Chylothorax After Heart Surgery in Children.

Chylothorax is a consequence of a thoracic duct injury that can occur during surgical procedures in patients with congenital heart disease. It is associated with high rates of morbimortality and increased use of clinical and hospital resources. The aim of this study was to evaluate the risk factors, distribution, manifestations, complications, and treatments for chylothorax in patients undergoing cardiac surgery in a tertiary pediatric hospital in southern Brazil. This is a retrospective, quantitative study, in which all medical records (n = 166) of patients with chylothorax after pediatric cardiac surgery between January 2014 and December of 2020 and a matched control group (n = 166) were analyzed. Over the study period, there was an increase in incidence of chylothorax from 4.5% in 2014 to 7.6% in 2020, a trend that has been reported in the literature. After multivariate analysis, the following were identified as risk factors for the diagnosis of chylothorax: genetic syndrome (OR 2.298); prolonged cardiopulmonary bypass time (greater than 120 min) (OR 2.410); fluid overload in the immediate postoperative period (OR 1.110); and SIRS (OR 2.527). Mortality was two times greater (p = 0.021) and there was a higher rate (34.4%) of infection (p < 0.001) in patients who developed chylothorax. In addition, a sensitivity analysis was performed comparing patients with low- and high-output chylothorax (> 20 mL/kg), which confirmed unfavorable outcomes for the latter group. Herein, we show that hemodynamic alterations were important factors for diagnosis. Understanding the risk factors, outcomes, and complications helps early identification and enables the reduction of morbidity and mortality.

PRAT tool: a harmonization of antimicrobial stewardship program interventions

Objective: The Antimicrobial Stewardship Program (ASP) in hospitals aims to promote the rational use of antimicrobials, providing better results to patients (increasing effectiveness and decreasing the risk of adverse events), hospital epidemiology (impact on levels of microbial resistance), and enable cost-effectiveness studies. Therefore, a tool (called PRAT­ antimicrobial therapy-related problem) is suggested in this paper. This unvalidated tool is the initial step towards organizing the antimicrobial therapy-related interventions to improve the use of this drug class, mainly by suggesting a harmonized registry process of ASP interventions. Methods: Therefore, this work presents the PRAT tool, developed based on the 10 years' experience of ASP at Pequeno Príncipe Hospital, inspired by the classification for drug-related problems of the Pharmaceutical Care Network Europe and according to a collaborative work using the Delphi technique. Results: This tool allows the identification and exact description of the antimicrobial therapy-related problem in 17 domains and 67 subcategories. Based on this identification, it suggests how to classify this problem (effectiveness, safety and need/indication) and what interventions can be conducted. Conclusion: This tool has the potential to establish a profile of antimicrobial-related problems, allowing prioritization to be visualized through the most (and least) interventions made in a given period, and might be useful in improving the quality of care through settings, by means of targeted educational interventions. Furthermore, if there is a harmonization of terminology for the classification of antimicrobial therapy-related problems, other hospitals can adopt it, and so the tool can improve research and comparison between institutions (benchmarking).

Standard concentration infusions of inotropic and vasoactive drugs in paediatric intensive care: a strategy for patient safety.

OBJECTIVES: To evaluate the advantages and disadvantages of using different standard concentration infusions for high-alert inotropic and vasoactive drugs in paediatric intensive care units (ICUs). METHODS: Retrospective data analysis was performed on drug prescriptions for patients in paediatric ICUs. A matrix was developed based on optimal concentration recommendations for each drug, taking into consideration solution stability and patient safety. Hypothetical volumes were calculated for three standard solutions (high concentration - HC, low concentration - LC and fluid restriction - FR) and compared to the actual administered volumes to evaluate the impact of the volumes of each standard solution for varying weight ranges in paediatric care. Finally, a risk assessment of the standard infusions was conducted using the NPSA 20 tool along with an assessment of the pharmacoeconomic impact. KEY FINDINGS: The results suggest the need for at least two standard concentrations for each of the studied drugs in order to attend to the different weight ranges and clinical conditions of paediatric patients in intensive care. CONCLUSIONS: High concentration is ideal for patients up to 20 kg. For patients over 20 kg, FR is recommended, while LC should only be used in specific situations. Modifying the hospital pharmacotherapy system to include standard solutions is safer and reduces the risks of adverse effects. The pharmacoeconomic analysis did not show any impact on costs, although a reduction in adverse effects should be considered.

Development of a self-report format of ASSIST with university students.

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a reliable and valid tool to early detection in the harmful and hazardous drug use in primary care settings when administered by interview in the general population. As the risk of substance related problems in university students is high, it is necessary to have screening instruments that can be used beyond the health care settings. Thus, we compared a self-report adaptation of ASSIST with the validated interview format in a convenience sample of university students. A counter-balance design was chosen with students alternating between the interview and the self-report formats. Both formats were completed by all students (n=170) over 30 days. The scores for total involvement, tobacco, alcohol, cannabis and cocaine obtained from the two formats demonstrated good intra-class correlation coefficient (ICC >0.60). The agreement assessed by kappa between questions of the two formats was considered moderate for tobacco (0.76) and cannabis (0.69) and discrete for alcohol (0.47). The consistency of the self-report questionnaire was also good to moderate (Cronbach's alpha of 0.90 for tobacco, 0.71 for alcohol, 0.86 for cannabis and 0.89 for cocaine) and showed acceptable sensitivity (66.7-100%) and specificity (83.5-97.1%) for tobacco, alcohol, cannabis and cocaine when compared to the ASSIST interview format (gold standard). The findings suggest that self-report version is as acceptable as the interview and that the scores on the two formats are comparable. However, the participants reported more motivation for change behavior and more concern about substance use when they were interviewed.