Fisiología respiratoria: fisiopatología de las enfermedades obstructivas / Pathophysiology of obstructive diseases

Las enfermedades obstructivas de la vía aérea pediátrica son muy frecuentes debido a los fenómenos mecánicos que están involucrados. En los niños más pequeños, la marcada resistencia de las vías aéreas pequeñas, determinada por la falta de tejido elástico y una caja torácica aún no bien desarrollada; tanto su estructura como la musculatura, facilitarán que cuadros infecciosos, mecánicos (cuerpo extraño) y compresivos, determinen que los flujos de aire se vean limitados y con ello la ventilación alveolar. La respuesta fisiológica con aumento del trabajo respiratorio es limitada y por lo tanto la fatiga muscular determinará hipoventilación con las consecuencias de hipoxemia e hipercapnia.

Obstructive diseases of the pediatric airway are very frequent due to the mechanical phenomena that are involved. The marked resistance of the small airways, such as the lack of elastic tissue and a thoracic cage that is not yet well developed, both in its structure and in the musculature, will make it easier for infectious, mechanical (foreign body), compressive and other conditions to determine that the flows of air are limited and with it the alveolar ventilation. The physiological response with increased work of breathing is limited and therefore muscle fatigue will determine hypoventilation, with the consequences of hypoxemia and hypercapnia.

Prise en charge médicale du premier épisode de bronchiolite aiguë des nourrissons de moins de 12 mois hospitalisés au CHU de Cocody de 2020 à 2022 / Medical management of first episode of acute bronchiolitis in children less than 12 months old hospitalized at Cocody University Hospital from 2020 to 2022

Introduction. La bronchiolite aiguë du nourrisson est une infection virale des voies aériennes inférieures qui représente un problème majeur de santé publique. L'objectif de cette étude était de décrire la prise en charge médicale du premier épisode de bronchiolite aiguë au CHU de Cocody. Méthodes. Il s'agissait d'une étude rétrospective à visée descriptive qui a consisté à décrire la prise en charge médicale des nourrissons hospitalisés dans le CHU de Cocody du 1er Janvier 2020 au 31 Décembre 2022. Résultats : Sur la période d'étude, 125 nourrissons sont hospitalisés pour bronchiolite aiguë. La tranche d'âge de 4 à 6 mois était majoritaire (49,6%). L'âge moyen des patients est de 4,7 mois avec des extrêmes de 1 à 12 mois (écart-type=1,277 mois). Le sex-ratio était de 1,27. La numération formule anguine (NFS), la C Reactive Protein (CRP) et la radiographie thoracique standard ont été réalisées chez tous les patients. La désobstruction rhino-pharyngée (DRP) a été pratiquée dans 96,0% des cas. Une nébulisation avec du salbutamol a été appliquée à tous les patients. Cette nébulisation a été associée à une antibiothérapie (71,2 %), une corticothérapie (52 %) et à une kinésithérapie respiratoire (48 %). L'évolution a été favorable dans 96 % des cas, malgré une sous-utilisation de la ventilation non-invasive dans notre dans notre contexte. Conclusion : L'analyse de la prise en charge de la bronchiolite aiguë du nourrisson au CHU de Cocody, a revélé des écarts par rapport aux recommandations de la HAS française. Il serait judicieux d'établir un consensus national adapté à notre contexte de travail.

Acute bronchiolitis in infants is a viral infection of the lower airways that represents a major public health problem. The main objective was to describe the management of this condition in the Ivorian pediatric hospital context. Methods. This was a descriptive cross-sectional study, with retrospective data collection. We have described the care of infants aged 1 month to 12 months, hospitalized for bronchiolitis in the Pediatrics department of the CHU of Cocody from January 01, 2020 to December 31, 2022. Results. We collected 125 files. The age group of 4 to 6 months was the majority (49.6%). The average age of the patients was 4.7 months (ecart-type=1,277 months) with extremes of 1 to 12 months. The sex ratio was 1.27. NFS, CRP and AP chest X-ray were performed in all patients. Nasopharyngeal clearance was performed in 96.0% of cases. The infants were all nebulized with salbutamol. Among them, 52% received a corticosteroid, 71.2% antibiotic therapy and in 48% of cases respiratory physiotherapy was performed. The evolution was favorable in 96% of cases. Conclusion : The analysis of the management of acute bronchiolitis in infants at the Cocody University Hospital reveals deviations from the recommendations of the French HAS. It would be wise to establish a national consensus adapted to our work context.

Administración de Oxigenoterapia de Alto Flujo en pacientes pediátricos del Hospital de Niños Santísima Trinidad / Administration of High Flow Oxygen Therapy in pediatric patients of the Santísima Trinidad Children's Hospital

La manera de proveer oxígeno ha sido una idea en permanente evolución que ha gatillado en los médicos la inquietud de implementar distintos dispositivos de soporte, desde la cánula nasal, la máscara de reinhalación y bajo flujo, hasta la presión continua en la vía aérea (CPAP) y la ventilación no invasiva (VNI). Recientemente se ha insertado entre ambos extremos mencionados un nuevo dispositivo que provee oxígeno a alto flujo. El objetivo del presente trabajo fue describir aspectos clínicos y técnicos en la administración de Oxigenoterapia de Alto Flujo (OAF) en pacientes pediátricos del Hospital de Niños de la Santísima Trinidad, en el servicio de UEPE (Unidad estabilización pediátrica en emergencia) 2017 y SIP (sala de internación pediátrica) 500 2018, 2019, en el periodo estival. Se realizó un Estudio descriptivo transversal, retrospectivo. El universo fueron los pacientes pediátricos que recibieron OAF en el Hospital de Niños Santísima Trinidad, en el servicio de UEPE del 2017 y SIP 500 2018, 2019 en el periodo estival. Se utilizó como instrumento la tabla de volcado de datos. Los principales resultados demuestran que se asistieron un total de 697 pacientes. La edad prevalente fue de menores de 6 meses, con un promedio del 60%. Los niños que requerían este tratamiento, en su gran mayoría ingresaban por diagnóstico de bronquiolitis, seguido de BOR (bronquitis obstructiva recurrente).En relación al escore de tal modifcado al ingreso, podemos observar que en el sector de UEPE la media es de 8, mientras que la SIP 500 es de 7. En referente al recurso material, existen varios sistemas de OAF. No hay estudios que demuestren la superioridad de un sistema sobre otro.Por último, se observó que el haber implementado esta técnica en la institución, se logró evitar en gran numero la escalada ventilatoria máxima requerida, ya que en el servicio de UEPE la evolución fue 65% la OAF, mientras que en la SIP 500 en el 2018 fue 72%y en el 2019 fue 79%. Por lo que podemos establecer que la OAF logra una mejoría clínica a través de su impacto en el síndrome funcional respiratorio, así como en el score de Tal modifcado en los niños y permite un tratamiento de estos pacientes en salas de internado general, con mínimos efectos adversos, disminuyendo el ingreso a cuidados intensivos[AU]

