ABSTRACT
OBJECTIVE: To describe the practice of pediatric intensive care in Latin America and compare it with two European countries. DESIGN: Analysis of data presented by member countries of the Sociedad Latinoamericana de Cuidado Intensivo Pediátrico (SLACIP), Spain and Portugal, in the context of a Symposium of Spanish and Portuguese - speaking pediatric intensivists during the Fifth World Congress on Pediatric Intensive Care. SETTING: Pediatric intensive care units (PICUs). PARTICIPANTS: Pediatric intensivists in representation of each member country of the SLACIP, Spain and Portugal. INTERVENTIONS: None. VARIABLES OF INTEREST: Each country presented its data on child health, medical facilities for children, pediatric intensive care units, pediatric intensivists, certification procedures, equipment, morbidity, mortality, and issues requiring intervention in each participating country. RESULTS: Data from 11 countries was analyzed. Nine countries were from Latin America (Argentina, Colombia, Cuba, Chile, Ecuador, Honduras, México, Dominican Republic and Uruguay), and two from Europe (Spain and Portugal). Data from Bolivia and Guatemala were partially considered. Populational, institutional, and operative differences were identified. Mean PICU mortality was 13.29% in Latin America and 5% in the European countries (P=0.005). There was an inverse relationship between mortality and availability of pediatric intensive care units, pediatric intensivists, number of beds, and number of pediatric specialty centers. Financial and logistic limitations, as well as deficiencies in support disciplines, severity of diseases, malnutrition, late admissions, and inadequate initial treatments could be important contributors to mortality at least in some of these countries. CONCLUSION: There are important differences in population, morbidity and mortality in critically ill children among the participating countries. Mortality shows an inverse correlation to the availability of pediatric intensive care units, intensive care beds, pediatric intensivists, and pediatric subspecialty centers.
Subject(s)
Intensive Care Units, Pediatric/statistics & numerical data , Adolescent , Age Distribution , Child , Child, Preschool , Developing Countries , Diagnosis-Related Groups , Health Services Needs and Demand , Health Status Indicators , Hospital Mortality , Humans , Infant , Infant Mortality , Infant, Newborn , Intensive Care Units, Neonatal/statistics & numerical data , Intensive Care Units, Neonatal/supply & distribution , Intensive Care Units, Pediatric/organization & administration , Intensive Care Units, Pediatric/supply & distribution , Latin America , Patient Admission , Pediatrics/education , Portugal , Societies, Medical , Spain , Technology, High-Cost/statistics & numerical data , WorkforceABSTRACT
UNLABELLED: Post-extubation laryngeal edema (PLE) is a common complication (10-15%) in pediatric intensive care units, and some authors have reported high failure rates for conventional treatment. HYPOTHESIS: Non-invasive continuous positive airways pressure (CPAP) in children with PLE may have a lower failure rate than conventional management. PATIENTS AND METHOD: Twenty-five patients were needed to detect a difference between the two treatment groups. The patients were assigned to receive the conventional treatment (nebulized epinephrin and humidified oxygen) or the experimental treatment (non-invasive CPAP treatment for 18 hours), using a randomized block design (10-patient blocks). After 9 months, the study was halted when a significant difference emerged between the two groups. RESULTS: Of 270 children extubated during the study, 28 (10.3%) developed PLE and 25 met the enrollment requirements. Thirteen were assigned to conventional therapy and 12 to CPAP. General characteristics, time of intubation, FiO2 upon admission, use of corticoids before extubation and scores for respiratory difficulty upon admission were similar in the two groups (p > 0.05). With conventional therapy, 5 (38.5%) children improved and 8 patients worsened or remained the same. Eleven (91.7%) of the patients receiving CPAP improved (p = 0.01). Those who failed on conventional treatment were prescribed CPAP and all then improved, although one had to be re-intubated. CONCLUSION: The hypothesis was confirmed. CPAP treatment reduced the failure rate by 53.2% in comparison with conventional therapy.
Subject(s)
Intubation, Intratracheal/adverse effects , Laryngitis/etiology , Laryngitis/therapy , Positive-Pressure Respiration , Age Factors , Child, Preschool , Epinephrine/administration & dosage , Female , Humans , Infant , Infant, Newborn , Laryngeal Edema/etiology , Male , Nebulizers and Vaporizers , Oxygen Inhalation Therapy , Time Factors , Ventilator WeaningABSTRACT
Systolic blood pressure (SBP) was measured by Doppler method in an aleatory sample of 251 healthy children from south-east Santiago Chile (131 females and 120 males) which were divided by age in five groups: 0 to 28 days (n = 5) 1 to 5 months (n = 48), 6 to 11 months (n = 48), 12 to 17 months (n = 46) and 18 to 24 months (n = 45). Great dispersion of SBP values occurred among newborn infants (range 85 to 125) in comparison with groups 1 to 5 months (105 to 130), 6 to 11 months (118 to 130). Fifty and 95 percentiles were, respectively, 107 to 125; 116 to 130; 121 to 130; 118 to 130 and 120 to 130. These values were greater than those obtained by sphygmomanometry in a similar matched group of children.
