discharge when the infant had reached 2000 g). RESULTS There were no start- or end-of-study differences between the two groups, except for daily increase in length (p = 0.010). At baseline, both groups had similar BMC: 5.49 ± 3.65 vs. 4.34 ± 2.98 g (p = 0.39) for the intervention and control group, respectively. However, at the end of the study, BMC was higher in the intervention group: 10.3 ± 4.71 vs. 6.19 ± 3.23 g (p = 0.003). The mean increase in BMC during the observation period was 4.90 ± 4.46 g for the intervention group and 1.86 ± 3.17 g for the control group (p = 0.020). Serum alkaline phosphatase levels were higher in the control group (720 ± 465 vs. 391 ± 177 IU/L; p = 0.007). CONCLUSIONS Our data suggest that supplementation of human milk with FM 85® leads to improved bone mineralization in very low birth weight preterm newborns.
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Comparison of two maintenance electrolyte solutions in children in the postoperative appendectomy period: a randomized, controlled trial. J Pediatr (Rio J) 2015; 91:428-34. [PMID: 25913046 DOI: 10.1016/j.jped.2015.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/18/2014] [Accepted: 11/11/2014] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To compare two electrolyte maintenance solutions in the postoperative period in children undergoing appendectomy, in relation to the occurrence of hyponatremia and water retention. METHODS A randomized clinical study involving 50 pediatric patients undergoing appendectomy, who were randomized to receive 2,000mL/m(2)/day of isotonic (Na 150 mEq/L or 0.9% NaCl) or hypotonic (Na 30 mEq/L NaCl or 0.18%) solution. Electrolytes, glucose, urea, and creatinine were measured at baseline, 24h, and 48h after surgery. Volume infused, diuresis, weight, and water balance were analyzed. RESULTS Twenty-four patients had initial hyponatremia; in this group, 13 received hypotonic solution. Seventeen patients remained hyponatremic 48h after surgery, of whom ten had received hypotonic solution. In both groups, sodium levels increased at 24h (137.4±2.2 and 137.0±2.7mmol/L), with no significant difference between them (p=0.593). Sodium levels 48h after surgery were 136.6±2.7 and 136.2±2.3mmol/L in isotonic and hypotonic groups, respectively, with no significant difference. The infused volume and urine output did not differ between groups during the study. The water balance was higher in the period before surgery in patients who received hypotonic solution (p=0.021). CONCLUSIONS In the post-appendectomy period, the use of hypotonic solution (30 mEq/L, 0.18%) did not increase the risk of hyponatremia when compared to isotonic saline. The use of isotonic solution (150 mEq/L, 0.9%) did not favor hypernatremia in these patients. Children who received hypotonic solution showed higher cumulative fluid balance in the preoperative period.
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Progress and perspectives in pediatric acute respiratory distress syndrome. Rev Bras Ter Intensiva 2015; 27:266-73. [PMID: 26331971 PMCID: PMC4592122 DOI: 10.5935/0103-507x.20150035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/30/2015] [Indexed: 11/24/2022] Open
Abstract
Acute respiratory distress syndrome is a disease of acute onset characterized by
hypoxemia and infiltrates on chest radiographs that affects both adults and children
of all ages. It is an important cause of respiratory failure in pediatric intensive
care units and is associated with significant morbidity and mortality. Nevertheless,
until recently, the definitions and diagnostic criteria for acute respiratory
distress syndrome have focused on the adult population. In this article, we review
the evolution of the definition of acute respiratory distress syndrome over nearly
five decades, with a special focus on the new pediatric definition. We also discuss
recommendations for the implementation of mechanical ventilation strategies in the
treatment of acute respiratory distress syndrome in children and the use of adjuvant
therapies.