Te way to provide oxygen has been an idea in constant evolution that has triggered in doctors the concern to implement different support devices, from the nasal cannula, the rebreathing mask and low flow, to continuous pressure in the airway (CPAP). ) and noninvasive ventilation (NIV). Recently, a new device that provides high-flow oxygen has been inserted between both extremes. Te objective of the present work was to describe clinical and technical aspects in the administration of High Flow Oxygen Terapy (OAF) in pediatric patients of the Santísima Trinidad Children's Hospital, in the UEPE service (Emergency Pediatric Stabilization Unit) 2017 and SIP ( pediatric hospitalization room) 500 2018, 2019, in the summer period. A retrospective cross-sectional descriptive study was carried out. Te universe was the pediatric patients who received HFO at the Santísima Trinidad Children's Hospital, in the UEPE service in 2017 and SIP 500 2018, 2019 in the summer period. Te data dump table was used as an instrument. Te main results show that a total of 697 patients were attended. Te prevalent age was under 6 months, with an average of 60%. Te vast majority of children who required this treatment were admitted due to a diagnosis of bronchiolitis, followed by BOR (recurrent obstructive bronchitis). In relation to the score of such modifed on admission, we can observe that in the UEPE sector the mean is 8, while the SIP 500 is 7. Regarding the material resource, there are several OAF systems. Tere are no studies that demonstrate the superiority of one system over another. Finally, it was observed that having implemented this technique in the institution, the maximum required ventilatory escalation was avoided in large numbers, since in the UEPE service the evolution was 65% of the OAF, while in the SIP 500 in 2018 it was 72% and in 2019 it was 79%. Terefore, we can establish that HFO achieves clinical improvement through its impact on functional respiratory syndrome, as well as on the modifed Tal score in children, and allows treatment of these patients in general hospital wards, with minimal effects. adverse effects, reducing admission to intensive care[AU]

A forma de fornecer oxigênio tem sido uma ideia em constante evolução que desencadeou nos médicos a preocupação em implementar diferentes dispositivos de suporte, desde a cânula nasal, a máscara de reinalação e baixo fluxo, até a pressão contínua nas vias aéreas (CPAP). ) -ventilação invasiva (VNI). Recentemente, um novo dispositivo que fornece oxigênio de alto fluxo foi inserido entre os dois extremos. O objetivo do presente trabalho foi descrever aspectos clínicos e técnicos na administração de Oxigenoterapia de Alto Fluxo (OAF) em pacientes pediátricos do Hospital Infantil Santísima Trinidad, no serviço UEPE (Unidade de Emergência Pediátrica de Estabilização) 2017 e SIP (internação pediátrica quarto) 500 2018, 2019, no período de verão. Foi realizado um estudo descritivo transversal retrospectivo. O universo foram os pacientes pediátricos que receberam HFO no Hospital Infantil Santísima Trinidad, no serviço da UEPE em 2017 e SIP 500 2018, 2019 no período de verão. A tabela de despejo de dados foi utilizada como instrumento. Os principais resultados mostram que foram atendidos um total de 697 pacientes, sendo a idade prevalente inferior a 6 meses, com média de 60%. A grande maioria das crianças que necessitaram desse tratamento foi internada por diagnóstico de bronquiolite, seguido de BOR (bronquite obstrutiva recorrente). Em relação ao escore desta modifcada na admissão, observa-se que no setor da UEPE a média é 8 , enquanto o SIP 500 é 7. Em relação ao recurso material, existem vários sistemas OAF. Não há estudos que demonstrem a superioridade de um sistema sobre o outro. Por fm, observou-se que com a implantação dessa técnica na instituição, evitou-se em grande número o escalonamento ventilatório máximo necessário, pois no serviço da UEPE a evolução foi de 65% de na OAF, enquanto no SIP 500 em 2018 foi de 72% e em 2019 foi de 79%. Portanto, podemos estabelecer que a HFO obtém melhora clínica por meio de seu impacto na síndrome respiratória funcional, bem como no escore de Tal modifcado em crianças, e permite o tratamento desses pacientes em enfermarias de hospital geral, com efeitos mínimos. tratamento intensivo[AU]

Efeito agudo do método reequilíbrio toracoabdominal em lactentes com diagnóstico de bronquiolite / Acute effect of thoracic-abdominal rebalance method in infants diagnosed with bronchiolitis

Nos lactentes, o sistema imunológico ainda é imaturo, o que torna as crianças mais suscetíveis ao vírus sincicial respiratório, o principal causador da bronquiolite. O Reequilíbrio Toraco-abdominal (RTA) é um método de terapia manual que atua sobre o sistema respiratório por meio de uma leitura global em situações de doenças. Objetivos: Avaliar os efeitos do método RTA, comparado à fisioterapia tradicional (FT) em lactentes com bronquiolite. Metodologia: Pesquisa experimental e prospectiva, na qual 24 lactentes foram divididos em dois grupos, FT (n = 12) e RTA (n = 12). Parâmetros fisiológicos (frequência respiratória, frequência cardíaca, saturação de pulso de oxigênio e ausculta pulmonar), desconforto respiratório e desequilíbrio da biomecânica respiratória foram avaliados antes e após os manuseios. Resultados: A idade média foi de 13 (± 11,07) semanas no grupo FT e no grupo RTA 13,3 (± 8,41) semanas. Após os manuseios, obteve diferença estatística no grupo do RTA comparado ao da FT nos seguintes parâmetros: observamos uma diminuição significativa da frequência cardíaca (p = 0,02) e da frequência respiratória (p = 0,0002), no quesito esforço respiratório em tórax superior (p = 0,004) e tórax inferior (p = 0,017) e no escore de Wood-Downes em moderada com (p = 0,0001). Conclusão: O RTA mostrou-se mais eficaz que as técnicas da FT em relação aos benefícios ao lactente. (AU)

Effect of glucocorticoid therapy on long-term growth and development of children with bronchiolitis / 中国当代儿科杂志

OBJECTIVES@#To explore the effect of glucocorticoid therapy on the growth and development of children with bronchiolitis.@*METHODS@#A total of 143 children with bronchiolitis who were treated with glucocorticoids from February 2017 to March 2018 were enrolled. The medical data were retrospectively collected, including height, weight, course of the disease, and diagnosis and treatment plan at initial admission. After three years of treatment, physical development indices were measured, growth and development were evaluated by Z-score, and related hematological parameters were measured, including osteocalcin, serum phosphorus, and insulin-like growth factor-1.@*RESULTS@#As for the children with bronchiolitis, the incidence rates of growth retardation and obesity increased significantly after three years of glucocorticoid therapy (P<0.05). The children treated with glucocorticoids for ≥29 days showed a significantly higher incidence rate of obesity than those treated with glucocorticoids for <29 days (P<0.05), while nebulized glucocorticoid treatment had no effect on the growth and development (P>0.05). Compared with the children with growth retardation, the children with normal development had significantly higher levels of serum phosphorus and insulin-like growth factor-1 (P<0.05).@*CONCLUSIONS@#Glucocorticoid therapy can adversely affect long-term growth and development in children with bronchiolitis.

