[Analysis of ROX Index, ROX-HR Index, and SpO2/FIO2 Ratio in Patients Who Received High-Flow Nasal Cannula Oxygen Therapy in Pediatric Intensive Care Unit].

PURPOSE: This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit. METHODS: A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ² test, Mann-Whitney U test, and area under the curve (AUC). RESULTS: Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption. CONCLUSION: The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.

Erythrocyte and plasma selenium in children with acute inflammatory response.

OBJECTIVES: Plasma selenium may not reflect selenium status in critically ill patients because it transiently decreases inversely with the magnitude of the systemic inflammatory response. The decision to supplement selenium should ideally be based on laboratory measurements that reliably reflect selenium status. We hypothesized that erythrocyte selenium, unlike plasma selenium, is not affected by the systemic inflammatory response in critically ill children. METHODS: In a prospective study of 109 critically ill children, plasma and erythrocyte selenium concentrations were evaluated on admission, and plasma selenoprotein P was evaluated on days 1, 2, and 3 of the ICU stay. The main outcome was the effect of systemic inflammation on the erythrocyte and plasma selenium concentrations. The magnitude of the systemic inflammatory response was measured using serum C-reactive protein (CRP) and procalcitonin levels. The covariates were age, sex, anthropometric nutritional status, diagnosis of severe sepsis/septic shock, and clinical severity on admission. Multiple linear regression and generalized estimating equations were used for statistical analysis. RESULTS: Erythrocyte selenium levels were not influenced by the magnitude of the inflammatory response or by the patient's clinical severity. Procalcitonin (ß coefficient=-0.99; 95%CI: -1.64; -0.34, p = 0.003) and clinical severity (ß coefficient= -11.13; 95%CI: -21.6; -0.63), p = 0.038) on admission were associated with decreased plasma selenium concentrations. Erythrocyte selenium was associated with selenoprotein P in the first three days of ICU stay (ß coefficient=0.32; 95%CI: 0.20; 0.44, p < 0.001). CONCLUSION: Unlike plasma selenium, erythrocyte selenium does not change in children with an acute systemic inflammatory response and is associated with selenoprotein P concentrations. Erythrocyte selenium is probably a more reliable marker than plasma selenium for evaluating the selenium status in critically ill children.

Continuous Electroencephalogram and Antiseizure Medication Use in an International Pediatric Traumatic Brain Injury Population.

BACKGROUND: Electrographic seizures are frequent and associated with worse outcomes following traumatic brain injury (TBI). Despite this, the use of continuous electroencephalogram (cEEG) remains low. Our study describes cEEG usage and treatment dosing antiseizure medications (ASMs) in an international pediatric TBI population, hypothesizing that children monitored with cEEG have an increased rate of treatment ASMs because of electrographic seizure detection, compared with children who are not monitored with cEEG. METHODS: This subanalysis of the TBI cohort of the international PANGEA study included children, 7 days to 17 years of age, with acute neurological insults admitted to pediatric intensive care units. We analyzed demographics, injury severity, and therapies including prophylactic or treatment ASMs. We evaluated the relationships between cEEG use, seizure frequency, and receipt of treatment ASMs. [Formula: see text] or Fisher's exact test was used to analyze categorical variables, and the Kruskal-Wallis or Mann-Whitney U-test was used for continuous variables. Multivariable analysis for treatment ASM use was performed using logistic regression. RESULTS: One hundred-twenty-three of 174 patients with TBI were included. Twenty-seven patients (21.9%) underwent cEEG at any point during pediatric intensive care unit admission. Preexisting seizure disorder (18.2% vs. 2.3%, p = 0.014) and neuromuscular blockade use (52.4% vs. 24.1%, p = 0.011) were more frequently observed in the group monitored on cEEG when compared with those that were not. Presenting median Glasgow Coma Scale score was worse in the cEEG group (7 vs. 9, p = 0.044). There was no significant difference in age, use of intracranial pressure monitoring, or hyperosmolar therapy between the cEEG monitored and nonmonitored groups. Patients who were monitored on cEEG were more likely to receive a treatment dose ASM than those without cEEG monitoring (66.7% vs. 28.1%, p = 0.0002). When compared with those without treatment ASM, the treatment ASM group had more electrographic seizures on their first electroencephalogram following injury (51.6% vs. 4%, p = 0.0001) and more clinical seizures (55.8% vs. 0%, p < 0.0001). CONCLUSIONS: Children monitored with cEEG after TBI have an increased prescription of treatment ASMs and clinical and electrographic seizures. The increased rate of treatment ASMs in the cEEG group may indicate increased recognition of electrographic seizures.

Da técnica à tékhne: comunicação de notícias difíceis em unidade de terapia intensiva pediátrica / De la técnica al tékhne: comunicación de noticias difíciles en unidad de terapia intensiva pediátrica / From technology to tékhne: communication of bad news in pediatric intensive care unit

RESUMO Objetivo compreender as percepções de familiares de crianças hospitalizadas em Unidade de Terapia Intensiva Pediátrica diante da comunicação de notícias difíceis. Método estudo fenomenológico com 15 familiares de crianças hospitalizadas em Unidade de Terapia Intensiva Pediátrica de um hospital universitário público do estado de São Paulo. Entrevistas foram realizadas no período de outubro de 2018 a março de 2019. A compreensão dos discursos se deu à luz da fenomenologia existencial heideggeriana. Resultados duas categorias ontológicas emergiram: O familiar da criança existindo em um mundo impróprio; e O familiar da criança vislumbrando a essência da técnica. O familiar recebe as notícias difíceis dos profissionais de saúde na instrumentalidade, emergindo a necessidade de extrapolar a técnica em busca da sua essência. Conclusão e implicações para a prática os discursos revelam que a tecnologia moderna se sobrepõe à ontologia tradicional, uma vez que o profissional de saúde, ao comunicar as notícias difíceis, afasta-se do ser e perde-se de sua essência. O aprimoramento de competências interpessoais e de comunicação dos profissionais de saúde pode extrapolar a dimensão técnica, prevalente em terapia intensiva.

