ABSTRACT
Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4-36.3).
ABSTRACT
El síndrome inflamatorio multisistémico en niños y adolescentes temporalmente relacionado con COVID-19 es una presentacioÌn clínica de la infeccioÌn por SARS-CoV-2. Comparte algunas características con la enfermedad de Kawasaki, el shock toÌxico, la sepsis, el síndrome de activacioÌn macrofágica y la miocarditis. Son escasas las publicaciones que abordan su manejo inicial, que tiene semejanzas con el propuesto para el shock seÌptico. Esta revisioÌn analiza dicho abordaje basado en las características propias del síndrome inflamatorio multisisteÌmico relacionado con COVID-19, de acuerdo con el paradigma de construccioÌn de una "guía de práctica institucional", y sugiere estrategias de aproximacioÌn terapeÌutica, que incluyen deteccioÌn temprana, estabilizacioÌn, referencia, tratamiento específico y análisis de proceso
Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that proposed for septic shock. This review analyzes such approach based on the characteristics typical of multisystem inflammatory syndrome related to COVID-19 in accordance with the paradigm of an "institutional practice guideline" and suggests therapeutic approach strategies, including early detection, stabilization, referral, specific treatment, and process analysis.
Subject(s)
Humans , Male , Female , Child , Adolescent , Coronavirus Infections/therapy , Referral and Consultation , Shock, Septic/physiopathology , Shock, Septic/therapy , Coronavirus Infections/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/therapyABSTRACT
Resumen El enfoque moderno de la sepsis se ha centrado en la creación de consensos globales que utilizan distintos criterios para pesquisarla en forma precoz, con el fin de disminuir la morbimortalidad asociada a ella. Hasta la aparición del tercer y último consenso de adultos (Sepsis-3), el síndrome de respuesta inflamatoria sistémica (SIRS) fue el pilar diagnóstico utilizado por defecto en todas las edades. En Sepsis-3 se decidió retirar el SIRS, lo que generó un debate internacional sobre la oportunidad de dicho cambio. Esta revisión narrativa desarrolla la historia de las distintas definiciones de sepsis centradas en SIRS, las fortalezas, las debilidades y la pertinencia de los distintos elementos que ocasionaron el debate. Dada la ausencia de actualizaciones pediátricas en Sepsis-3, se hace especial énfasis en las implicaciones para las futuras definiciones de sepsis en esta etapa de la vida.
Abstract The modern approach to sepsis has focused on creating a global consensus with different criteria to early investigate it in order to reduce the morbidity and mortality associated with this complex entity. Until the third and last consensus of adults (Sepsis-3), the systemic inflammatory response syndrome (SIRS) was the diagnostic pillar used by default for all ages. In Sepsis-3, it was decided to withdraw the SIRS, which generated an international debate about the timing of such change. This narrative review develops the history of the different definitions of sepsis focused on SIRS, their strengths and weaknesses, and the relevance of the different elements that caused the debate. Given the absence of pediatric updates in Sepsis-3, a particular emphasis is placed on the implications for future definitions of sepsis at this stage of life
Subject(s)
Child , Humans , Systemic Inflammatory Response Syndrome , Sepsis , Hospital Mortality , Systemic Inflammatory Response Syndrome/diagnosis , Sepsis/diagnosisABSTRACT
Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that proposed for septic shock. This review analyzes such approach based on the characteristics typical of multisystem inflammatory syndrome related to COVID-19 in accordance with the paradigm of an "institutional practice guideline" and suggests therapeutic approach strategies, including early detection, stabilization, referral, specific treatment, and process analysis.
El síndrome inflamatorio multisistémico en niños y adolescentes temporalmente relacionado con COVID-19 es una presentación clínica de la infección por SARS-CoV-2. Comparte algunas características con la enfermedad de Kawasaki, el shock tóxico, la sepsis, el síndrome de activación macrofágica y la miocarditis. Son escasas las publicaciones que abordan su manejo inicial, que tiene semejanzas con el propuesto para el shock séptico. Esta revisión analiza dicho abordaje basado en las características propias del síndrome inflamatorio multisistémico relacionado con COVID-19, de acuerdo con el paradigma de construcción de una "guía de práctica institucional", y sugiere estrategias de aproximación terapéutica, que incluyen detección temprana, estabilización, referencia, tratamiento específico y análisis de procesos.
Subject(s)
COVID-19/therapy , Practice Guidelines as Topic , Systemic Inflammatory Response Syndrome/therapy , Adolescent , COVID-19/physiopathology , Child , Humans , Referral and Consultation , Shock, Septic/physiopathology , Shock, Septic/therapy , Systemic Inflammatory Response Syndrome/physiopathologyABSTRACT
The modern approach to sepsis has focused on creating a global consensus with different criteria to early investigate it in order to reduce the morbidity and mortality associated with this complex entity. Until the third and last consensus of adults (Sepsis-3), the systemic inflammatory response syndrome (SIRS) was the diagnostic pillar used by default for all ages. In Sepsis-3, it was decided to withdraw the SIRS, which generated an international debate about the timing of such change. This narrative review develops the history of the different definitions of sepsis focused on SIRS, their strengths and weaknesses, and the relevance of the different elements that caused the debate. Given the absence of pediatric updates in Sepsis-3, a particular emphasis is placed on the implications for future definitions of sepsis at this stage of life.