The effect of recombinant human interferon α1b treatment of infants hospitalized with lower respiratory tract infection on subsequent wheezing

Abstract Objective: To investigate the impact of recombinant human interferon α1b (rhIFNα1b) treatment in infants hospitalized with lower respiratory tract infections on subsequent wheezing. Methods: The clinical data of infants (n = 540) with viral pneumonia, wheezy bronchitis, or bronchiolitis hospitalized in 19 Chinese hospitals from June 2009 to June 2015 were retrospectively analyzed. The parameters relevant to wheezing episodes within the last year were collected by telephone and questionnaires. The rhIFNα1b treatment group (n = 253) and control group (n = 287) were compared in terms of wheezing episodes within the last year. Moreover, the wheezing group (95 cases) and non-wheezing group (445 cases) were compared. Results: Out of 540 cases, 95 (17.6%) experienced wheezing episodes, 13.8% (35/253) cases treated with rhIFNα1b, and 20.9% (60/287) cases without rhIFNα1b experienced wheezing episodes within the last year. The rhIFNα1b treatment significantly improved wheezing episodes within the last year, compared with the control peers (p = 0.031). Single-factor regression showed statistically significant differences between the wheezing and non-wheezing groups in terms of age, rhIFNα1b use, childhood and family history of allergy, housing situation, and feeding history (p < 0.05). Binary logistic regression showed a childhood history of allergy (OR = 2.14, p = 0.004), no rhIFNα1b use (OR = 1.70, p = 0.028), and living in a crowded house (OR = 1.92, p = 0.012) might be risk factors of subsequent wheezing. Accordingly, breastfeeding (OR = 0.44, p = 0.008) and hospitalization age of 1-year-old (OR = 0.58, p = 0.024) were protective factors. Conclusions: Early use of rhIFNα1b in infants hospitalized with lower respiratory tract infections and breastfeeding could prevent subsequent wheezing. Living in a crowded house could promote subsequent wheezing.

Impacto de la Terapia de Alto Flujo de Oxigeno (TAFO) en un Hospital Pediátrico de la Provincia de Buenos Aires / Impact of High Flow Oxygen Therapy (TAFO) in a Pediatric Hospital of the Province of Buenos Aires

Introducción: Las infecciones respiratorias agudas bajas (IRAB), representan la causa más frecuente de consulta e internación en los meses de invierno. La insuficiencia respiratoria aguda es la complicación que motiva la internación de los pacientes y la necesidad de Unidad Terapia Intensiva (UTI).El objetivo del trabajo fue describir los resultados de la implementación de la Terapia de Alto Flujo (TAFO) en pacientes con IRAB grave internados en Terapia Intermedia Métodos: Estudio prospectivo y descriptivo que incluyó pacientes de 1 a 36 meses internados en Terapia Intermedia en el Hospital Sor María Ludovica de la ciudad de La Plata, desde junio de 2018 a septiembre de 2019. Se ingresaron a TAFO pacientes sin respuesta al tratamiento con oxígeno a bajo flujo. El ingreso a UTI se consideró fracaso de la TAFO Resultados: De 760 pacientes internados con IRAB, 91(11,9%) ingresaron a TAFO de los cuales 59 (64,8 %) tuvieron respuesta favorable con disminución de la frecuencia respiratoria (FR), frecuencia cardiaca (FC) y mejoría de la mecánica respiratoria; el resto (35,2%) pasó a UTI por fracaso terapéutico. Presentaron complicaciones a la TAFO el 5,5% de los pacientes Conclusión: La TAFO fue una terapéutica segura, de fácil utilización que, a través de un aporte de oxígeno conocido, permitió la corrección de la hipoxemia, logrando la disminución de la FR, FC y mejoría de la mecánica respiratoria, dándole mayor comodidad al paciente durante su enfermedad

Introduction: Respiratory infections remain the major cause of outpatient consultation and hospital admissions during the winter season. Lower respiratory illness may cause severe acute respiratory insufficiency and hypoxemic respiratory failure, thus determining the need for hospitalization and eventual intensive care (ICU). The purpose of this paper is to describe the results of High Flow Oxygen Therapy (HFOT) implementation for patients with acute lower respiratory infections (ALRI) admitted to intermediate therapy unit. Methods: Prospective and descriptive study which included patients from age 1 to 36 months, hospitalized at intermediate therapy care unit at "Sor María Ludovica", Hospital, in La Plata, from June, 2018 to September, 2019. Patients who did not show any improvement to low flow oxygen therapy were the subjects of this study. Further submission to ICU was considered as HFOT failure Results: From 760 patients hospitalized with ALRI, 91 (11.9%) were admitted to TAFO. Fifty nine, (64.8%) had a favorable response with decreased respiratory and heart frequency rate, and an improvement of the work of breathing. The rest (35.1%) went to ICU due to therapeutic failure. Five point five percent of patients presented complications to TAFO. Conclusion: HFOT was a safe, easy to implement therapy treatment which improved the hypoxemic respiratory failure. This therapy reduced the respiratory and heart rate, and yielded a better and lower respiratory work, making patients more comfortable during illness

Recomendaciones para el manejo de las infecciones respiratorias agudas bajas en menores de 2 años. Actualización 2021 / Recommendations for the management of acute lower respiratory infections in children under 2 years of age. Update 2021

Las infecciones respiratorias agudas bajas (IRAB) continúan representando una importante causa de morbimortalidad en nuestro medio. El manejo normatizado de casos constituye una valiosa herramienta para enfrentarlas.Además de los aspectos relacionados con el diagnóstico y tratamiento de estas enfermedades, el análisis de factores de riesgo (tanto biológicos como socioambientales), desde una perspectiva local y actual, permitie implementar medidas efectivas de control y/o prevención, así como identificar aquellos pacientes susceptibles de presentar formas graves o complicaciones.Desde 1996 la Sociedad Argentina de Pediatría asumió el desafío de generar un documento que guíe el manejo integral de los pacientes con IRAB. En esta cuarta actualización se incluyen los últimos adelantos en el tema.

Acute lower respiratory infections (ARI) continue being an important cause of morbidity and mortality in our region. Standardized case management is a valuable tool to deal with them.In addition to aspects related to the diagnosis and treatment of these diseases, the analysis of risk factors (both biological and socio-environmental) from a local and current perspective, allows the implementation of effective control and/or prevention measures, as well as identifying those patients susceptible to presenting serious forms or complications.Since 1996, the Sociedad Argentina de Pediatría asumed the challenge of generating a document that guides the comprehensive management of patients with ARI. This fourth update includes the latest advances on the subject.

Virus respiratorios y características clínico-epidemiológicas en los episodios de infección respiratoria aguda / Respiratory viruses and clinical- epidemiological characteristics in episodes of acute respiratory infection

RESUMEN Con el objetivo de determinar la frecuencia viral y las características clínico-epidemiológicas en los episodios de infección respiratoria aguda de pacientes del Instituto Nacional de Salud del Niño San Borja en Lima, se analizó la información de los episodios de pacientes que requirieron al menos una prueba de inmunofluorescencia directa desde el 1 de enero del 2017 al 31 de diciembre del 2018. Se identificaron 1153 episodios en 707 pacientes. La mediana de la edad fue de 1 año y el 55% fueron del sexo masculino. La frecuencia viral fue del 13,4%; el virus respiratorio sincitial se identificó en el 10,7% de los episodios. La frecuencia viral fue mayor en los menores de 1 año (16,2%); en aquellos con enfermedad congénita respiratoria (38,9%) y durante el otoño (24,2%). Los síntomas más comunes fueron tos (70,3%) y fiebre (53,4%); y los principales diagnósticos fueron neumonía viral (31,8%) y bronquiolitis (23,4%). Se concluye que la frecuencia viral respiratoria estuvo relacionada con la edad, estacionalidad y patología preexistente.