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Intramuscular midazolam versus intravenous diazepam for treatment of seizures in the pediatric emergency department: a randomized clinical trial. Med Intensiva 2014; 39:160-6. [PMID: 24928286 DOI: 10.1016/j.medin.2014.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 03/31/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
Abstract
AIM To compare the therapeutic efficacy of intramuscular midazolam (MDZ-IM) with that of intravenous diazepam (DZP-IV) for seizures in children. DESIGN Randomized clinical trial. SETTING Pediatric emergency department. PATIENTS Children aged 2 months to 14 years admitted to the study facility with seizures. INTERVENTION Patients were randomized to receive DZP-IV or MDZ-IM. MAIN MEASUREMENTS Groups were compared with respect to time to treatment start (min), time from drug administration to seizure cessation (min), time to seizure cessation (min), and rate of treatment failure. Treatment was considered successful when seizure cessation was achieved within 5min of drug administration. RESULTS Overall, 32 children (16 per group) completed the study. Intravenous access could not be obtained within 5min in four patients (25%) in the DZP-IV group. Time from admission to active treatment and time to seizure cessation was shorter in the MDZ-IM group (2.8 versus 7.4min; p<0.001 and 7.3 versus 10.6min; p=0.006, respectively). In two children per group (12.5%), seizures continued after 10min of treatment, and additional medications were required. There were no between-group differences in physiological parameters or adverse events (p=0.171); one child (6.3%) developed hypotension in the MDZ-IM group and five (31%) developed hyperactivity or vomiting in the DZP-IV group. CONCLUSION Given its efficacy and ease and speed of administration, intramuscular midazolam is an excellent option for treatment of childhood seizures, enabling earlier treatment and shortening overall seizure duration. There were no differences in complications when applying MDZ-IM or DZP-IV.
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High-frequency oscillatory ventilation in children with acute respiratory distress syndrome: experience of a pediatric intensive care unit. Rev Assoc Med Bras (1992) 2013; 59:368-74. [PMID: 23849709 DOI: 10.1016/j.ramb.2013.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/29/2013] [Accepted: 02/11/2013] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe the effects of high-frequency oscillatory ventilation (HFOV) as a rescue ventilatory support in pediatric patients with acute respiratory distress syndrome (ARDS). METHODS Twenty-five children (1 month < age < 17 years) admitted to a university hospital pediatric intensive care unit (ICU) with ARDS and submitted to HFOV for a minimum of 48 hours after failure of conventional mechanical ventilation were assessed. RESULTS Twenty eight days after the onset of ARDS, the mortality rate was 52% (13/25). Over the course of 48 hours, the use of HFOV reduced the oxygenation index [38 (31-50) vs. 17 (10-27)] and increased the ratio of partial arterial pressure O2 and fraction of inspired O2 [65 [44-80) vs. 152 (106-213)]. Arterial CO2 partial pressure [54 (45-74) vs. 48 (39-58) mmHg] remained unchanged. The mean airway pressure ranged between 23 and 29 cmH2O. HFOV did not compromise hemodynamics, and a reduction in heart rate was observed (141±32 vs. 119±22 beats/min), whereas mean arterial pressure (66±20 vs. 71±17 mmHg) and inotropic score [44 (17-130) vs. 20 (16-75)] remained stable during this period. No survivors were dependent on oxygen. CONCLUSION HFOV improves oxygenation in pediatric patients with ARDS and severe hypoxemia refractory to conventional ventilatory support.
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Validação Concorrente de Escores de Enfermagem (NEMS e TISS-28) em terapia intensiva pediátrica. ACTA PAUL ENFERM 2013. [DOI: 10.1590/s0103-21002013000200004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Examinar a validade concorrente do escore Nine Equivalents of Nursing Manpower Use Score (NEMS) em comparação ao Therapeutic Intervention Scoring System-28 (TISS-28) em uma Unidade de Terapia Intensiva Pediátrica (UTIP). MÉTODOS: Estudo de coorte prospectivo observacional, realizado na UTIP de um hospital universitário brasileiro, no período de dois anos, com uma amostra de 816 pacientes. Foram realizadas 7.702 observações de cada um dos escores. RESULTADOS: A média da pontuação máxima do NEMS foi 26,6±9,2 e do TISS-28 21,3±8,2. Em todas as médias, o TISS-28 foi inferior ao NEMS (p<0,001). Houve uma boa correlação entre eles (r²=0,704 para todas as observações). A concordância entre o TISS-28 e o NEMS foi boa, apresentando apenas 6,2% de diferença entre os escores. CONCLUSÃO: Os resultados mostraram boa correlação e concordância entre o TISS-28 e o NEMS, permitindo validar o NEMS nessa população de pacientes pediátricos.
