ABSTRACT
Background and Aims: Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals. Methods: It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow-up was carried out at 1, 6, and 48 h after starting the management. Results: Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6 h. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%. Conclusion: The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies.
ABSTRACT
Background: Acute respiratory failure is a life-threatening medical condition, associated with a variety of conditions and risk factors, including acute respiratory diseases which are a frequent cause of pediatric morbidity and mortality worldwide. In Colombia, the literature related to ARF is scarce. Objective: To determine the incidence, causes, and sociodemographic and clinical characteristics of ARF in three hospitals in Bogota, a high-altitude city located in Colombia, during the COVID-19 pandemic. Methods: A multicenter prospective cohort study called the FARA cohort was developed between April 2020 - December 2021. Patients older than one month and younger than 18 years with respiratory distress who developed ARF were included. Results: 685 patients with respiratory distress were recruited in 21 months. The incidence density of ARF was found to be 41.7 cases per 100 person-year CI 95%, (37.3-47.7). The median age was 4.5 years.. Most of the patients consulted during the first 72â h after the onset of symptoms. Upon admission, 67.2% were potentially unstable. The most frequent pathologies were asthma, bronchiolitis, pneumonia, and sepsis. At admission, 75.6% of the patients required different oxygen delivery systems, 29,5% a low-flow oxygen system, 36,8% a high-flow oxygen system, and 9,28% invasive mechanical ventilation. SARS-COV-2, respiratory syncytial virus, rhinovirus/enterovirus, and adenovirus were the most frequently isolated viral agents. The coinfection cases were scarce. Conclusions: This multicenter study, the FARA cohort, developed at 2,600 meters above sea level, shows the first data on incidence, etiology, sociodemographic and clinical characterization in a pediatric population with ARF that also concurs with the COVID-19 pandemic. These results, not only have implications for public health but also contribute to the scientific and epidemiological literature on a disease developed at a high altitude.
ABSTRACT
In the midst of the health emergency caused by COVID-19 in Colombia, strategies have been generated to strengthen food security and sovereignty. Among the mechanisms adopted by urban and rural communities and local governments are alternative ways of obtaining food, one of which is trueque, which allows the exchange of food produced by peasants between territories. In Bogota, mercados campesinos have been strengthened, which have made it possible to bring food produced by peasants in Tolima, Meta and Boyacá to urban households, promoting short marketing circuits and fair payment to producers. In spite of these alternatives, the demonstrations to make visible the hunger of the households emerged the trapos rojos (red rags) in the houses, which have alerted about the situation of a good part of Colombians and have encouraged solidarity among neighbors. The position of academia has been avant-garde, directly involving peasants in processes to guarantee the right to food in Colombia.
En medio de la emergencia sanitaria producida por la COVID-19 en Colombia se han generado estrategias para el fortalecimiento de la seguridad y soberanía alimentaria. Dentro de los mecanismos adoptados por las comunidades urbanas y rurales y los gobiernos locales se encuentran formas alternativas en la obtención de alimentos, una de ellas es el trueque, el cual permite intercambiar alimentos producidos por las y los campesinos entre territorios. En Bogotá se han estado fortaleciendo los mercados campesinos, los que han permitido llevar a los hogares urbanos alimentos producidos por las y los campesinos en Tolima, Meta y Boyacá fomentando los circuitos cortos de comercialización y el pago justo a los productores. A pesar de estas alternativas, las manifestaciones para visibilizar el hambre de los hogares surgieron como trapos rojos en las puertas y ventanas de las casas, los que han alertado sobre la situación de buena parte de colombianos y han alentado la solidaridad entre vecinos. La posición de la academia ha sido vanguardista vinculando de manera directa a las y los campesinos en procesos por la garantía del derecho a la alimentación en Colombia.