ABSTRACT The aim of the study was to determine the viral frequency and clinical-epidemiological characteristics in the episodes of acute respiratory infection in patients of the Instituto Nacional de Salud del Niño San Borja in Lima, the information of the episodes of patients who required at least one direct Immunofluorescence test from January 1, 2017 to December 31, 2018 was analyzed. 1153 episodes were identified in 707 patients. The median age was 1 year and 55% were male. The viral frequency was 13.4%; respiratory syncytial virus was identified in 10.7% of the episodies. The viral frequency was higher in children under 1 year of age (16.2%); in those with congenital disease respiratory (38.9%) and during the autumn (24.2%). The most common symptoms were cough (70.3%) and fever (53.4%); and the main diagnoses, viral pneumonia (31.8) and bronchiolitis (23.4%). It is concluded that the respiratory viral frequency was related to age, seasonality and pre-existing pathology.

Spontaneous remission of follicular bronchiolitis with nonspecific interstitial pneumonia: A case report and literature review / 北京大学学报(医学版)

A 41-year-old female patient was admitted in Department of Respiratory and Critical Care Medicine, Peking University Third Hospital because of having cough for a year. Multiple subpleural ground grass and solid nodules could be seen on her CT scan. Four months before admission, she began to experience dry mouth and eyes, blurred vision, finger joints pain, muscle pain and weakness in both lower limbs and weight loss. At the time of admission, the patient's vital signs were normal, no skin rash was seen, breath sounds in both lungs were clear, no rales or wheeze, no deformities in her hands, no redness, swelling, or tenderness in the joints. There was no edema in both lower limbs. Some lab examinations were performed. Tumor markers including squamous cell carcinoma (SCC) antigen, neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), Cyfra21-1, pro-gastrin-releasing peptide (proGRP), carbohydrate antigen 125 (CA125) and carbohydrate antigen 199 (CA199) were all normal. The antinuclear antibody, rheumatoid factor, antineutrophil cytoplasmic antibody, anti-dsDNA antibody, anti-Sm antibody, anti-SSA/SSB antibody, anti-ribonucleoprotein (RNP) antibody, anti-Jo-1 antibody, anti-SCL-70 antibody and anti-ribosomal antibody were all negative. The blood IgG level was normal. The blood fungal β-1.3-D glucose, aspergillus galactomannan antigen, sputum bacterial and fungal culture, and sputum smear test for acid-fast staining were all negative. Lung function was normal. Bronchoscopy showed the airways and mucosa were normal. To clarify the diagnosis, she underwent thoracoscopic lung biopsy, the histopathology revealed follicular bronchiolitis (FB) with nonspecific interstitial pneumonia (NSIP). She did not receive any treatment and after 7 months, the lung opacities were spontaneously resolved. After 7 years of follow-up, the opacities in her lung did not relapse. To improve the understanding of FB, a literature research was performed with "follicular bronchiolitis" as the key word in Wanfang, PubMed and Ovid Database. The time interval was from January 2000 to December 2018. Relative articles were retrieved and clinical treatments and prognosis of FB were analyzed. Eighteen articles concerning FB with complete records were included in the literature review. A total of 51 adult patients with FB were reported, including 18 primary FB and 33 secondary FB, and autoimmune disease was the most common underlying cause. Forty-one (80.4%) patients were prescribed with corticosteroids and/or immunosuppressive agents, 6 (11.8%) patients were treated with anti-infective, 5 (9.8%) patients did not receive any treatment. The longest follow-up period was 107 months. Among the 5 patients without any treatment, 1 patients died of metastatic melanoma, the lung opacities were unchanged in 1 patient and getting severe in 3 patients. In conclusion, FB is a rare disease, the treatment and prognosis are controversial. Corticosteroid and immunosuppressive agents could be effective. This case report suggests the possibility of spontaneous remission of FB.

Effectiveness of non-invasive ventilation in treating infants aged 1 to 12 months with severe bronchiolitis: A systematic review and meta-analysis

@#<p style="text-align: justify;"><strong>Objective.</strong> This study was done to determine the effectiveness of non-invasive ventilation (NIV) in treating infants aged 1 to 12 months with severe bronchiolitis based on a systematic review of literature and meta-analysis of quantitative results.</p><p style="text-align: justify;"><strong>Methods.</strong> We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for identification, screening, and identification of eligible studies. Five databases (PubMed, Herdin, Cochrane Library, Google Scholar, and Science Direct) were searched for relevant studies involving the use of NIV among children with severe bronchiolitis. Included studies were assessed for quality and risk of bias.</p><p style="text-align: justify;"><strong>Results.</strong> There were 9 included eligible studies. The length of hospital stay and duration of respiratory support were significantly lower with the use of NIV compared with IMV (invasive mechanical ventilation) based on pooled standard mean difference (SMD) estimates; however, there was high statistical heterogeneity in the included studies. This can be attributed to differences in the mode of intervention used among studies, patient-specific factors, and viral virulence. Significant improvements in heart rate, oxygen saturation, and tCO2 were seen in the included studies. One study showed statistically significant differences in changes in respiratory rate and improvement in respiratory status based on two bronchiolitis severity scores among infants placed on NIV.</p><p style="text-align: justify;"><strong>Conclusion.</strong> Fair to good-quality evidence from included studies reveals that there is a significant reduction in length of hospital stay, duration of respiratory support, and improvements in respiratory parameters among infants who received NIV for severe bronchiolitis. Larger, well-designed clinical trials on the use of NIV among resource-limited settings wherein it may offer valuable clinical utility, are recommended for future study</p>

Desfecho da aplicação da ventilação mecânica não invasiva na bronquiolite / Outcome of the application of noninvasive mechanical ventilation in bronchiolitis

A bronquiolite é uma infecção viral que pode levar a insuficiência ventilatória, nestes casos a aplicação de ventilação não invasiva é uma opção ao tratamento convencional. O objetivo deste estudo é identificar o desfecho da aplicação de ventilação não invasiva em crianças com bronquiolite. Trata-se de uma revisão da literatura, com busca de artigos nas bases de dados Biblioteca Virtual em Saúde, Cochrane Library, PEDro, Pubmed, Scielo e Science Direct, sem restrição de período, a partir das palavras chave Noninvasive ventilation AND Bronchiolitis. De um total de 1.192 artigos encontrados, 11 foram inclusos no presente estudo, quatro abordaram o desfecho relacionado à aspectos clínicos gerais (aumento no uso de VNI; menor tempo de internação; redução da frequência respiratória e fração inspirada de oxigênio) e sete relataram o índice de sucesso ou falha, e apesar da diferença entre as médias (sucesso 88,5 versus falha 15,1) não houve diferença significativa. Conclui-se que o desfecho de falha tem alta prevalência (11,5%), apesar disso, os estudos encontraram diferentes benefícios advindos do incremento na aplicação de VNI (redução da necessidade de ventilação mecânica invasiva, menor tempo de permanência em UTI, redução da mortalidade, melhora da frequência respiratória e da fração inspirada de oxigênio). (AU)