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End-of-life care in Brazilian ICUs is not just a legal issue: adequate training and knowledge are essential to improve care. Rev Bras Ter Intensiva 2011; 23:388-390. [PMID: 23949451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Cuidados de final de vida nas UTIs brasileiras, certamente não é apenas uma questão legal: treinamento e conhecimento adequados são essenciais para melhorar estes cuidados. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000400002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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[Nine Equivalents of Nursing Manpower Use Score (NEMS): a study of its historical process]. ACTA ACUST UNITED AC 2011; 31:584-90. [PMID: 21574347 DOI: 10.1590/s1983-14472010000300025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aims to describe, through an integrative review of literature, the historical trajectory of therapeutic intervention scores with emphasis on Nine Equivalents of Nursing Manpower Use Score in Intensive Care Units. The descriptors "Intensive care units" and "scales" were looked up in publications issued between 2000 and 2009. The terms selected were: "Nine Equivalents of Nursing Manpower Use Score" or "NEMS", "Unidade de Terapia Intensiva", "Therapeutic Intervention Scoring System-76", "Therapeutic Intervention Scoring System-28 or "TISS-28". As to the publications, "Medical Literature Analysis and Retrieval System Online" (MEDLINE) and "Literatura Latino-Americana e do Caribe em Ciências da Saúde" (LILACS) were selected Among the 295 papers reviewed, 18 were chosen, of which 55,5% were in English. The studies deal with NEMS (33,3%), Therapeutic Intervention Scoring System-76 (11,1%), TISS-28 (33,3%), among others. Research emphasized that NEMS has been a useful, operational and succinct tool.
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Falta de acurácia dos índices ventilatórios para predizer sucesso de extubação em crianças submetidas a ventilação mecânica. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000200013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Nurses’ participation in the end-of-life — process in two paediatric intensive care units in Brazil. Int J Palliat Nurs 2011; 17:264, 267-70. [DOI: 10.12968/ijpn.2011.17.6.264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lack of accuracy of ventilatory indexes in predicting extubation success in children submitted to mechanical ventilation. Rev Bras Ter Intensiva 2011; 23:199-206. [PMID: 25299721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/23/2011] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES Between 10% and 20% of children submitted to mechanical ventilation in the pediatric intensive care unit present extubation failure. Several ventilatory indexes have been proposed to predict extubation failure. The aim of this study was to analyze the accuracy of these indices in predicting successful extubation in children and to evaluate these variables according to the age of the patient and the specific disease. METHODS A prospective observational study including all children submitted to mechanical ventilation in a Brazilian referral pediatric intensive care unit was conducted between August 2007 and August 2008. The tidal volume, maximal negative inspiratory pressure, rapid shallow breathing index and other ventilatory indexes were measured before extubation. These variables were analyzed according to the extubation outcome (success or failure) as well as age and specific disease (post cardiac surgery and acute viral bronchiolitis). RESULTS A total of 100 patients were included (median age of 2.1 years old). Extubation failure was observed in 13% and was associated with lower weight (10.3+8.1 Kg vs. 5.5+2.4 Kg; p=0.01). We also evaluated the relationship between extubation failure and the main cause indicating mechanical ventilation: children who had received cardiac surgery (n=17) presented an extubation failure rate of 29.4% with a relative risk of 4.6 (1.2-17.2) when compared to children with acute viral bronchiolitis (n=47, extubation failure rate of 6.4%). The maximal inspiratory pressure was the only physiologic variable independently associated with the outcome. However, this variable showed a wide dispersion and lack of accuracy for predicting extubation success (sensitivity of 82% and specificity of 55% for a cut point of -37.5 cmH2O predicting successful extubation). The same wide dispersion was observed with other ventilatory indexes. CONCLUSION The indexes for predicting extubation success in children submitted to mechanical ventilation are not accurate; they vary widely depending on age, main disease and other clinical aspects. New formulas including clinical variables should be developed for better prediction of extubation success in children submitted to mechanical ventilation.
