ABSTRACT
OBJECTIVE: The proportion of children with complex chronic conditions is increasing in PICUs around the world. We determined the prevalence and functional status of children with complex chronic conditions in Brazilian PICUs. METHODS: We conducted a point prevalence crosssectional study among fifteen Brazilian PICUs during the COVID-19 pandemic. The study had IRB consent. We enrolled all children admitted to the participating PICUs with complex chronic conditions on 3 different days, 4 weeks apart, starting on April 4th, 2020. We recorded the patient's characteristics and functional status at the admission and discharge days. RESULTS: During the 3 study days from March to June 2020, we enrolled 248 patients admitted to the 15 PICUs;148 had CCC (prevalence of 59.7%). Patients had a median of 1 acute diagnosis and 2 chronic diagnoses. The use of resources/devices was extensive. The main mode of respiratory support was conventional mechanical ventilation. Most patients had a peripherally inserted central catheter (63.1%), followed by a central venous line (52.5%), and 33.3% had gastrostomy or/and tracheostomy. The functional status score was significantly better at discharge compared to admission day due to the respiratory status improvement. CONCLUSIONS: The prevalence of children with CCC admitted to the Brazilian PICUs during the COVID-19 pandemic was higher than studies in other countries, representing 59.7% of patients in the PICUs. The functional status of these children improved during hospitalization, mainly due to the respiratory component.
ABSTRACT
Background: Vancomycin is a hydrophilic antimicrobial is largely prescribed to gram-positive bacterial infections prophylaxis in patients receiving extracorporeal membrane oxygenation (ECMO). Otherwise, the use of ECMO may affect the vancomycin pharmacokinetics. Case Presentation Summary: A 3-days-old girl, 2865 g, 48.5 cm, term newborn, with a maternal respiratory coronavirus 2 (SARS-CoV-2) diagnosis. The patient remained hospitalized for transposition of large arteries, and received extracorporeal membrane oxygenation (ECMO) after surgery. Vancomycin therapy started with an empirical dose of 10 mg/kg every 12h for open chest prophylaxis. At the 12th hour a blood sample was collected with an undetectable value. The empirical dose was adjusted to 15 mg/Kg every 8h. Two steady-state blood samples were collected and the vancomycin area under the curve (AUC) estimated by the logarithmic trapezoidal rule was 419.1 mg/L.h, therefore the dose was maintained. After the ECMO therapy ended, another sample was collected at the 8th hour with 23 mg/L value, the vancomycin administration has stopped to decrease nephrotoxicity risk. The patient's chest was closed and stayed hospitalized for post-surgical observation and to ensure weight gain. Conclusion: Neonate patients receiving ECMO may require higher vancomycin doses than recommended by the data bases, mostly because of the increased volume distribution and the dose must be revaluate after the end of life support devices therapy. The vancomycin AUC-guided monitoring allows specific dose adjustments based on individual pharmacokinetic parameters in different critically ill patient's population and it can be implemented in clinical practice to maximize antimicrobial treatment.