Bronchiolitis is a viral infection that can lead to ventilatory failure. In such cases, the application of noninvasive ventilation (NIV) is an alternative to conventional treatment. The aim of this study is to identify the outcome of the application of NIV in children with bronchiolitis. This is a literature review whose search for articles included the Virtual Health Library, Cochrane Library, PEDro, PubMed, SciELO, and Science Direct databases, with no date restriction, based on the keywords Noninvasive ventilation AND Bronchiolitis. Of a total of 1192 articles found, 11 were included in the present study. Four addressed the outcome related to general clinical aspects (increased use of NIV, shorter hospital stay, and reduced respiratory rate and inspired oxygen fraction) and seven reported the success or failure rate. Despite the difference between the means (success 88.5 versus failure 15.1) there was no significant difference. In conclusion, the failure outcome has a high prevalence (11.5%); however, studies have found different benefits arising from the increased application of NIV (reduced need for invasive mechanical ventilation, shorter intensive care unit stay, reduced mortality, and improved respiratory rate and inspired oxygen fraction). (AU)

The importance of viral load in the severity of acute bronchiolitis in hospitalized infants

OBJECTIVE: The relationship between viral load and the clinical evolution of bronchiolitis is controversial. Therefore, we aimed to analyze viral loads in infants hospitalized for bronchiolitis. METHODS: We tested for the presence of human respiratory syncytial virus (HRSV) or human rhinovirus (HRV) using quantitative molecular tests of nasopharyngeal secretions and recorded severity outcomes. RESULTS: We included 70 infants [49 (70%) HRSV, 9 (13%) HRV and 12 (17%) HRSV+HRV]. There were no differences among the groups according to the outcomes analyzed individually. Clinical scores showed greater severity in the isolated HRSV infection group. A higher isolated HRSV viral load was associated with more prolonged ventilatory support, oxygen therapy, and hospitalization days, even after adjustment for the age and period of nasopharyngeal secretion collection. In the co-infection groups, there was a longer duration of oxygen therapy when the HRSV viral load was predominant. Isolated HRV infection and co-infection with a predominance of HRV were not associated with severity. CONCLUSION: Higher HRSV viral load in isolated infections and the predominance of HRSV in co-infections, independent of viral load, were associated with greater severity. These results contribute to the development of therapeutic and prophylactic approaches and a greater understanding of the pathophysiology of bronchiolitis.

High-flow nasal cannula failure: can clinical outcomes determine early interruption? / Falha da cânula nasal de alto fluxo: os desfechos clínicos podem determinar a interrupção precoce?

ABSTRACT Objective: To evaluate the evolution of clinical outcomes in children with bronchiolitis who used a high-flow nasal cannula, and to determine after long of non-clinical improvement the therapy should be discontinued, and treatment should be escalated to other forms of ventilatory support. Methods: An observational retrospective study of infants with bronchiolitis who used a high-flow nasal cannula. Patients were divided into two study groups according to success or failure of high-flow nasal cannula therapy, namely the Success Group and the Failure Group. The main demographics and clinical variables were assessed 30 minutes and 6 hours after initiating therapy until removal of the high-flow nasal cannula. Results: A total of 83 children were studied and 18 children (21.7%) failed therapy. Among subjects with successful therapy, a significant decrease in respiratory rate (p<0.001), and a significant increase in peripheral oxygen saturation (p<0.001) were observed within 30 minutes. The Success Group was significantly different from the Failure Group after 6 hours, for both respiratory rate (p<0.01) and peripheral oxygen saturation (p<0.01). Conclusion: The absence of clinical sign improvement within 30 minutes and for up to a maximum of 6 hours can be considered as failure of the high-flow nasal cannula therapy. If this time elapses with no improvements, escalating to another type of ventilatory support should be considered.

RESUMO Objetivo: Avaliar a evolução de desfechos clínicos em crianças com bronquiolite que utilizaram cânula nasal de alto fluxo, e determinar com quanto tempo de não melhora clínica a terapia deve ser interrompida para escalonamento do tratamento para outras formas de suporte ventilatório. Métodos: Estudo observacional retrospectivo, de lactentes com bronquiolite que utilizaram cânula nasal de alto fluxo. Os pacientes foram divididos em dois grupos de estudo, de acordo com o sucesso ou não da terapêutica com cânula nasal de alto fluxo, nomeados Grupo Sucesso e Grupo Falha. Foram analisadas as principais características demográficas e variáveis clínicas, tendo sido avaliadas 30 minutos e 6 horas após o início do tratamento até a retirada da cânula nasal de alto fluxo. Resultados: Foram estudados 83 crianças; destas, 18 crianças (21,7%) falharam. Entre os pacientes que tiveram sucesso na terapia, observou-se diminuição significativa da frequência respiratória (p<0,001), e também aumento significativo da saturação de oxigênio (p<0,001) já nos primeiros 30 minutos. O Grupo Sucesso foi significativamente diferente do Grupo Falha a partir de 6 horas, tanto para frequência respiratória (p<0,01), quanto para saturação de oxigênio (p<0,01). Conclusão: Na ausência de melhora dos sinais clínicos, a falha da terapia com cânula nasal de alto fluxo já pode ser considerada a partir de 30 minutos e, no máximo, em até 6 horas após o início da terapia. Após esse período sem melhora, o escalonamento para outro tipo de suporte ventilatório deve ser avaliado.

Admisiones por bronquiolitis en 13 unidades de cuidados intensivos pediátricos del Uruguay: ¿es igual en Montevideo que en el interior? / Bronchiolitis admissions in 13 pediatric intensive care units in Uruguay: is it the same in Montevideo (capital city) and the provinces? / Internações por bronquiolite em 13 unidades de terapia intensiva pediátrica do Uruguai: são iguais em Montevidéu e no Interior do país?

Resumen: Objetivos: describir las características clínicas y epidemiológicas de niños admitidos por bronquiolitis en 13 unidades de cuidados intensivos pediátricos (UCIP) del Uruguay y comparar los resultados asistenciales finales entre UCIP de Montevideo (UM) y del interior del país (UI). Material y método: estudio observacional retrospectivo multicéntrico de los registros ingresados a base de datos prospectiva de LARed Network. Se incluyeron niños mayores de 1 mes y menores de 2 años admitidos en el período 1 de mayo de 2017 y 30 de abril de 2019 con diagnóstico de bronquiolitis comunitaria. Se analizaron datos demográficos, clínicos, así como intervenciones y desenlaces al alta. Resultados: se analizaron 666 casos. No se detectaron diferencias significativas de comorbilidades ni en el soporte respiratorio al ingreso. En UI los pacientes fueron derivados con más frecuencia desde otro hospital. La distancia y tiempo medio, así como el porcentaje de traslados mayor de 50 km, fue también mayor. En UI los pacientes tuvieron mayor gravedad clínica y gasométrica al ingreso. El perfil radiológico y etiológico fue similar. Virus respiratorio sincicial (VRS) aislado > 50%. La indicación global de corticoides superó el 25% y el de broncodilatadores el 85%. La prescripción de antibióticos y adrenalina nebulizada fue mayor en UI. La cánula nasal de alto flujo (CNAF) fue globalmente el método de soporte respiratorio más utilizado, aunque se observó un mayor uso de ventilación mecánica invasiva (VMI) y CPAP en UI (47% vs 28% en UM). No hubo diferencias en el número de complicaciones por VMI o ventilación no invasiva, ni en el uso de terapias de rescate. Tampoco se notaron diferencias significativas en la duración de la estadía en UCIP, ni en la mortalidad absoluta y ajustada, y hubo un solo caso de nueva morbilidad. Conclusiones: los niños admitidos en UI tuvieron mayor gravedad al ingreso y más factores de riesgo relacionados con mal pronóstico en el traslado, recibiendo más antibióticos y soporte invasivo que aquellos ingresados en UM. El CNAF fue el tipo de soporte respiratorio más utilizado en el país. Se detectó alto porcentaje de prescripción de terapias no recomendadas, como broncodilatadores y corticoides. La mortalidad y complicaciones fueron bajas, así como la generación de morbilidad residual.

