Respiración de Cheyne-Stokes en una adolescente con insuficiencia cardíaca secundaria a miocardiopatía dilatada que requirió trasplante cardíaco / Cheyne-Stokes respiration in an adolescent with heart failure secondary to dilated cardiomyopathy requiring heart transplantation

La respiración de Cheyne-Stokes es una variante cíclica o tipo de apnea central del sueño poco frecuente en la población pediátrica. Se describe a una paciente de 12 años con insuficiencia cardíaca grave relacionada con miocardiopatía dilatada que demostró trastornos del sueño con características de respiración de Cheyne-Stokes, que se resolvieron completamente después del trasplante cardíaco.

Cheyne-Stokes respiration is a cyclic variant or type of central sleep apnea rare in pediatric population. We describe a 12-year-old female patient with severe heart failure related to dilated cardiomyopathy who demonstrated sleep disorders with Cheyne-Stokes breathing features, which completely resolved following cardiac transplantation.

[Cheyne-Stokes respiration in an adolescent with heart failure secondary to dilated cardiomyopathy requiring heart transplantation]. / Respiración de Cheyne-Stokes en una adolescente con insuficiencia cardíaca secundaria a miocardiopatía dilatada que requirió trasplante cardíaco.

Cheyne-Stokes respiration is a cyclic variant or type of central sleep apnea rare in pediatric population. We describe a 12-yearold female patient with severe heart failure related to dilated cardiomyopathy who demonstrated sleep disorders with Cheyne-Stokes breathing features, which completely resolved following cardiac transplantation.

La respiración de Cheyne-Stokes es una variante cíclica o tipo de apnea central del sueño poco frecuente en la población pediátrica. Se describe a una paciente de 12 años con insuficiencia cardíaca grave relacionada con miocardiopatía dilatada que demostró trastornos del sueño con características de respiración de Cheyne-Stokes, que se resolvieron completamente después del trasplante cardíaco.

Use of a Humanized Anti-CD6 Monoclonal Antibody (Itolizumab) in Elderly Patients with Moderate COVID-19.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a recent outbreak of coronavirus disease (COVID-19). In Cuba, the first case of COVID-19 was reported on March 11, 2020. Elderly individuals with multiple comorbidities are particularly susceptible to adverse clinical outcomes in the course of SARS-CoV-2 infection. During the outbreak, a local transmission event took place in a nursing home in Villa Clara province, Cuba, in which 19 elderly residents tested positive for SARS-CoV-2. METHODS: Based on the increased susceptibility to cytokine release syndrome, inducing respiratory and systemic complications in this population, 19 patients were included in an expanded access clinical trial to receive itolizumab, an anti-CD6 monoclonal antibody. RESULTS: All patients had underlying medical conditions. The product was well tolerated. After the first dose, the course of the disease was favorable, and 18 of the 19 patients (94.7%) were discharged clinically recovered with negative real-time reverse transcription polymerase chain reaction test results at 13 days. After one dose of itolizumab, circulating IL-6 decreased within the first 24-48 h in patients with high baseline values, whereas in patients with low levels, this concentration remained over low values. To preliminarily assess the effect of itolizumab, a control group was selected among the Cuban COVID-19 patients that did not receive immunomodulatory therapy. The control subjects were well matched regarding age, comorbidities, and severity of the disease. The percentage of itolizumab-treated, moderately ill patients who needed to be admitted to the intensive care unit was only one-third of that of the control group not treated with itolizumab. Additionally, treatment with itolizumab reduced the risk of death 10 times as compared with the control group. CONCLUSION: This study corroborates that the timely use of itolizumab in combination with other antivirals reduces COVID-19 disease worsening and mortality. The humanized antibody itolizumab emerges as a therapeutic alternative for patients with COVID-19. Our results suggest the possible use of itolizumab in patients with cytokine release syndrome from other pathologies.

