Implications of sedation during the use of noninvasive ventilation in children with acute respiratory failure (SEDANIV Study).

BACKGROUND: The objective of this study was to analyze the effects of sedation administration on clinical parameters, comfort status, intubation requirements, and the pediatric intensive care unit (PICU) length of stay (LOS) in children with acute respiratory failure (ARF) receiving noninvasive ventilation (NIV). METHODS: Thirteen PICUs in Spain participated in a prospective, multicenter, observational trial from January to December 2021. Children with ARF under the age of five who were receiving NIV were included. Clinical information and comfort levels were documented at the time of NIV initiation, as well as at 3, 6, 12, 24, and 48 h. The COMFORT-behavior (COMFORT-B) scale was used to assess the patients' level of comfort. NIV failure was considered to be a requirement for endotracheal intubation. RESULTS: A total of 457 patients were included, with a median age of 3.3 months (IQR 1.3-16.1). Two hundred and thirteen children (46.6%) received sedation (sedation group); these patients had a higher heart rate, higher COMFORT-B score, and lower SpO2/FiO2 ratio than did those who did not receive sedation (non-sedation group). A significantly greater improvement in the COMFORT-B score at 3, 6, 12, and 24 h, heart rate at 6 and 12 h, and SpO2/FiO2 ratio at 6 h was observed in the sedation group. Overall, the NIV success rate was 95.6%-intubation was required in 6.1% of the sedation group and in 2.9% of the other group (p = 0.092). Multivariate analysis revealed that the PRISM III score at NIV initiation (OR 1.408; 95% CI 1.230-1.611) and respiratory rate at 3 h (OR 1.043; 95% CI 1.009-1.079) were found to be independent predictors of NIV failure. The PICU LOS was correlated with weight, PRISM III score, respiratory rate at 12 h, SpO2 at 3 h, FiO2 at 12 h, NIV failure and NIV duration. Sedation use was not found to be independently related to NIV failure or to the PICU LOS. CONCLUSIONS: Sedation use may be useful in children with ARF treated with NIV, as it seems to improve clinical parameters and comfort status but may not increase the NIV failure rate or PICU LOS, even though sedated children were more severe at technique initiation in the present sample.

Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock.

Hemorrhagic shock is a leading cause of morbidity and mortality in pediatric patients. Interpretation of the clinical indicators validated in adults to guide resuscitation and comparison between different therapies is difficult in children due to the inherent heterogeneity of this population. As a result, compared to adults, appropriate management of pediatric hemorrhagic shock is still not well established. In addition, the scarcity of pediatric patients with hemorrhagic shock precludes the development of clinically relevant studies. For this reason, an experimental pediatric animal model is necessary to study the effects of hemorrhage in children as well as their response to different therapies. We present an infant animal model of volume-controlled hemorrhagic shock in anesthetized young pigs. Hemorrhage is induced by withdrawing a previously calculated blood volume, and the pig is subsequently monitored and resuscitated with different therapies. Here, we describe a precise and highly reproducible model of hemorrhagic shock in immature swine. The model yields hemodynamic data that characterizes compensatory mechanisms that are activated in response to severe hemorrhage.

Microcirculatory Changes in Pediatric Patients During Congenital Heart Defect Corrective Surgery.

A prospective, observational single-center study was carried out. Pediatric patients undergoing congenital heart defect surgery were evaluated before, during, and after surgery. At each time point, sublingual microcirculation and clinical parameters were assessed, along with analytical variables. Twenty-four patients were included. All microcirculatory parameters worsened during cardiopulmonary bypass and returned to baseline values after surgery (p ≤ 0.001). In the intraoperative evaluation, body temperature correlated with perfused small vessel density (p = 0.014), proportion of perfused small vessels (p < 0.001), small vessel microvascular flow index (p = 0.003), and small vessel heterogeneity index (p < 0.002). Patients with cyanotic disease exhibited higher small vessel density (p < 0.008) and higher density of perfused small vessels (p < 0.022) at baseline, and a lower microvascular flow index (p = 0.022) and higher heterogeneity (p = 0.026) in the intraoperative phase. Children with congenital heart disease exhibited decreased vascular density and microvascular blood flow and increased heterogeneity during cardiopulmonary bypass. All these parameters returned to baseline values after surgery.