Summary: Objectives: to describe the clinical and epidemiological characteristics of children admitted for bronchiolitis in 13 Pediatric Intensive Care Units (UCIP) in Uruguay and compare the final care outcomes between Montevideo (UM) and Interior of the country (IU). Method: multicenter, retrospective, observational study of data entered in the LARed Network prospective database. Children over 1 month and younger than 2 years admitted between May 1, 2017 and April 30, 2019 with a diagnosis of Community Bronchiolitis were included in the study. Demographic and clinical data were analyzed, as well as interventions and discharge outcomes. Results: 666 cases were analyzed. No significant differences in comorbidity and respiratory support were detected at admission. In IU patients were referred more frequently from another hospital. The distance and average time, as well as the percentage of transfers greater than 50 km, was also higher. In IU, patients had greater clinical and gasometrical severity at admission. The radiological and etiological profile was similar (VRS at > 50%). The overall indication of corticosteroids exceeded 25% and that of bronchodilators exceeded 85%. The prescription for antibiotics and nebulized adrenaline was higher in IU. The high flow nasal cannula (HFNC) was globally the most widely used respiratory support method, although increased use of invasive mechanical ventilation (IMV) and CPAP in IU (43% vs 28% in UM) was observed. There were no differences in the number of complications from IVF or non-invasive ventilation, nor in the use of rescue therapies. There were also no significant differences in the length of stay at UCIP or in absolute and adjusted mortality and there was only one case of new morbidity. Conclusions: children admitted to IU had higher severity scores and more transfer-related risk factors, received more antibiotics and invasive support. HFNC was the most widely used type of respiratory support in the country. A high prescription of non-recommended therapies such as bronchodilators and corticosteroids was detected. Mortality and complications were low, as were the generation of new morbidity.

Resumo: Objetivos: descrever as características clínicas e epidemiológicas de crianças internadas por bronquiolite em 13 Unidades de Terapia Intensiva Pediátrica (UTIP) do Uruguai e comparar os resultados finais do atendimento entre UTIP de Montevidéu (UM) e do Interior do país (IU). Material e métodos: estudo observacional retrospectivo multicêntrico dos dados inseridos no banco de dados prospectivo da Rede LARed. Foram incluídas crianças maiores de 1 mês e menores de 2 anos internadas no período de 1º de maio de 2017 a 30 de abril de 2019 com diagnóstico de bronquiolite comunitária. Dados demográficos e clínicos, bem como intervenções e desfechos na alta, foram analisados. Resultados: foram analisados 666 casos. Não foram detectadas diferenças significativas nas comorbidades ou no suporte respiratório na admissão. No IU, os pacientes foram encaminhados com maior frequência a outro hospital. A distância e o tempo médios, assim como o percentual de transferências superiores a 50 km, também foram maiores. No IU, os pacientes apresentaram maior gravidade clínica e gasométrica na admissão. O perfil radiológico e etiológico foi semelhante. O vírus sincicial respiratório (RSV) foi isolado em > 50%. A indicação global de corticosteroides ultrapassou 25% e a de broncodilatadores 85%. A prescrição de antibióticos e adrenalina nebulizada foi maior no IU. A cânula nasal de alto fluxo (CNAF) foi o método de suporte respiratório mais utilizado, embora tenha sido observado um maior uso de ventilação mecânica invasiva (VMI) e CPAP no IU (47% vs 28% em UM). Não houve diferenças no número de complicações devido à VMI ou Ventilação Não Invasiva, ou no uso de terapias de resgate. Também não foram observadas diferenças significativas no tempo de internação na UTIP ou na mortalidade absoluta e ajustada, havendo apenas um caso de nova morbidade. Conclusões: as crianças admitidas no IU apresentaram maior gravidade na admissão e mais fatores de risco relacionados ao mau prognóstico na transferência, recebendo mais antibióticos e suporte invasivo do que as internadas em UM. O CNAF foi o tipo de suporte respiratório mais utilizado no país. Detectou-se alto percentual de prescrição de terapias não recomendadas, como broncodilatadores e corticosteroides. A mortalidade e as complicações foram baixas, assim como a geração de morbidade residual.

Actualización de la bronquiolitis aguda / Acute bronchiolitis update

La bronquiolitis aguda es una condición respiratoria frecuente en los niños menores de 2 años. Representa la principal causa de hospitalización infantil y se caracteriza por la presencia de sibilancias asociada a signos de una infección respiratoria alta. El agente etiológico más común es el virus respiratorio sincicial. Existe una falta de consenso con respecto a su definición clínica; y por ello, su tratamiento varía en todo el mundo. El diagnóstico es clínico, sin necesidad de emplear laboratorio o imágenes en forma rutinaria. Diversas revisiones han demostrado que los broncodilatadores, adrenalina, corticoides y antibióticos, entre otros, carecen de eficacia por lo que no se sugiere su empleo. El tratamiento sigue siendo de soporte, mediante la administración de oxígeno y manteniendo una adecuada hidratación. Cuando no se logra disminuir el trabajo respiratorio o corregir la hipoxemia se puede utilizar la presión positiva en la vía aérea para prevenir y controlar la insuficiencia respiratoria. Este artículo desarrolla una breve revisión de las principales características clínicas, epidemiológicas, radiológicas, así como algunos de los diferentes tratamientos publicados en las últimas dos décadas.

Acute bronchiolitis is a common respiratory condition in children under 2 years old. It represents the main cause of childhood hospitalization characterized by the presence of wheezing associated with signs of an upper respiratory infection. The most common etiologic agent is respiratory syncytial virus. There is a lack of consensus regarding its clinical definition; and therefore, its treatment varies around the world. Diagnosis is clinical, without the need for routine laboratory or imaging. Various reviews have shown that bronchodilators, epinephrine, corticosteroids, and antibiotics, among others, lack efficacy, so their use is not suggested. Treatment continues to be supportive, by administering oxygen and maintaining adequate hydration. When it is not possible to reduce the work of breathing or correct the hypoxemia, positive airway pressure can be used to prevent and control respiratory failure. This article develops a brief review of the main clinical, epidemiological, and radiological characteristics, as well as some of the different treatments published in the last two decades.