Estado actual del soporte neurológico crítico en pediatría en la Argentina / Current status of pediatric neurocritical care in Argentina

Introducción. Los pacientes con lesiones neurocríticas representan el 10-16 % de los ingresos a unidades de cuidados intensivos pediátricas (UCIP) y, frecuentemente, requieren neuromonitoreo. Objetivo. Describir el estado actual del neuromonitoreo en la Argentina. Métodos. Encuesta con 37 preguntas sobre neuromonitoreo sin incluir datos de pacientes. Período: abril-junio, 2017. Resultados. Se recibieron 38 respuestas a 71 solicitudes (14 distritos con 11498 egresos anuales). La relación camas de UCIP/hospitalarias fue 21,9 (rango: 4,2-66,7). El 74 % fueron públicas; el 61 %, universitarias, y el 71 %, nivel 1. La disponibilidad fue similar entre públicas y privadas (porcentajes): presión intracraneana (95), electroencefalografía (92), doppler transcraneano (53), potenciales evocados (50), saturación yugular (47) e índice bispectral (11). El principal motivo de monitoreo fue trauma. Conclusión. Excepto la presión intracraneana y la electroencefalografía, los recursos de neuromonitoreo son escasos y la disponibilidad de neurocirugía activa es mínima. Se necesita un registro nacional de UCIP.

Introduction. Patients with neurocritical injuries account for 10-16 % of pediatric intensive care unit (PICU) admissions and frequently require neuromonitoring. Objective. To describe the current status of neuromonitoring in Argentina. Methods. Survey with 37 questions about neuromonitoring without including patients' data. Period: April-June 2017. Results. Thirty-eight responses were received out of 71requests (14districts with 11498annual discharges). The PICU/hospital bed ratio was 21.9 (range: 4.2-66.7). Seventy-four percent of PICUs were public; 61%, university-affiliated; and 71%, levelI. The availability of monitoring techniques was similar between public and private (percentages): intracranial pressure (95), electroencephalography (92), transcranial Doppler (53), evoked potentials (50), jugular saturation (47), and bispectral index(11). Trauma was the main reason for monitoring. Conclusion. Except for intracranial pressure and electroencephalography, neuromonitoring resources are scarce and active neurosurgery availability is minimal. A PICU national registry is required.

Current status of pediatric neurocritical care in Argentina. / Estado actual del soporte neurológico crítico en pediatría en la Argentina.

INTRODUCTION: Patients with neurocritical injuries account for 10-16 % of pediatric intensive care unit (PICU) admissions and frequently require neuromonitoring. OBJECTIVE: To describe the current status of neuromonitoring in Argentina. METHODS: Survey with 37 questions about neuromonitoring without including patients' data. Period: April-June 2017. RESULTS: Thirty-eight responses were received out of 71 requests (14 districts with 11 498 annual discharges). The PICU/hospital bed ratio was 21.9 (range: 4.2-66.7). Seventy-four percent of PICUs were public; 61 %, university-affiliated; and 71 %, level I. The availability of monitoring techniques was similar between public and private (percentages): intracranial pressure (95), electroencephalography (92), transcranial Doppler (53), evoked potentials (50), jugular saturation (47), and bispectral index (11). Trauma was the main reason for monitoring. CONCLUSION: Except for intracranial pressure and electroencephalography, neuromonitoring resources are scarce and active neurosurgery availability is minimal. A PICU national registry is required.

Introducción. Los pacientes con lesiones neurocríticas representan el 10-16 % de los ingresos a unidades de cuidados intensivos pediátricas (UCIP) y, frecuentemente, requieren neuromonitoreo. Objetivo. Describir el estado actual del neuromonitoreo en la Argentina. Métodos. Encuesta con 37 preguntas sobre neuromonitoreo sin incluir datos de pacientes. Período: abril-junio, 2017. Resultados. Se recibieron 38 respuestas a 71 solicitudes (14 distritos con 11 498 egresos anuales). La relación camas de UCIP/hospitalarias fue 21,9 (rango: 4,2-66,7). El 74 % fueron públicas; el 61 %, universitarias, y el 71 %, nivel 1. La disponibilidad fue similar entre públicas y privadas (porcentajes): presión intracraneana (95), electroencefalografía (92), doppler transcraneano (53), potenciales evocados (50), saturación yugular (47) e índice bispectral (11). El principal motivo de monitoreo fue trauma. Conclusión. Excepto la presión intracraneana y la electroencefalografía, los recursos de neuromonitoreo son escasos y la disponibilidad de neurocirugía activa es mínima. Se necesita un registro nacional de UCIP.

The occurrence of adverse events is associated with increased morbidity and mortality in children admitted to a single pediatric intensive care unit.

