ABSTRACT
INTRODUCTION: In critically ill patients, nutritional support is a challenge in terms of both estimating their requirements and ensuring adherence to the prescribed treatment. OBJECTIVE: To assess the association between requirements, prescription and adherence to energy and protein supplementation based on the phase of disease in critically ill patients. SAMPLE AND METHODS: We conducted a prospective, observational and analytical study in patients aged 0-18 years admitted to the paediatric intensive or intermediate care unit in 2020-2021. We collected data on demographic and anthropometric characteristics and the phase of disease (acute phase [AP] vs. non-acute phase [nAP]), in addition to prescribing (P) (indication of nutritional support), basal metabolic rate (BMR, Schofield equation), adherence to nutritional support (A) and protein requirements (R), and calculated the following ratios: P/BMR, P/R, A/BMR, A/R, and A/P. RESULTS: The sample included 131 participants with a median age of 16 (4.5) months, of who 128 (97.7%) had comorbidities and 13 (9.9%) were in the AP. Comparing the phases of disease (AP vs. nAP), the median values for energy supplementation were P/BMR, 0.5 (IQR, 0.1-1.4) vs. 1.3 (IQR, 0.9-1.8) (P = 0.0054); A/BMR, 0.4 (IQR, 0-0.6) vs. 1.2 (IQR, 0.8-1.7) (P = 0.0005); A/P, 0.7 (IQR, 0-0.9) vs. 1 (IQR, 0.8-1) (P = 0.002), and for protein were P/R, 0.7 (IQR, 0-1.1) vs. 1.2 (0.9-1.6) (P = 0.0009); A/R 0.3 (IQR, 0-0.6) vs. 1.1 (IQR, 0.8-1.5) (P = 0.0002); A/P 0.7 (IQR, 0-1) vs. 1(IQR, 0.8-1) (P = 0.002). We found AP/nAP ratios greater than 110% for energy in the P/BMR (4 patients [30.8%]/72 patients [61%]; P = 0.007), A/BMR (3 [23%]/63 [53.4%]; P = 0.009) and A/P (1 [7%]/3 [2.5%]; P = 0.007). As for protein, more than 1.5 g/kg/day was prescribed in 3 patients (23.1%) in the AP and 71 (60.1%) in the nAP. We found adherence to the prescribed intake in 2 (15.4%) patients in the AP and 66 (56%) in the nAP. We found a correlation coefficient of 0.6 between the energy P/R and the protein P/R. Prescribed support was discontinued in 7 patients (53.8%) in the AP and 31 (26.3%) in the nAP (P = 0.002). CONCLUSIONS: The proportion of adherence to prescribed nutritional support was high in patients in the nAP of the disease. Overfeeding was frequent, more so in the nAP. We identified difficulties in adhering to prescribed support, chief of which was the discontinuation of feeding.
Subject(s)
Critical Illness , Nutritional Support , Child , Humans , Infant , Critical Illness/therapy , Nutritional Requirements , Prescriptions , Prospective Studies , Infant, Newborn , Child, Preschool , AdolescentABSTRACT
INTRODUCTION: Diabetic ketoacidosis (DKA) is the main cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM) due to clinical and biochemical alterations associated, cerebral edema as one of the most critical because of the high mortality rates and long-term neurological se quelae. OBJECTIVE: To analyze the clinical characteristics and complications of patients with DKA ad mitted to a pediatric intensive care unit. PATIENTS AND METHODS: Retrospective study of DKA patients treated at the Hospital Clínico, Pontificia Universidad Católica de Chile (UPCPUC) between 2000 and 2015. Demographic characteristics, clinical manifestations, biochemical alterations, treatment, complications, and prognosis were assessed. Patients with T1DM onset were compared with those patients already diagnosed with diabetes, analyzing variables according to distribution. RESULTS: 46 DKA events were identified, 67% of them were the first episode of DKA. 66% of patients already diagnosed with diabetes were admitted due to poor adherence to treatment. The main symptoms described were: 63% polydipsia, 56% polyuria, 48% vomiting, 39% weight loss and 35% abdominal pain, and mean blood sugar levels of 522 mg/dL, pH 7.17, and plasma osmolality of 305 mOsm/L. 89% of patients received insulin infusion, and 37% presented hypokalemia. No episodes of cerebral edema or deaths were registered. CONCLUSIONS: Most of the DKA admissions were due to T1DM onset. In the group of patients already diagnosed with diabetes, the poor adherence to treatment was the main cause of decompensation. There were no serious complications or deaths associated with DKA management during the studied period. Early diagnosis and proper and standardized treatment contributed to reducing morbidity and mortality in children with DKA.