Perfil del lactante con insuficiencia respiratoria que se beneficia del uso de cánula nasal de alto flujo, Bogotá - Colombia / Profile of the infant with respiratory failure benefited from the high flow nasal cannula, Bogota ­ Colombia

OBJETIVO: el propósito de este estudio fue determinar los principales desenlaces clínicos en lactantes con insuficiencia respiratoria aguda (IRA), tratados con cánula nasal de alto flujo (CNAF) en una unidad de cuidado intensivo pediátrico (UCIP). MATERIALES Y MÉTODOS: se realizó un estudio observacional descriptivo de cohorte histórica, se reclutaron niños entre 1 y 24 meses que ingresaron a la UCIP de un hospital de referencia con diagnóstico de IRA (Julio 1, 2016 a junio 30, 2017) tratados con CNAF como terapia inicial. Los datos extraídos incluyeron variables demográficas, clínicas y principales desenlaces. RESULTADOS: se identificaron 112 casos que cumplieron los criterios de inclusión durante el periodo del estudio. El diagnóstico más frecuente fue neumonía multilobar (41%), seguido por bronquiolitis (34%). Se encontró que el 22.4% de los niños poseía alguna comorbilidad, siendo la más frecuente la displasia broncopulmonar. El virus más frecuentemente aislado fue el virus sincitial respiratorio (VSR) en el 37.5% de los casos. De los 112 pacientes, 59 niños (53%) requirieron intubación traqueal. Los factores asociados con el riesgo de intubación fueron el diagnóstico de neumonía multilobar, el uso de sedación, el aislamiento de VSR y el sexo femenino. CONCLUSIONES: la CNAF es un sistema de soporte respiratorio no invasivo, seguro, bien tolerado y capaz de disminuir la necesidad de intubación y los días de estancia en cuidado intensivo. En niños con IRA, el diagnóstico de neumonía multilobar, la necesidad de sedación, la presencia de comorbilidades asociadas y el sexo femenino son factores asociados con la necesidad de requerir ventilación mecánica invasiva.

OBJECTIVE: the purpose of this study was to determine the main clinical outcomes in infants with acute respiratory failure (ARF), treated with a high-flow nasal cannula (CNAF) in a pediatric intensive care unit (PICU). MATERIALS AND METHODS: a retrospective observational study was conducted on a cohort of children between 1 and 24 months of age who were admitted to the PICU entered UCIP of a referral hospital with a diagnosis of ARF treated with CNAF as initial therapy. The data extracted included demographic and clinical variables and main outcomes. RESULTS: 112 cases were identified that met the inclusion criteria during the study period. The most frequent diagnosis was pneumonia (41%), followed by bronchiolitis (34%). It was found that 22.4% of the children had some comorbidity, the most frequent being bronchopulmonary dysplasia. The most frequently isolated virus was respiratory syncytial virus (RSV) in 37.5% of the cases. Of the 112 patients, 59 children (53%) required tracheal intubation. The factors associated with the risk of intubation were the diagnosis of pneumonia, the use of sedation, the isolation of RSV and the female gender. CONCLUSIONS: CNAF is a non-invasive respiratory support system, capable of reducing the need for intubation and days of stay in intensive care. In children with ARF, the diagnosis of pneumonia, the need for sedation, the presence of associated comorbidities, and the female gender are factors associated with the need to require invasive mechanical ventilation.

Evolución de pacientes con bronquiolitis tratados con cánulas de alto flujo de oxígeno que ingresan a la unidad de cuidados intensivos / Outcome of patients with bronchiolitis treated with high-flow oxygen nasal cannulas admitted to the intensive care unit

Objetivo: Describir la evolución en la Unidad de Cuidados Intensivos Pediátricos (UCIP) de los pacientes con bronquiolitis, tratados inicialmente con cánula nasal de alto flujo de oxígeno (CAFO) en la Unidad Emergencias. Determinar factores predisponentes de ingreso a ventilación no invasiva (VNI) o invasiva con intubación orotraqueal (TET). Métodos: Trabajo descriptivo retrospectivo por revisión de historias clínicas. Se incluyeron todos los pacientes menores de 2 años de edad con diagnóstico de bronquiolitis, sin comorbilidades, que ingresaron a UCIP polivalente luego de haber sido previamente tratados con CAFO en la Unidad de Emergencias entre los meses de Agosto 2017 y Agosto 2019. Resultados: Se evaluaron 145 pacientes. La mediana de edad fue de 4,4 meses (RIC 2-6 meses), con una mediana de tiempo desde el inicio de los síntomas hasta la consulta de 45,4 hs (RIC 24-72). La mediana del score de TAL modificado al ingreso a UCIP 8,4 (RIC 8-9). El 98,6% requirió asistencia respiratoria mecánica (ARM), en el grupo VNI 52,4% (75) y en el grupo TET 47,5% (68). El rescate de germen fue en 60% de los casos virus sincicial respiratorio (VSR). El 5,5% fueron co-infecciones. De los pacientes con rescate positivo para VSR, el 52,9% (46) requirieron VNI y 47,1% (41) TET. Los pacientes estudiados permanecieron en CAFO una mediana de 20 hs previo al ingreso a UCIP (RIC: 6-24). Aquellos que estuvieron en VNI con una mediana de 23,3 hs (RIC 6-24) y los que requirieron TET 17 hs (RIC 6-21). La mortalidad evidenciada en el grupo TET fue de 1,38% correspondiente a 2 pacientes, donde también se encontró un 7,5% de complicaciones. La mediana de días de internación en UCIP fue de 8,6 (5-11) para la totalidad de la población estudiada siendo 5,2 (4-6) para los pacientes en VNI y 12 días (9-14) para los pacientes en TET. Conclusiones: Casi la totalidad de pacientes tratados con CAFO en la Unidad Emergencias que requirieron pasar a UCI necesitaron ARM. Ni el score de TAL ni la cantidad de horas de CAFO previo al ingreso en UCI nos permitieron diferenciar los pacientes del grupo VNI de aquellos del grupo TET (AU)

Objective: To describe outcome of patients who were admitted to the pediatric intensive care unit (PICU) with bronchiolitis initially treated with high-flow oxygen through a nasal cannula (HFNC) at the emergency department and to determine predisposing factors for the need for non-invasive ventilation (NIV) or invasive endotracheal intubation (ETI). Methods: A retrospective descriptive study with a review of the clinical records was conducted. All patients less than 2 years of age with bronchiolitis without comorbidities that were admitted to the general PICU following treatment with HFNC at the emergency department between August 2017 and August 2019 were included in the study. Results: 145 patients were evaluated. Median age was 4.4 months (IQR 2-6 months). Median time from symptom onset to first consultation was 45.4 hours (IQR 24-72). Median modified TAL score on PICU admission was 8.4 (IQR 8-9). Overall 98,6% required mechanical ventilation (MV), 52.4% (75) in the NIV and 47.5% (68) in the ETI group. In 60% of the cases respiratory syncytial virus (RSV) was isolated. Co-infections were found in 5.5%. Of the patients with an RSV-positive isolate, 52.9% (46) required NIV and 47.1% (41) ETI. Patients had remained on HFNC for a median of 20 hours prior to PICU admission (IQR 6-24). Patients were on NIV for a median time of 23.3 hours (IQR 6-24) and on ETI for a median time of 17 hours (IQR 6-21). In the ETI group, mortality rate was 1.38%, corresponding to two patients, while the complication rate was 7.5%. Median length of PICU stay was 8.6 days (5-11) for the entire study population, 5.2 days (4-6) for patients on NIV, and 12 days (9-14) for those on ETI. Conclusions: Almost all patients treated with HFNC at the emergency department who required admission to the PICU needed MV. Neither TAL score nor time on HFNC allowed us to differentiate patients requiring NIV from those who needed ETI (AU)