Healthcare can cause harm. The goal of this study is to evaluate the association between the occurrence of adverse events (AEs) and morbidity-mortality in critically ill children. A prospective cohort study was designed. All children admitted to the Pediatric Intensive Care Unit (PICU) between August 2016 and July 2017 were followed. An AE was considered any harm associated with a healthcare-related incident. AEs were identified in two steps: first, adverse clinical incidents (ACI) were recognized through direct observation and active surveillance by PICU physicians, and then the patient safety committee evaluated every ACI to define which would be considered an AE. The outcome was hospital morbidity-mortality. There were 467 ACI registered, 249 (53.31%) were considered AEs and the rate was 4.27/100 patient days. From the 842 children included, 142 (16.86%) suffered AEs, 39 (4.63%) experienced morbidity-mortality: 33 (3.92%) died, and 6 (0.71%) had morbidity. Multivariate analysis revealed that the occurrence of AEs was significantly associated with morbidity-mortality, OR 5.70 (CI95% 2.58-12.58, p = 0.001). This association was independent of age and severity of illness score.Conclusion: Experiencing AEs significantly increased the risk of morbidity-mortality in this cohort of PICU children.What is Known:• Many children suffer healthcare-associated harm during pediatric intensive care hospitalization.What is New:• This prospective cohort study shows that experiencing adverse events during pediatric intensive care hospitalization significantly increases the risk of morbidity and mortality independent of age and severity of illness at admission.

Alcohol use disorders.

Alcohol use disorders consist of disorders characterised by compulsive heavy alcohol use and loss of control over alcohol intake. Alcohol use disorders are some of the most prevalent mental disorders globally, especially in high-income and upper-middle-income countries; and are associated with high mortality and burden of disease, mainly due to medical consequences, such as liver cirrhosis or injury. Despite their high prevalence, alcohol use disorders are undertreated partly because of the high stigma associated with them, but also because of insufficient systematic screening in primary health care, although effective and cost-effective psychosocial and pharmacological interventions do exist. Primary health care should be responsible for most treatment, with routine screening for alcohol use, and the provision of a staggered treatment response, from brief advice to pharmacological treatment. Clinical interventions for these disorders should be embedded in a supportive environment, which can be bolstered by the creation of alcohol control policies aimed at reducing the overall level of consumption.

Implementación de una lista de cotejo para mejorar la adherencia a prácticas basadas en evidencia en una Unidad de Cuidados Intensivos Pediátricos / Implementation of a checklist to increase adherence to evidence-based practices in a single pediatric intensive care unit

Introducción. El uso de listas de cotejo para mejorar la adherencia a prácticas basadas en evidencia en unidades de cuidados intensivos pediátricos no está generalizado. El objetivo del estudio fue, mediante una lista específicamente diseñada, alcanzar el 90% de adherencia a las prácticas estudiadas. Población y métodos. Estudio cuasiexperimental tipo serie de tiempo en niños ventilados en la Unidad de Cuidados Intensivos Pediátricos. Las prácticas estudiadas fueron ventana de sedación, presión plateau ≤ 30 cmH2O, fracción inspirada de oxígeno ≤ 60%, cabecera a 30º, higiene bucal con clorhexidina, recambio semanal del circuito del respirador, preferencia de alimentación enteral, disminución del umbral de transfusiones (hemoglobina: 7 g/dl), consideración diaria de prueba de respiración espontánea y de retiro de catéter central. La lista fue utilizada durante el pase de sala, por médicos de planta responsables de la Unidad de Cuidados Intensivos Pediátricos , como intervención para mejorar la adherencia y herramienta de registro. Se consideró observación a cada formulario completado diariamente. Las observaciones fueron clasificadas como defectuosas si no hubo adherencia a uno o más ítems. La adherencia (proporción de observaciones sin defecto) se resume en el gráfico de control. Resultados. El estudio abarcó 420 días. Se internaron732pacientes; 218 recibieronventilación mecánica; se realizaron 1201 observaciones y 1191 fueron incluidas. El gráfico de control con horizonte temporal de 14 meses mostró un aumento de adherencia, un patrón de variabilidad de causa especial en los últimos 3 meses y adherencia > 90% en los últimos dos. Conclusiones. El uso de la lista de cotejo permitió mejorar la adherencia a las prácticas estudiadas y alcanzar más de 90% en los últimos 2 meses.