Diffuse persistent pulmonary interstitial emphysema secondary to mechanical ventilation in bronchiolitis.

BACKGROUND: Persistent interstitial pulmonary emphysema (PIE) is a rare disease and it is even more uncommon in full-term infants, like our patient. When conservative management is not successful, surgical treatment should be considered. In our case, ECMO support was iniciated to keep the patient ventilated in order to allow the lung to heal using lung protection strategies. CASE PRESENTATION: We report an 18-day-old male infant with bronchiolitis that required mechanical ventilation with high positive airway pressures due to severe respiratory insufficiency. Chest X-rays and computed tomography scan revealed a severely hyperinflated left lung with extensive destructive changes and multiple small bullae. These findings were consistent with diffuse persistent interstitial emphysema (PIE), probably due to mechanical ventilation. The patient required high frequency oscillatory ventilation, inotropic support and continuous renal replacement therapy. He eventually suffered a cardiac arrest that required cardiopulmonary resuscitation and ECMO during 5 days with progressive clinical improvement and normalization of the X-ray. CONCLUSION: We present a patient with diffuse persistent interstitial emphysema who, despite an unfavorable evolution with different mechanical ventilation strategies, had a good response after ECMO assistance.

Piedra blanca genital / Genital white piedra

ANTECEDENTES: la piedra blanca es una micosis caracterizada por la presencia de nódulos de color blanco a pardo claro, adheridos a los pelos de la región genital, axilas, cejas, pestañas y cuero cabelludo, es causada principalmente por Trichosporon inkin y Trichosporon ovoides. PRESENTACIÓN DEL CASO: paciente del sexo femenino de 35 años, originaria de San Pedro Sula, Honduras, de buena presencia física y buenos hábitos higiénicos, acude a consulta por presentar nódulos en los pelos púbicos, asintomáticos, de 2 meses de evolución. Al examen físico se pudo observar la presencia de nódulos de color blanquecino a pardo claro, blandos, de 1 a 2 mm, que rodeaban los pelos. No se detectó fluorescencia de los pelos a la luz de Wood. Al examen microscópico se observaron blastoconidios y artroconidios; en el cultivo se obtuvo el crecimiento de colonias levaduriformes, elevadas, de aspecto cerebriforme; en el microcultivo en agar extracto de malta se observaron hifas hialinas, tabicadas que formaban apresorios, pseudohifas fragmentadas, artroconidios rectangulares y blastoconidios. Mediante el sistema API ID32C fue identificado como Trichosporon inkin. Se instauró tratamiento con crema de isoconazol, previo rasurado del vello púbico. Los exámenes realizados al final del tratamiento fueron negativos. CONCLUSIONES: se presenta un caso de piedra blanca genital en el sexo femenino y se hace una actualización sobre la taxonomía del género Trichosporon sobre la base de los estudios moleculares, se discute el papel de T. inkin en esta micosis y su relevancia creciente como agente de infecciones invasivas en pacientes inmunocomprometidos, así como la importancia del diagnóstico de laboratorio para la confirmación de los casos.