Subject(s)
Diabetic Ketoacidosis/diagnosis , Adolescent , Child , Child, Preschool , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/etiology , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/therapy , Female , Humans , Infant , Intensive Care Units , Male , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCCIÓN: La cetoacidosis (CAD) es la principal causa de morbimortalidad en niños con diabetes mellitus tipo 1 (DM1) debido a las alteraciones bioquímicas asociadas, siendo el más temido el edema cerebral, con altas tasas de mortalidad y secuelas neurológicas a largo plazo. OBJETIVO: caracterizar el perfil clínico y las complicaciones de pacientes con CAD ingresados en una unidad de paciente crítico pediátrico. PACIENTES Y MÉTODO: Revisión retrospectiva de pacientes con CAD atendidos en el Hospital Clínico de la Pontificia Universidad Católica de Chile (UPCPUC) entre los años 2000 y 2015. Se evaluaron características demográficas, manifestaciones clínicas, alteraciones bioquímicas, tratamiento, complicaciones y pronóstico. Se compararon pacientes con debut de DM1 versus diabéticos conocidos, analizándose variables según distribución. RESULTADOS: Se identificaron 46 episodios de CAD. El 67% de éstos correspondió a un debut de DM1. El 66% de los diabéticos conocidos ingresaron por mala adherencia al tratamiento. Los principales síntomas de presentación fueron: 63% polidipsia, 56% poliuria, 48% vómitos, 39% pérdida de peso y 35% dolor abdominal, con medias de Glicemia 522 mg/dL, pH 7,17 y osmolaridad plasmática 305 mOsm/L. El 89% recibió insulina en infusión. El 37% presentó hipokalemia. No se registraron episodios de edema cerebral ni muertes. CONCLUSIONES: La mayoría de los ingresos por CAD correspondió a debut de DM1. En el grupo de diabéticos conocidos, la mala adherencia al tratamiento fue la principal causa de descompensación. No se presentaron complicaciones graves ni muertes asociadas al manejo de la CAD durante el período estudiado. El diagnóstico precoz y el tratamiento adecuado y estandarizado pudieran contribuir a reducir la morbilidad y mortalidad en niños con CAD.
INTRODUCTION: Diabetic ketoacidosis (DKA) is the main cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM) due to clinical and biochemical alterations associated, cerebral edema as one of the most critical because of the high mortality rates and long-term neurological se quelae. OBJECTIVE: To analyze the clinical characteristics and complications of patients with DKA ad mitted to a pediatric intensive care unit. PATIENTS AND METHODS: Retrospective study of DKA patients treated at the Hospital Clínico, Pontificia Universidad Católica de Chile (UPCPUC) between 2000 and 2015. Demographic characteristics, clinical manifestations, biochemical alterations, treatment, complications, and prognosis were assessed. Patients with T1DM onset were compared with those patients already diagnosed with diabetes, analyzing variables according to distribution. RESULTS: 46 DKA events were identified, 67% of them were the first episode of DKA. 66% of patients already diagnosed with diabetes were admitted due to poor adherence to treatment. The main symptoms described were: 63% polydipsia, 56% polyuria, 48% vomiting, 39% weight loss and 35% abdominal pain, and mean blood sugar levels of 522 mg/dL, pH 7.17, and plasma osmolality of 305 mOsm/L. 89% of patients received insulin infusion, and 37% presented hypokalemia. No episodes of cerebral edema or deaths were registered. CONCLUSIONS: Most of the DKA admissions were due to T1DM onset. In the group of patients already diagnosed with diabetes, the poor adherence to treatment was the main cause of decompensation. There were no serious complications or deaths associated with DKA management during the studied period. Early diagnosis and proper and standardized treatment contributed to reducing morbidity and mortality in children with DKA.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Diabetic Ketoacidosis/diagnosis , Prognosis , Retrospective Studies , Treatment Outcome , Diabetic Ketoacidosis/etiology , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/therapy , Diabetes Mellitus, Type 1/complications , Intensive Care UnitsABSTRACT
BACKGROUND: The most used test for the diagnosis of viral respiratory infection is the detection of viral antigens by direct immunofluorescence (DFA), in samples taken by nasopharyngeal swab (NPS) or aspirate (NPA). It would be desirable to have a less uncomfortable technique to obtain a sample from the patient, but of equal performance. AIM: To evaluate the diagnostic agreement between nasal swab (NS) and nasopharyngeal swab (NPS) in the detection of respiratory viruses by DFA and compare the degree of discomfort of both techniques in pediatric patients. METHODOLOGY: Cross-sectional study in children who consulted to a pediatric emergency service with respiratory symptoms. Two samples (NPS and NS) per child were collected. The concordance between the two was determined by Kappa (K) coefficient and the degree of discomfort by a visual pain scale. RESULTS: We obtained 112 samples from 56 children, one by each technique. 82.1% were concordant, K = 0.61 (CI 95%, 0.39-0.83) for the detection of any virus, and K = 0.69 (CI 95%, 0.46-0.92) and K = 0.76 (CI 95%, 0.51-1) for syncytial respiratory virus and influenza A detection, respectively. The degree of discomfort was significantly lower for the NS. CONCLUSION: There is considerable agreement in the detection of respiratory viruses by DFA between samples obtained by NS and NPS, but not enough to recommend a change in the sampling method in this population.