Introduction. The use of checklists to increase adherence to evidence-based practices is not yet widespread in pediatric intensive care units. The objective of this study was to achieve 90% compliance with studied practices using an ad hoc checklist. Population and methods. Time series quasiexperimental study conducted in ventilated children hospitalized in the pediatric intensive care unit. Studied practices included sedation breaks, plateau pressure ≤ 30 cm H2O, fraction of inspired oxygen ≤ 60%, maintenance of headboard at > 30°, chlorhexidine mouthwash, weekly ventilator circuit changes, preference for enteral feeding, reduction in the threshold for blood transfusions (hemoglobin: 7 g/dL), daily consideration of spontaneous breathing trials and central venous catheter removal. The checklist was used during ward rounds by the staff physicians in charge of the pediatric intensive care unit as part of an intervention to increase adherence and as a tracking tool. Each form completed on a daily basis was considered an observation. Observations were classified as defective in the case of non-compliance with one or more items. Adherence (the rate of nondefective units of observation) is summarized in the control chart. Results. The study period lasted 420 days. A total of 732 patients were hospitalized; 218 underwent mechanical ventilation; 1201 observations were made, and 1191 were included in the study. The control chart with a 14-month time horizon showed increased adherence, a special cause variation pattern in the last 3 months of the study period, and > 90% compliance over the last 2 months. Conclusions. The implementation of a checklist increased adherence to studied practices and achieved more than 90% compliance over the last 2 months of the study period.

Implementation of a checklist to increase adherence to evidence-based practices in a single pediatric intensive care unit. / Implementación de una lista de cotejo para mejorar la adherencia a prácticas basadas en evidencia en una Unidad de Cuidados Intensivos Pediátricos.

INTRODUCTION: The use of checklists to increase adherence to evidence-based practices is not yet widespread in pediatric intensive care units. The objective of this study was to achieve 90% compliance with studied practices using an ad hoc checklist. POPULATION AND METHDOS: Time series quasiexperimental study conducted in ventilated children hospitalized in the pediatric intensive care unit. Studied practices included sedation breaks, plateau pressure ≤ 30 cm H 2O, fraction of inspired oxygen ≤ 60%, maintenance of headboard at > 30°, chlorhexidine mouthwash, weekly ventilator circuit changes, preference for enteral feeding, reduction in the threshold for blood transfusions (hemoglobin: 7 g/dL), daily consideration of spontaneous breathing trials and central venous catheter removal. The checklist was used during ward rounds by the staff physicians in charge of the pediatric intensive care unit as part of an intervention to increase adherence and as a tracking tool. Each form completed on a daily basis was considered an observation. Observations were classified as defective in the case of non-compliance with one or more items. Adherence (the rate of nondefective units of observation) is summarized in the control chart. RESULTS: The study period lasted 420 days. A total of 732 patients were hospitalized; 218 underwent mechanical ventilation; 1201 observations were made, and 1191 were included in the study. The control chart with a 14-month time horizon showed increased adherence, a special cause variation pattern in the last 3 months of the study period, and > 90% compliance over the last 2 months. CONCLUSIONS: The implementation of a checklist increased adherence to studied practices and achieved more than 90% compliance over the last 2 months of the study period.

INTRODUCCIÓN: El uso de listas de cotejo para mejorar la adherencia a prácticas basadas en evidencia en unidades de cuidados intensivos pediátricos no está generalizado. El objetivo del estudio fue, mediante una lista específicamente diseñada, alcanzar el 90% de adherencia a las prácticas estudiadas. POBLACIÓN Y MÉTODOS: Estudio cuasiexperimental tipo serie de tiempo en niños ventilados en la Unidad de Cuidados Intensivos Pediátricos. Las prácticas estudiadas fueron ventana de sedación, presión plateau ≤ 30 cmH 2O, fracción inspirada de oxígeno ≤ 60%, cabecera a 30 o, higiene bucal con clorhexidina, recambio semanal del circuito del respirador, preferencia de alimentación enteral, disminución del umbral de transfusiones (hemoglobina: 7 g/dl), consideración diaria de prueba de respiración espontánea y de retiro de catéter central. La lista fue utilizada durante el pase de sala, por médicos de planta responsables de la Unidad de Cuidados Intensivos Pediátricos , como intervención para mejorar la adherencia y herramienta de registro. Se consideró observación a cada formulario completado diariamente. Las observaciones fueron clasificadas como defectuosas si no hubo adherencia a uno o más ítems. La adherencia (proporción de observaciones sin defecto) se resume en el gráfico de control. RESULTADOS: El estudio abarcó 420 días. Se internaron732pacientes; 218 recibieronventilación mecánica; se realizaron 1201 observaciones y 1191 fueron incluidas. El gráfico de control con horizonte temporal de 14 meses mostró un aumento de adherencia, un patrón de variabilidad de causa especial en los últimos 3 meses y adherencia > 90% en los últimos dos. CONCLUSIONES: El uso de la lista de cotejo permitió mejorar la adherencia a las prácticas estudiadas y alcanzar más de 90% en los últimos 2 meses.