INTRODUCTION: white piedra is a type of mycosis characterized by white to light brown nodules attached the hair shafts of genitals, axilla, eyelashes, eyebrowns, and scalp and is mainly caused by Trichosporon inkin and Trichosporon ovoides. CASE PRESENTATION: a 35 years-old female with good physical condition and good hygienic habits, who came from San Pedro Sula in Honduras, went to the doctor because of some nodules in their genital hair, asymptomatic, two months of evolution. On physical examination, it was observed that there were white-to-light brown coloured nodules measuring 1-2mm and surrounding the hair shafts. No fluorescence was detected in the hair on Wood´s light. On microscopic examination, blastoconidia and arthroconidia were observed; the culture yielded the growth of elevated yeastlike colonies; the microculture in malt extract agar showed disarticulating hyaline hyphae, partitioned appressoria, fragmented pseudohyphae, rectangular arthroconidia and blastoconidia. Through the API ID32C system, it was identified as Trichosporon inkin. The patient was treated with Isoconazole cream after her genital hair had been shaved. At the end of treatment, the exam results were negative. CONCLUSIONS: the case of a female with genital white piedra was presented and an updating on Trichosporon genus taxonomy on the basis of molecular studies. The role of T. inkin in this mycosis, and its growing importance as an agent of invasive infections in immunocompromised patients, as well as the relevance of lab diagnosis to confirm cases, were discussed.

Piedra blanca genital / Genital white piedra

ANTECEDENTES: la piedra blanca es una micosis caracterizada por la presencia de nódulos de color blanco a pardo claro, adheridos a los pelos de la región genital, axilas, cejas, pestañas y cuero cabelludo, es causada principalmente por Trichosporon inkin y Trichosporon ovoides. PRESENTACIÓN DEL CASO: paciente del sexo femenino de 35 años, originaria de San Pedro Sula, Honduras, de buena presencia física y buenos hábitos higiénicos, acude a consulta por presentar nódulos en los pelos púbicos, asintomáticos, de 2 meses de evolución. Al examen físico se pudo observar la presencia de nódulos de color blanquecino a pardo claro, blandos, de 1 a 2 mm, que rodeaban los pelos. No se detectó fluorescencia de los pelos a la luz de Wood. Al examen microscópico se observaron blastoconidios y artroconidios; en el cultivo se obtuvo el crecimiento de colonias levaduriformes, elevadas, de aspecto cerebriforme; en el microcultivo en agar extracto de malta se observaron hifas hialinas, tabicadas que formaban apresorios, pseudohifas fragmentadas, artroconidios rectangulares y blastoconidios. Mediante el sistema API ID32C fue identificado como Trichosporon inkin. Se instauró tratamiento con crema de isoconazol, previo rasurado del vello púbico. Los exámenes realizados al final del tratamiento fueron negativos. CONCLUSIONES: se presenta un caso de piedra blanca genital en el sexo femenino y se hace una actualización sobre la taxonomía del género Trichosporon sobre la base de los estudios moleculares, se discute el papel de T. inkin en esta micosis y su relevancia creciente como agente de infecciones invasivas en pacientes inmunocomprometidos, así como la importancia del diagnóstico de laboratorio para la confirmación de los casos(AU)

INTRODUCTION: white piedra is a type of mycosis characterized by white to light brown nodules attached the hair shafts of genitals, axilla, eyelashes, eyebrowns, and scalp and is mainly caused by Trichosporon inkin and Trichosporon ovoides. CASE PRESENTATION: a 35 years-old female with good physical condition and good hygienic habits, who came from San Pedro Sula in Honduras, went to the doctor because of some nodules in their genital hair, asymptomatic, two months of evolution. On physical examination, it was observed that there were white-to-light brown coloured nodules measuring 1-2mm and surrounding the hair shafts. No fluorescence was detected in the hair on Wood´s light. On microscopic examination, blastoconidia and arthroconidia were observed; the culture yielded the growth of elevated yeastlike colonies; the microculture in malt extract agar showed disarticulating hyaline hyphae, partitioned appressoria, fragmented pseudohyphae, rectangular arthroconidia and blastoconidia. Through the API ID32C system, it was identified as Trichosporon inkin. The patient was treated with Isoconazole cream after her genital hair had been shaved. At the end of treatment, the exam results were negative. CONCLUSIONS: the case of a female with genital white piedra was presented and an updating on Trichosporon genus taxonomy on the basis of molecular studies. The role of T. inkin in this mycosis, and its growing importance as an agent of invasive infections in immunocompromised patients, as well as the relevance of lab diagnosis to confirm cases, were discussed(AU)