Caracterización de prematuros ingresados por bronquiolitis en el Hospital Nacional de Niños / Characterization of premature patients admitted for bronchiolitis at the National Children's Hospital

Resumen Antecedentes: La bronquiolitis es la infección del tracto respiratorio inferior más frecuente en lactantes. El virus respiratorio sincicial es el principal agente y responde hasta por un 85 % de los casos. Los principales factores de riesgo asociados son: sexo masculino; lactantes menores; prematuros; patologías médicas de fondo como: cardiopatía congénita, displasia broncopulmonar, síndrome de Down y enfermedades neuromusculares; así como otros factores ambientales y sociales. El objetivo de este estudio fue caracterizar los prematuros, el tratamiento utilizado, el perfil de la inmunofluorescencia viral, las complicaciones, el uso de palivizumab y los costos de hospitalización en pacientes hospitalizados por bronquiolitis durante enero de 2011 y diciembre de 2011. Pacientes y métodos: Estudio observacional, descriptivo, basado en la revisión retrospectiva de expedientes clínicos de una serie de pacientes hospitalizados en el Hospital Nacional de Niños de la Caja Costarricense de Seguro Social. Se incluyeron todos los pacientes menores de 2 años egresados con el diagnóstico de bronquiolitis durante 2011, con el antecedente de prematuridad (menor de 37 semanas de edad gestacional). Resultados: Se incluyó un total de 141 pacientes; un 63 % (n=89) de sexo masculino, promedio de edad 5,7 meses (rango 0-24). Un 43 % (n=61) de los pacientes manifestó bronquiolitis antes de los 3 meses de edad. Con respecto a la edad gestacional, se obtuvo que el 35,46 % de los pacientes eran de 32 a 35 semanas, de 35 a 37 semanas un 31,2 %, de 30 a 32 semanas un 19,86 % y el resto menores de las 29 semanas. En 93 niños (66 %) se anotó el antecedente de tabaquismo en el entorno del hogar; de forma específica, en 17 % de estos pacientes se presentó el antecedente de tabaquismo pasivo, al reportarse que el padre o el abuelo eran los fumadores activos. El antecedente heredofamiliar de asma fue positivo en el 41,8 %. Con respecto al tratamiento recibido durante su hospitalización, el 100 % ameritó oxígeno suplementario y un 61 % recibió nebulizaciones con salbutamol; los esteroides sistémicos se utilizaron en el 33 % de los pacientes y solo en un 29 % se utilizó la terapia antibiótica. Un 28 % de la población estudiada presentó complicaciones, de los cuales 28 (19,86 %) prematuros ameritaron soporte ventilatorio. El hallazgo de atelectasia en la radiografía de tórax se evidenció en el 7,8 % de los pacientes. Únicamente un 4,25 % de los pacientes tuvo una sobreinfección bacteriana. Debido a la dificultad de los accesos venosos de este grupo de niños, 14 (9,93 %) ameritaron la colocación de catéter venoso central. El rango de estancia hospitalaria fue de 1 a 31 días, con un promedio de 7; la hospitalización en la Unidad de Cuidados Intensivos alcanzó un rango de 5 a 18 días, con un promedio de 10, y el promedio de la necesidad de ventilación mecánica asistida fue de 8,2 días, y de cánula de alto flujo de 2,8 días. Únicamente un 6,38 % (n=9) tenía el antecedente de haber recibido profilaxis con palivizumab: la mayoría había recibido más de dos dosis y ninguno de los pacientes había completado el esquema de las 5 dosis. Durante 2011, el Hospital reportó que el costo promedio diario fue de ¢ 766 476. Con un total de 1001 días de hospitalización acumulada, se estimó un costo directo de ¢ 767 242 142, equivalente a $ 1 522 306 (dólares estadounidenses). Conclusión: El perfil de los prematuros en este estudio es muy similar a lo reportado internacionalmente, por ser un grupo de prematuros con prevalencia más elevada de complicaciones que la población pediátrica general. Dado el costo que implica el internamiento de estos pacientes, es necesario evaluar la aplicación de intervenciones como el palivizumab para prevenir la hospitalización y disminuir otros costos al sistema de salud solidario.

Abstract Background: Bronchiolitis is the most common lower respiratory tract infection in infants. Respiratory Syncytial Virus is the main agent and responds in up to 85% of cases. The main associated risk factors are: male sex, young infants, premature infants, underlying medical conditions such as: congenital heart disease, bronchopulmonary dysplasia, Down syndrome and neuromuscular diseases; as well as other environmental and social factors. The objective of this study was to characterize preterm infants, the treatment used, the viral immunofluorescence profile, complications, the use of palivizumab, and hospitalization costs in patients hospitalized for bronchiolitis during January 2011 and December 2011. Methods: An observational, descriptive study, based on a retrospective review of clinical records of a series of hospitalized patients at the National Children's Hospital (HNN) of the Costa Rican Social Security Fund. All patients under 2 years of age who were discharged with a diagnosis of bronchiolitis during 2011, with a history of prematurity (less than 37 weeks gestational age) were included. Results: A total of 141 patients were included, 63% (n = 89) were male, with an average age of 5.7 months (range 0-24). 43% (n = 61) of patients with Bronchiolitis manifested before 3 months of age. With regard to gestational age, it was found that 35.46% of the patients were between 32 and 35 weeks, 31.2% from 35 to 37 weeks, 19.86% from 30 to 32 weeks and the rest were under 29 weeks. In 93 children (66%) a history of smoking was noted in the home environment; specifically, 17% of these patients had a history of passive smoking as the father or grandfather was reported as active smokers. In relation to the hereditary family history of asthma, it was positive in 41.8%. Regarding the treatment received during their hospitalization, 100% required supplemental oxygen and 61% received nebulizations with salbutamol; systemic steroids were used in 33% of patients and antibiotic therapy was used in only 29%. 28% of the population studied presented complications, of which 28 (19.86%) premature babies required ventilatory support. The finding of atelectasis on the chest X-ray occurred in 7.8% of the patients. Only 4.25% of the patients had a bacterial superinfection. Due to the difficulty of the venous access in this group of children, 14 (9.93%) of them required the placement of a central venous catheter. The range of hospital stay was from 1 to 31 days with an average of 7 days, hospitalization in the Intensive Care Unit reached a range of 5 to 18 days with an average of 10 days and the average need for assisted mechanical ventilation It was 8.2 days and the high-flow cannula was 2.8 days. Only 6.38% (n = 9) had a history of having received prophylaxis with Palivizumab, the majority had received more than two doses, and none of the patients had completed the 5-dose schedule. During that year 2011, the hospital reported that the average daily cost was ¢ 766 476; With a total of 1001 cumulative hospitalization days, a total direct cost of ¢ 767 242 142 was estimated, equivalent to $ 1 522 306 (US dollars). Conclusion: The profile of the characteristics of premature infants in this study is very similar to that reported internationally, as it is a group of premature infants with a higher prevalence of complications than the general pediatric population. Given the cost involved in the hospitalization of these patients, it is necessary to evaluate the application of interventions such as palivizumab to prevent hospitalization and reduce other costs to the solidarity health system.