Photochemical Synthesis of Carbazoles Using an [Fe(phen)3](NTf2)2/O2 Catalyst System: Catalysis toward Sustainability.

An increasingly sustainable photochemical synthesis of carbazoles was developed using a catalytic system of Fe(phen)3(NTf2)2/O2 under continuous flow conditions and was demonstrated on gram-scale using a numbering-up strategy. Photocyclization of triaryl and diarylamines into the corresponding carbazoles occurs in general in higher yields than with previously developed photocatalysts.

Heteroleptic Cu-Based Sensitizers in Photoredox Catalysis.

Photochemistry is an important tool in organic synthesis that has largely been underdeveloped in comparison to thermal activation. Recent advances in technology have ushered in a new era in synthetic photochemistry. The emergence of photocatalysis, which exploits sensitizers for the absorption of visible light, has provided organic chemists with a new route to the generation of radical intermediates for synthesis. Of particular interest is the development of Cu-based complexes for photocatalysis, which possess variable photophysical properties and can display complementary reactivity with common photocatalysts based on heavier transition metals such as Ru or Ir. Heteroleptic Cu-based sensitizers incorporating the presence of both a bisphosphine and diamine ligand bound to the copper center are a promising class of photocatalysts. Their synthesis is a single step, often involving only precipitation for purification. In addition, it was shown that the sensitizers could be formed in situ in the reaction mixture, simplifying the experimental setup. The heteroleptic nature of the Cu-complexes also affords opportunities to fine-tune properties. For example, structurally rigidified bisphosphines reinforce geometries about the metal center to extend the excited state lifetime. Variation of the diamine ligand can influence the excited state oxidation/reduction potentials and optical absorbances. The heteroleptic complex Cu(XantPhos)(neo)BF4 has demonstrated utility in the synthesis of helical polyaromatic carbocycles. The synthesis of [5]helicene, a relatively simple member of the helicene family, was improved from the existing UV-light mediated method by eliminating the formation of unwanted byproducts. In addition, the Cu-based sensitizers also promoted the formation of novel pyrene/helicene hybrids for materials science applications. The synthetic methods that were developed were augmented when combined with continuous flow technology. The irradiation of reaction mixtures as they are pumped through small diameter tubing provides a more homogeneous and increased photon flux compared with irradiation in round-bottom flasks or other batch reactors. The value of continuous flow methods is also evident when examining UV-light photochemistry, where the simple and safe experimental set-ups allow for further exploration of high energy light for synthetic purposes. The synthesis of functionalized complex carbazoles was also studied using both a visible light method exploiting a heteroleptic copper-based sensitizer and a UV-light mediated method. It was demonstrated that both the photocatalysis methods and UV light photochemistries were rendered more user-friendly, safe, and reproducible when using continuous flow methods. Interestingly, the two photochemical methods often afford contrasting selectivities as a result of their inherently different mechanisms. It can be expected that the complementarity of the various photochemical methods will be an asset to synthetic chemists as the field continues to evolve.

Balance de fluidos y duración de la ventilación mecánica en niños internados en una Unidad de Terapia Intensiva Pediátrica / Fluid balance and length of mechanical ventilation in children admitted to a single Pediatric Intensive Care Unit

Introducción. Se han descrito asociaciones entre balance de fluido acumulado y mayor estadía en asistencia respiratoria mecánica en adultos. El objetivo fue evaluar si el balance de las primeras 48 horas de iniciada la asistencia respiratoria mecánica se asociaba a su prolongación en niños internados en Terapia Intensiva Pediátrica (UCIP). Métodos. Cohorte retrospectiva de pacientes de la UCIP del Hospital Italiano de Buenos Aires, entre el 1/1/2010 y el 30/6/2012. El balance se calculó en porcentaje del peso corporal; ventilación mecánica prolongada se definió como > 7 días y se registraron confundidores. Se realizó un análisis univariado y multivariado. Resultados. 249 pacientes permanecieron ventilados más de 48 horas; se incluyeron 163. El balance de las primeras 48 horas en ventilación mecánica fue 5,7%±5,86; 82 pacientes (50,3%) permanecieron más de 7 días con respirador. La edad < 4 años (OR 3,21; IC 95% 1,38-7,48; p 0,007), enfermedad respiratoria (OR 4,94; IC 95% 1,51-16,10; p 0,008), shock séptico (OR 4,66; IC 95% 1,10-19,65; p 0,036), puntaje de disfunción orgánica (PELOD) > 10 (OR 2,44; IC 95% 1,23-4,85; p 0,011) y balance positivo > 13% (OR 4,02; IC 95% 1,08-15,02; p 0,038) se asociaron a ventilación mecánica prolongada. El modelo multivariado mostró para PELOD > 10 un OR 2,58; IC 95%: 1,17-5,58; p 0,018, y para balance positivo > 13% un OR 3,7; IC 95%: 0,91-14,94; p 0,066. Conclusiones. En relación a ventilación mecánica prolongada, el modelo multivariado mostró una asociación independiente con disfunción de órganos (PELOD > 10) y una tendencia hacia la asociación con balance positivo > 13%.