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Dilemas e dificuldades envolvendo decisões de final de vida e oferta de cuidados paliativos em pediatria. Rev Bras Ter Intensiva 2011. [DOI: 10.1590/s0103-507x2011000100013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Dilemmas and difficulties involving end-of-life decisions and palliative care in children. Rev Bras Ter Intensiva 2011; 23:78-86. [PMID: 25299558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 01/18/2011] [Indexed: 06/04/2023] Open
Abstract
This review discusses the main dilemmas and difficulties related to end-of-life decision's in children with terminal and irreversible diseases and propose a rational sequence for delivering palliative care to this patients' group. The Medline and Lilacs databases were searched using the terms 'end of life', 'palliative care', 'death' and 'terminal disease' for articles published in recent years. The most relevant articles and those enrolling pediatric patients were selected and compared to previous authors' studies in this field. The current Brazilian Medical Ethics Code (2010) was analyzed regarding end-oflife practices and palliative care for terminal patients. Lack of knowledge, insufficient specific training, and legal concerns are the main reasons why end-of-life decisions in terminal children are based on medical opinion with scarce family participation. The current Brazilian Medical Ethics Code (2010) fully supports end-of-life decisions made consensually with active family participation. Honest dialogue with the family regarding diagnostic, prognostic, therapeutic and palliative care measures should be established gradually to identify the best strategy to meet the child's end-of-life needs. Treatment focused on the child's welfare combined with the family's participation is the basis for successful palliative care of children with terminal diseases.
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Lamellar body count and stable microbubble test on gastric aspirates from preterm infants for the diagnosis of respiratory distress syndrome. Neonatology 2010; 98:150-5. [PMID: 20234139 DOI: 10.1159/000279887] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 10/12/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lamellar body count (LBC) in amniotic fluid is being used to identify infants at risk of respiratory distress syndrome (RDS) who would benefit from surfactant prophylaxis or very early therapy. The test in gastric aspirates of newborns has not been properly explored. OBJECTIVE The main objective of this research was to evaluate the performance of LBC alone or in combination with the stable microbubble test (SMT), done on gastric aspirates from preterm babies to predict RDS. METHODS A total of 34 preterm infants with RDS and 29 without RDS, with a gestational age between 24 and 34 weeks, were included in the study. Gastric fluid was collected in the delivery room. A diluent (dithiothreitol) allowed all samples to be processed, even the thickest and non-homogeneous ones, without centrifugation. The SMT was done for comparison. RESULTS The best cut-off value was <42,000 lamellar bodies/microl to predict RDS, with a sensitivity of 92% (95% CI 73-100%) and specificity of 86% (95% CI 77-95%). The area under the receiver-operating characteristic curve was 0.928 (95% CI 0.86-0.99). SMT showed similar results. LBC and SMT together in series (positive result if both tests were positive) showed a sensitivity of 100% and a specificity of 86%. CONCLUSION LBC on gastric aspirates diluted in a solution of dithiothreitol can be rapidly and easily performed, and may be used alone or in combination with SMT as a predictor of RDS, allowing selective prophylaxis or very early treatment only in surfactant-deficient newborns.
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1st Forum of the Southern Cone End-of-Life Study Group: proposal for care of patients, bearers of terminal disease staying in the ICU. Rev Bras Ter Intensiva 2009; 21:306-309. [PMID: 25303553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 06/23/2009] [Indexed: 06/04/2023] Open
Abstract
Withholding of treatment in patients with terminal disease is increasingly common in intensive care units, throughout the world. Notwithstanding, Brazilian intensivists still have a great difficulty to offer the best treatment to patients that have not benefited from curative care. The objective of this comment is to suggest an algorithm for the care of terminally ill patients. It was formulated based upon literature and the experience of experts, by members of the ethics committee and end-of-life of AMIB - Brazilian Association of Intensive Care.
