How is mechanical ventilation employed in a pediatric intensive care unit in Brazil?

OBJECTIVE: to investigate the relationship between mechanical ventilation and mortality and the practice of mechanical ventilation applied in children admitted to a high-complexity pediatric intensive care unit in the city of São Paulo, Brazil. DESIGN: Prospective cohort study of all consecutive patients admitted to a Brazilian high-complexity PICU who were placed on mechanical ventilation for 24 hours or more, between October 1st, 2005 and March 31st, 2006. RESULTS: Of the 241 patients admitted, 86 (35.7 percent) received mechanical ventilation for 24 hours or more. Of these, 49 met inclusion criteria and were thus eligible to participate in the study. Of the 49 patients studied, 45 had chronic functional status. The median age of participants was 32 months and the median length of mechanical ventilation use was 6.5 days. The major indication for mechanical ventilation was acute respiratory failure, usually associated with severe sepsis / septic shock. Pressure ventilation modes were the standard ones. An overall 10.37 percent incidence of Acute Respiratory Distress Syndrome was found, in addition to tidal volumes > 8 ml/kg, as well as normo- or hypocapnia. A total of 17 children died. Risk factors for mortality within 28 days of admission were initial inspiratory pressure, pH, PaO2/FiO2 ratio, oxygenation index and also oxygenation index at 48 hours of mechanical ventilation. Initial inspiratory pressure was also a predictor of mechanical ventilation for periods longer than 7 days. CONCLUSION: Of the admitted children, 35.7 percent received mechanical ventilation for 24 h or more. Pressure ventilation modes were standard. Of the children studied, 91 percent had chronic functional status. There was a high incidence of Acute Respiratory Distress Syndrome, but a lung-protective strategy was not fully implemented. Inspiratory pressure at the beginning of mechanical ventilation was a predictor of mortality within 28 days and of a longer...

Prescripción y uso de antibióticos en una unidad de cuidados intensivos pediátricos de la Ciudad de Buenos Aires / Prscription and use of antibiotics at a pediatric intensive care unit in Buenos Aires City

Los antibióticos son los medicamentos de mayor prescripción en terapia intensiva pediátrica(UTIP) con impacto en la resistencia bacterianay los costos.Objetivos. Evaluar patrones de prescripción y consumo de antibióticos. Material y métodos. Desde julio de 2006 hasta enerode 2007, se realizaron cortes de prevalencia mensualessobre uso de antibióticos al 1º y 7º día de la prescripción. Se calculó un promedio de consumo mensual para cada antibiótico. Resultados. De 81 pacientes, 41 recibieron antibióticos y, de ellos, 34 cumplieron al menos 7 días. Indicadores: 1. Promedio antibiótico por paciente: 83 antibióticos fueron utilizados en el esquema empírico(meropenem 18 por ciento, vancomicina 16,8 por ciento, amicacina16,8 por ciento, cefotaxima 13,2 por ciento, ceftazidima 6 por ciento, claritromicina 6 por ciento, piperacilina-tazobactam 4,8 por ciento, colistin4,8 por ciento). Promedio: 2 antibióticos/paciente; 98 antibióticosfueron relevados al 7o día (vancomicina17,3 por ciento, meropenem 16,3 por ciento, amicacina 9,8 por ciento, minociclina 9,8 por ciento, colistin 9,1 por ciento, anfotericina B 6,1 por ciento, cotrimoxazol4 por ciento, ceftazidima 5,1 por ciento). Promedio: 2,8 antibióticos/paciente.2. Porcentaje toma de muestras: hemocultivos 100 por ciento,aspirados traqueales 68 por ciento, catéteres 54,5 por ciento.3. Porcentaje de pacientes con aislamiento: presentaronaislamiento el 56,1 por ciento del total. Los hallazgos fueron:bacterias 94,3 por ciento, bacilos gramnegativos no fermentadores60,6 por ciento, enterobacterias 24,2 por ciento, cocos grampositivos15 por ciento, hongos 5,7 por ciento.4. Porcentaje de ajuste de esquemas antibióticos segúnmicrobiología: 52 por ciento.5. Porcentaje de suspensión antibiótica con cultivosnegativos: 22,2 por ciento .El promedio mensual de consumofue: meropenem 13,44; vancomicina 10,2; cefotaxima3,6; ceftriaxona 2,20; piperacilina-tazobactam 7,38 yamicacina 2,3