Introduction. Associations between cumulative fluid balance and a prolonged duration of assisted mechanical ventilation have been described in adults. The aim of this study was to evaluate whether fluid balance in the first 48 hours of assisted mechanical ventilation initiation was associated with a prolonged duration of this process among children in the Pediatric Intensive Care Unit (PICU). Methods. Retrospective cohort of patients in the PICU of Hospital Italiano de Buenos Aires, between 1/1/2010 and 6/30/2012. Balance was calculated in percentage of body weight; prolonged mechanical ventilation was defined as >7 days, and confounders were registered. Univariate and multivariate analyses were performed. Results. Two hundred and forty-nine patients were mechanically ventilated for over 48 hours; 163 were included in the study. Balance during the first 48 hours of mechanical ventilation was 5.7% ± 5.86; 82 patients (50.3%) were on mechanical ventilation for more than 7 days. Age < 4 years old (OR 3.21, 95% CI 1.38-7.48, p 0.007), respiratory disease (OR 4.94, 95% CI 1.51-16.10, p 0.008), septic shock (OR 4.66, 95% CI 1.10-19.65, p 0.036), Pediatric Logistic Organ Dysfunction (PELOD) > 10 (OR 2.44, 95% CI 1.234.85, p 0.011), and positive balance > 13% (OR 4.02, 95% CI 1.08-15.02, p 0.038) were associated with prolonged mechanical ventilation. The multivariate model resulted in an OR 2.58, 95% CI: 1.17-5.58, p= 0.018 for PELOD > 10, and an OR 3.7, 95% CI: 0.91-14.94, p= 0.066 for positive balance > 13%. Conclusions. Regarding prolonged mechanical ventilation, the multivariate model showed an independent association with organ dysfunction (PELOD > 10) and a trend towards an association with positive balance > 13%.

Fluid balance and length of mechanical ventilation in children admitted to a single Pediatric Intensive Care Unit. / Balance de fluidos y duración de la ventilación mecánica en niños internados en una Unidad de Terapia Intensiva Pediátrica.

INTRODUCTION: Associations between cumulative fluid balance and a prolonged duration of assisted mechanical ventilation have been described in adults. The aim of this study was to evaluate whether fluid balance in the first 48 hours of assisted mechanical ventilation initiation was associated with a prolonged duration of this process among children in the Pediatric Intensive Care Unit (PICU). METHODS: Retrospective cohort of patients in the PICU o, Hospital Italiano de Buenos Aires, between 1/1/2010 and 6/30/2012. Balance was calculated in percentage of body weight; prolonged mechanical ventilation was defined as >7 days, and confounders were registered. Univariate and multivariate analyses were performed. RESULTS: Two hundred and forty-nine patients were mechanically ventilated for over 48 hours; 163 were included in the study. Balance during the first 48 hours of mechanical ventilation was 5.7% ± 5.86; 82 patients (50.3%) were on mechanical ventilation for more than 7 days. Age 〈 4 years old (OR 3.21, 95% CI 1.38-7.48, p 0.007), respiratory disease (OR 4.94, 95% CI 1.51-16.10, p 0.008), septic shock (OR 4.66, 95% CI 1.10-19.65, p 0.036), Pediatric Logistic Organ Dysfunction (PELOD) 〉 10 (OR 2.44, 95% CI 1.234.85, p 0.011), and positive balance 〉 13% (OR 4.02, 95% CI 1.08-15.02, p 0.038) were associated with prolonged mechanical ventilation. The multivariate model resulted in an OR 2.58, 95% CI: 1.17-5.58, p= 0.018 for PELOD 〉 10, and an OR 3.7, 95% CI: 0.91-14.94, p= 0.066 for positive balance 〉 13%. CONCLUSIONS: Regarding prolonged mechanical ventilation, the multivariate model showed an independent association with organ dysfunction (PELOD 〉 10) and a trend towards an association with positive balance 〉 13%.