Subject(s)
Nasal Mucosa/virology , Nasopharynx/virology , Respiratory Tract Infections/diagnosis , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Fluorescent Antibody Technique, Direct , Humans , Infant , Infant, Newborn , Male , Respiratory Tract Infections/virology , Sensitivity and Specificity , Specimen HandlingABSTRACT
Background: The most used test for the diagnosis of viral respiratory infection is the detection of viral antigens by direct immunofluorescence (DFA), in samples taken by nasopharyngeal swab (NPS) or aspirate (NPA). It would be desirable to have a less uncomfortable technique to obtain a sample from the patient, but of equal performance. Aim: To evaluate the diagnostic agreement between nasal swab (NS) and nasopharyngeal swab (NPS) in the detection of respiratory viruses by DFA and compare the degree of discomfort of both techniques in pediatric patients. Methodology: Cross-sectional study in children who consulted to a pediatric emergency service with respiratory symptoms. Two samples (NPS and NS) per child were collected. The concordance between the two was determined by Kappa (K) coefficient and the degree of discomfort by a visual pain scale. Results: We obtained 112 samples from 56 children, one by each technique. 82.1% were concordant, K = 0.61 (CI95%, 0.39-0.83) for the detection of any virus, and K = 0.69 (CI 95%, 0.46- 0.92) and K = 0.76 (CI 95%, 0.51-1) for syncytial respiratory virus and influenza A detection, respectively. The degree of discomfort was significantly lower for the NS. Conclusion: There is considerable agreement in the detection of respiratory viruses by DFA between samples obtained by NS and NPS, but not enough to recommend a change in the sampling method in this population.
Introducción: El examen más utilizado para el diagnóstico de infecciones respiratorias virales es la detección de antígenos virales por inmunofluorescencia directa (IFD) en muestras tomadas por hisopado nasofaríngeo (HNF) o aspirado (ANF). Sería deseable contar con una técnica de toma de muestra menos molesta para el paciente pero de igual rendimiento que las mencionadas. Objetivo: Evaluar la concordancia diagnóstica entre hisopado nasal (HN) e HNF en la detección de virus respiratorios por IFD y comparar el grado de molestia de ambas técnicas en pacientes pediátricos. Métodos: Estudio transversal en niños que consultaron en una urgencia pediátrica por síntomas respiratorios agudos. Se recolectaron dos muestras (por HNF y HN) por cada niño para detección viral mediante IFD. Se determinó la concordancia entre ambas mediante coeficiente Kappa (K) y se analizó el grado de molestia que causa la toma de muestra con escala visual. Resultados: Se obtuvo 112 muestras en 56 niños, una por cada técnica. La concordancia entre ellas fue de 82,1%, con un K = 0,61 (IC95% 0,39-0,83) para la detección de cualquier virus, K = 0,69 (IC 95% 0,46- 0,92) para virus respiratorio sincicial y K = 0,76 (IC 95% 0,51-1) para influenza A. El grado de molestia fue significativamente menor para el HN. Conclusiones: Existe una concordancia considerable en la detección de virus respiratorios mediante IFD en muestras tomadas por HNF como HN, pero insuficiente como para recomendar un cambio de metodología de la toma de muestra en esta población.