El enfoque moderno de la sepsis se ha centrado en la creación de consensos globales que utilizan distintos criterios para pesquisarla en forma precoz, con el fin de disminuir la morbimortalidad asociada a ella. Hasta la aparición del tercer y último consenso de adultos (Sepsis-3), el síndrome de respuesta inflamatoria sistémica (SIRS) fue el pilar diagnóstico utilizado por defecto en todas las edades. En Sepsis-3 se decidió retirar el SIRS, lo que generó un debate internacional sobre la oportunidad de dicho cambio. Esta revisión narrativa desarrolla la historia de las distintas definiciones de sepsis centradas en SIRS, las fortalezas, las debilidades y la pertinencia de los distintos elementos que ocasionaron el debate. Dada la ausencia de actualizaciones pediátricas en Sepsis-3, se hace especial énfasis en las implicaciones para las futuras definiciones de sepsis en esta etapa de la vida.
Subject(s)
Sepsis , Systemic Inflammatory Response Syndrome , Child , Hospital Mortality , Humans , Sepsis/diagnosis , Systemic Inflammatory Response Syndrome/diagnosisABSTRACT
OBJECTIVES: To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. DESIGN: Expert consensus recommendations with Delphi methodology. SETTING: Latin American countries. SUBJECTS: Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. INTERVENTIONS: Delphi methodology for expert consensus. MEASUREMENTS AND MAIN RESULTS: The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7-9), moderate agreement (score 4-6), and disagreement (score 1-3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. CONCLUSIONS: This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.
Subject(s)
Cardiopulmonary Resuscitation/methods , Critical Care/methods , Consensus , Delphi Technique , Humans , Latin America , Practice Guidelines as Topic , Societies, MedicalABSTRACT
RATIONALE: Limited data exist about the international burden of severe sepsis in critically ill children. OBJECTIVES: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials. METHODS: A point prevalence study was conducted on 5 days throughout 2013-2014 at 128 sites in 26 countries. Patients younger than 18 years of age with severe sepsis as defined by consensus criteria were included. Outcomes were severe sepsis point prevalence, therapies used, new or progressive multiorgan dysfunction, ventilator- and vasoactive-free days at Day 28, functional status, and mortality. MEASUREMENTS AND MAIN RESULTS: Of 6,925 patients screened, 569 had severe sepsis (prevalence, 8.2%; 95% confidence interval, 7.6-8.9%). The patients' median age was 3.0 (interquartile range [IQR], 0.7-11.0) years. The most frequent sites of infection were respiratory (40%) and bloodstream (19%). Common therapies included mechanical ventilation (74% of patients), vasoactive infusions (55%), and corticosteroids (45%). Hospital mortality was 25% and did not differ by age or between developed and resource-limited countries. Median ventilator-free days were 16 (IQR, 0-25), and vasoactive-free days were 23 (IQR, 12-28). Sixty-seven percent of patients had multiorgan dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multiorgan dysfunction. Among survivors, 17% developed at least moderate disability. Sample sizes needed to detect a 5-10% absolute risk reduction in outcomes within interventional trials are estimated between 165 and 1,471 [corrected] patients per group. CONCLUSIONS: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted.
Subject(s)
Global Health/statistics & numerical data , Multiple Organ Failure/epidemiology , Sepsis/epidemiology , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Databases, Factual , Hospital Mortality , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric/statistics & numerical data , Multiple Organ Failure/microbiology , Multiple Organ Failure/mortality , Outcome and Process Assessment, Health Care/statistics & numerical data , Prevalence , Prospective Studies , Respiration, Artificial/statistics & numerical data , Sepsis/microbiology , Sepsis/mortalityABSTRACT
OBJECTIVES: In 2002, the Surviving Sepsis Campaign pointed out the need to recognize sepsis as an important cause of death and high economic and social costs. There are few epidemiologic studies of this disease in pediatrics and none in Colombia. The objective of this study was to describe the sociodemographic and clinical characteristics of patients with sepsis who were admitted at participating pediatric intensive care units. DESIGN: Prospective study. SETTING AND PATIENTS: A Web site, http://www.sepsisencolombia.com, was created, in which 19 pediatric intensive care units from the ten principal cities in the country reported epidemiologic data about patients with sepsis between March 1, 2009, and February 28, 2010. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 1,051 patients. Of these, 55% were male. Fifty-six percent came from urban areas. Fifty-six percent were <2 yrs of age. Seventy-six percent belonged to a low socioeconomic strata and 44% received government-subsidized health insurance. Forty-eight percent of patients had septic shock, 25% severe sepsis, and 27% sepsis. Forty-three percent were diagnosed with multiple organ dysfunction syndrome. In 54%, the infection was of respiratory origin followed by the abdomen as the site of origin in 18% of the patients. In almost 50%, the etiological agent was detected with Gram-negative bacteria being the most frequent and of highest mortality. Fifty percent had some type of relevant pathologic antecedent. Eleven percent had an invasive device on admission. Sixty-eight percent of the patients required mechanical ventilation. Mortality rate was 18%. The most important risk factors for mortality were age under 2 yrs, presence of shock or multiple organ dysfunction syndrome, and presence of Gram-negative bacteria. CONCLUSIONS: Sepsis is common in Colombian pediatric intensive care units. Clear risk factors for getting sick and dying from this disease were identified. Mortality resulting from this disease is considerable for a developing society like ours.