INTRODUCCIÓN: Se han descrito asociaciones entre balance de fluido acumulado y mayor estadía en asistencia respiratoria mecánica en adultos. El objetivo fue evaluar si el balance de las primeras 48 horas de iniciada la asistencia respiratoria mecánica se asociaba a su prolongación en niños internados en Terapia Intensiva Pediátrica (UCIP). MÉTODOS: Cohorte retrospectiva de pacientes de la UCIP de, Hospital Italiano de Buenos Aires, entre el 1/1/2010 y el 30/6/2012. El balance se calculó en porcentaje del peso corporal; ventilación mecánica prolongada se definió como 〉 7 días y se registraron confundidores. Se realizó un análisis univariado y multivariado. RESULTADOS: 249 pacientes permanecieron ventilados más de 48 horas; se incluyeron 163. El balance de las primeras 48 horas en ventilación mecánica fue 5,7%±5,86; 82 pacientes (50,3%) permanecieron más de 7 días con respirador. La edad 〈 4 años (OR 3,21; IC 95% 1,38-7,48; p 0,007), enfermedad respiratoria (OR 4,94; IC 95% 1,51-16,10; p 0,008), shock séptico (OR 4,66; IC 95% 1,10-19,65; p 0,036), puntaje de disfunción orgánica (PELOD) 〉 10 (OR 2,44; IC 95% 1,23-4,85; p 0,011) y balance positivo 〉 13% (OR 4,02; IC 95% 1,08-15,02; p 0,038) se asociaron a ventilación mecánica prolongada. El modelo multivariado mostró para PELOD 〉 10 un OR 2,58; IC 95%: 1,17-5,58; p 0,018, y para balance positivo 〉 13% un OR 3,7; IC 95%: 0,91-14,94; p 0,066. CONCLUSIONES: En relación a ventilación mecánica prolongada, el modelo multivariado mostró una asociación independiente con disfunción de órganos (PELOD 〉 10) y una tendencia hacia la asociación con balance positivo 〉 13%.

Implementation of a Ventilator-Associated Pneumonia Prevention Bundle in a Single PICU.

OBJECTIVE: Ventilator-associated pneumonia is considered the second most frequent infection in pediatric intensive care, and there is agreement on its association with higher morbidity and increased healthcare costs. The goal of this study was to apply a bundle for ventilator-associated pneumonia prevention as a process for quality improvement in the PICU of Hospital Italiano de Buenos Aires, Argentina, aiming to decrease baseline ventilator-associated pneumonia rate by 25% every 6 months over a period of 2 years. DESIGN: Quasi-experimental uninterrupted time series. SETTING: PICU of Hospital Italiano de Buenos Aires, Argentina. PATIENTS: All mechanical ventilated patients admitted to the unit. INTERVENTION: It consisted of the implementation of an evidence-based ventilator-associated pneumonia prevention bundle adapted to our unit and using the plan-do-study-act cycle as a strategy for quality improvement. The bundle consisted of four main components: head of the bed raised more than 30°, oral hygiene with chlorhexidine, a clean and dry ventilator circuit, and daily interruption of sedation. MEASUREMENTS AND MAIN RESULTS: Ventilator-associated pneumonia prevention team meetings started in March 2012, and the ventilator-associated pneumonia bundle was implemented in November 2012 after it had been developed and made operational. Baseline ventilator-associated pneumonia rate for the 2 years before intervention was 6.3 episodes every 1,000 mechanical ventilation days. ventilator-associated pneumonia rate evolution by semester and during the 2 years was, respectively, 5.7, 3.2, 1.8, and 0.0 episodes every 1,000 mechanical ventilation days. Monthly ventilator-associated pneumonia rate time series summarized in a 51-point control chart showed the presence of special cause variability after intervention was implemented. CONCLUSIONS: The implementation over 2 years of a ventilator-associated pneumonia prevention bundle specifically adapted to our unit using quality improvement tools was associated with a reduction in ventilator-associated pneumonia rate of 25% every 6 months and a nil rate in the last semester.