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1º Forum do Grupo de Estudos do Fim da Vida do Cone Sul: proposta para atendimento do paciente portador de doença terminal internado em UTI. Rev Bras Ter Intensiva 2009. [DOI: 10.1590/s0103-507x2009000300011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Neuropsychomotor development before and after open-heart surgery in infants. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:457-62. [DOI: 10.1590/s0004-282x2009000300016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 03/26/2009] [Indexed: 05/25/2023]
Abstract
There are few Brazilian studies on neuropsychomotor follow-up after open-heart surgery with circulatory bypass in infants. Twenthy infants had neurodevelopmental outcomes (neurological exam and Denver II test) assessed before open-heart surgery, after intensive care unit discharge and 3-6 months after hospital discharge. Heart lesions consisted of septal defects in 11 cases (55%). The mean circulatory bypass time was 67 ± 23.6 minutes. Fifteen infants had altered neurological examination and also neurodevelopment delay before surgery. After 6 months it was observed normalization in 6 infants. When Denver II test indexes were analysed, it was observed an improvement in all domains except personal-social. Although those infants were in risk of new neurological findings, an early improvement on neuropsychomotor indexes were seen.
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Outcome and characteristics of infants with acute viral bronchiolitis submitted to mechanical ventilation in a Brazilian pediatric intensive care. Rev Bras Ter Intensiva 2009; 21:174-182. [PMID: 25303348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 05/29/2009] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE To describe the characteristics and the outcome of infants with acute viral bronchiolitis submitted to mechanical ventilation. METHODS We performed a retrospective study enrolling all infants (less than 12 months old) admitted with the diagnosis of acute viral bronchiolitis and submitted to mechanical ventilation in an university affiliated Brazilian pediatric intensive care unit between March, 2004 and September, 2006 (3 consecutives winters). The mechanical ventilation parameters' employed on 1st, 2nd, 3rd, 7th day and before extubation were evaluated as well as the evolution (mortality rate, presence of acute respiratory distress syndrome and the prevalence of complications). The groups were compared using the Student t test, the Mann-Whitney U test and the Chi-square test. RESULTS Fifty-nine infants were included (3.8 ± 2.7 months old, 59% male), with 9.0 ± 9.4 days on mechanical ventilation. Prior mechanical ventilation, non invasive ventilation was instituted in 71% of children. Anemia was observed in 78% of the sample. In 51 infants (86.5%) the lower airway obstructive pattern was maintained up to tracheal extubation with a nil mortality and low prevalence of pneumothorax (7.8%). Acute respiratory distress syndrome occurred in 8 infants (13.5%), with higher mortality and a higher prevalence of pneumothorax (62.5%). CONCLUSIONS The declining mortality in acute viral bronchiolitis is observed even in non developed regions, involving children with high rates of anemia and premature labor. The low mortality is associated with the maintenance of the lower airway obstructive pattern during the period on mechanical ventilation. The development of acute respiratory distress syndrome is associated with increased mortality and higher prevalence of complications, representing the actual challenge in the management of children with severe acute viral bronchiolitis.
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Evolução e característica de lactantes com bronquiolite viral aguda submetidos à ventilação mecânica em uma unidade de terapia intensiva pediátrica brasileira. Rev Bras Ter Intensiva 2009. [DOI: 10.1590/s0103-507x2009000200010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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End of life and palliative care in intensive care unit. Rev Bras Ter Intensiva 2008; 20:422-428. [PMID: 25307249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 12/12/2008] [Indexed: 06/04/2023] Open
Abstract
The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on palliative care is desirable.
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Dexmedetomidine in anesthesia of children submitted to videolaparoscopic appendectomy: a double-blind, randomized and placebo-controlled study. Rev Assoc Med Bras (1992) 2008; 54:308-13. [DOI: 10.1590/s0104-42302008000400015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 04/01/2008] [Indexed: 11/22/2022] Open
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