Photochemical Synthesis of Complex Carbazoles: Evaluation of Electronic Effects in Both UV- and Visible-Light Methods in Continuous Flow.

An evaluation of both a visible-light- and UV-light-mediated synthesis of carbazoles from various triarylamines with differing electronic properties under continuous-flow conditions has been conducted. In general, triarylamines bearing electron-rich groups tend to produce higher yields than triarylamines possessing electron-withdrawing groups. The incorporation of nitrogen-based heterocycles, as well as halogen-containing arenes in carbazole skeletons, was well tolerated, and often synthetically useful complementarity was observed between the UV-light and visible-light (photoredox) methods.

Synthesis, crystal structure and photophysical properties of pyrene-helicene hybrids.

Synthesis of helically chiral aromatics resulting from fusion of pyrene and [4]- or [5]helicene has been accomplished using photoredox catalysis employing a Cu-based sensitizer as the key step. Photocyclisation experiments for the synthesis of the target compounds were carried out in batch and using continuous flow strategies. The solid-state structures, UV/Vis absorption spectra and fluorescence spectra of the pyrene-helicene hybrids were investigated and compared to that of the parent [5]helicene to discern the effects of merging a pyrene moiety within a helicene skeleton. The studies demonstrated that pyrene-helicene hybrids adopt co-planar or stacked arrangements in the solid state, in contrast to the solid-state structure of the parent [5]helicene. The UV/Vis and fluorescence spectra of the pyrene-helicene hybrids exhibited strong red-shifts when compared to the parent [5]helicene. DFT calculations suggest that the strategy of extending the π surface in the y axis of the helicenes increased their HOMO levels while also decreasing their LUMO levels, resulting in significantly reduced band gaps.

Toward a visible light mediated photocyclization: Cu-based sensitizers for the synthesis of [5]helicene.

A photochemical synthesis of [5]helicene employing a copper-based sensitizer 7 has been developed that avoids the disadvantages associated with the traditional UV light mediated method. The visible light mediated synthesis uses common glassware and a simple household light bulb without the competing formation of [2 + 2] cycloadducts, regioisomers, or the overoxidation product benzo[ghi]perylene 3. Preliminary results show that the reaction time can be significantly reduced through the use of a continuous flow strategy.

Satisfacción de los padres de los pacientes en una unidad de cuidados intensivos pediátricos / Parents’ satisfaction in a single pediatric intensive care unit

El objetivo fue validar y aplicar un instrumento para medir satisfacción de padres de pacientes internados en Cuidados Intensivos Pediátricos del Hospital Italiano de Buenos Aires. Población y métodos. Aplicamos el cuestionario Picker’s Pediatric Acute Care luego de traducirlo y determinar su validez de construcción, contenido y consistencia interna. Calculamos puntaje de satisfacción general y dominios. La población fue dividida en Alto y Bajo Grados de Satisfacción según la respuesta a la pregunta “ ¿Cómocalificaría los cuidados recibidos?” Las variables asociadas con estos grupos fueron identificadas. Resultados. Validez de construcción, contenido y consistencia interna fueron adecuados (α de Cronbach= 0,87). El puntaje de satisfacción generalfue 85,7 (IC95 por ciento 83,5-87,8). Los puntajes por dominios fueron, impresión general, 84,8 (IC95 por ciento82,3-87,3); accesibilidad y disponibilidad, 88,8 (IC95 por ciento 86,4-91,2); consideración y respeto, 85,7(IC95 por ciento 83,1-88,3); coordinación e integración decuidados, 84,6 (IC95 por ciento 80,9-88,3); información y comunicación, 85,5 (IC95 por ciento 82-89); relación entre padres y equipo de salud, 89,5 (IC95 por ciento 86,7-92,3); confort físico, 91,8 (IC95 por ciento 89-94,6) y continuidad de cuidados 70,9 (IC95 por ciento 64,9-76,9). Este últimopuntaje, significativamente menor a los anteriores, permitió identificar un aspecto por mejorar. El 89 por ciento (89/100) de los padres se incluyó en el Grupo Alto Grado de Satisfacción. El 100 por ciento manifestó que sus hijos habían recibido cuidados que necesitaban cuando los necesitaban y 98,2 por ciento que sus hijos habían sido tratados con dignidad y respeto, y que tanto a médicos como a enfermeras les interesaba calmar el dolor. Conclusiones. La validación del instrumento fue adecuada. Los cuidados oportunos y el trato digno y respetuoso se asocian con altos niveles de satisfacción.