RESUMEN Objetivo comprender las percepciones de los familiares de niños internados en una Unidad de Cuidados Intensivos Pediátricos frente a la comunicación de noticias difíciles. Método estudio fenomenológico con 15 familiares de ninõs hospitalizados en la Unidad de Cuidados Intensivos Pediátricos de un hospital universitario público en el estado de São Paulo. Las entrevistas se realizaron de octubre de 2018 a marzo de 2019. Los discursos fueron entendidos a la luz de la fenomenología existencial de Heidegger. Resultados emergieron dos categorías ontológicas: El familiar del niño existiendo en un mundo inapropiado; y El familiar del niño vislumbrando la esencia de la técnica. El familiar recibe noticias difíciles por parte de los profesionales de salud de instrumental, surgiendo la necesidad de extrapolar la técnica en busca de su esencia. Conclusión e implicaciones para la práctica los discursos revelan que la tecnología moderna se superpone a la ontología tradicional, ya que el profesional de la salud, al comunicar noticias difíciles, se aleja del ser y pierde su esencia. La mejora de las habilidades interpersonales y de comunicación de los profesionales de la salud puede extrapolar la dimensión técnica, prevalente en cuidados intensivos.

ABSTRACT Objective to understand the perceptions of family members of children hospitalized in the Pediatric Intensive Care Unit regarding the communication of bad news. Methods this is a phenomenological study with 15 family members of children hospitalized in the Pediatric Intensive Care Unit of a public university hospital in the state of São Paulo. Interviews were carried out from October 2018 to March 2019. The discourses were understood grounded Heidegger's existential phenomenology. Results two ontological categories emerged: The child's family member existing in an inappropriate world; and The child's family member glimpsing the essence of technology. Family members receive difficult news from health professionals in the instrumentality, emerging the need to extrapolate the technology in search of its essence. Conclusions and implications for practice the discourses reveal that modern technology overlaps with traditional ontology, since health professionals, when communicating difficult news, move away from the being and lose their essence. Health professionals' improving interpersonal and communication skills can extrapolate the technical dimension, prevalent in intensive care.

Factores asociados al fracaso de la terapia con cánulas nasales de alto flujo en pacientes pediátricos con insuficiencia respiratoria en dos unidades de cuidados críticos pediátricos a gran altitud / Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude

Introducción: El fallo respiratorio agudo es la principal causa de hospitalización en pediatría. Las cánulas nasales de alto flujo (CNAF) ofrecen una nueva alternativa, pero sigue existiendo debate en torno a la evidencia e indicaciones. No se ha descrito su comportamiento en gran altitud. Objetivo Describir el uso de CNAF en pacientes pediátricos que ingresan con insuficiencia respiratoria y explorar los factores asociados al fracaso de la terapia. Metodología Estudio de cohortes prospectivo. Pacientes entre un mes y 18 años manejados con CNAF. Se describieron datos demográficos y se evaluó la respuesta al inicio, 1.a, 6.a y 24.a horas. Se determinó el número de fracasos, así como estancia, complicaciones y mortalidad. Se compararon los pacientes con fracaso al tratamiento. Resultados Ingresaron 539 pacientes. Fueron más frecuentes los lactantes (70,9%) de sexo masculino (58,4%) con afecciones respiratorias como asma y bronquiolitis (61,2%). Se presentaron 53 fracasos (9,8%), 21 en las primeras 24 horas. La mediana de estancia fue de 4 días (RIQ 4), hubo 5 éxitus (0,9%) y 13 eventos adversos –epistaxis– (2,2%). Se observó mejoría de signos vitales y gravedad en el tiempo con diferencias en el grupo que fracasó, pero sin interacciones. El modelo logístico final estimó una relación independiente del fracaso, entre el hospital (OR 2,78; IC95% 1,48-5,21) y la frecuencia respiratoria inicial (OR 1,56; IC95% 1,21-2,01). Conclusión La CNAF es un sistema con buena respuesta clínica, pocas complicaciones y una baja tasa de fracasos. Las diferencias entre las instituciones sugieren una relación subjetiva de la decisión del fracaso. (AU)

Introduction: Acute respiratory failure is the leading cause of hospitalization in pediatrics. High-flow nasal cannulas (HFNCs) offer a new alternative, but the evidence and indications are still debated. The performance of HFNCs at high altitude has not been described to date. Objective To describe the use of HFNCs in pediatric patients admitted with respiratory failure and explore the factors associated with treatment failure. Methodology A prospective cohort study was carried out in patients between 1 month and 18 years of age managed with HFNCs. The demographic and treatment response data were recorded at baseline and after 1, 6 and 24hours. The number of failures was determined, as well as the length of stay, complications and mortality. Patients with treatment failure were compared with the rest. Results A total of 539 patients were enrolled. Infants (70.9%) of male sex (58.4%) and airway diseases such as asthma and bronchiolitis (61.2%) were more frequent. There were 53 failures (9.8%), with 21 occurring in the first 24hours. The median length of stay was 4 days (IQR 4); there were 5 deaths (0.9%) and 13 adverse events (epistaxis) (2.2%). Improvement was observed in vital signs and severity over time, with differences in the group that failed, but without interactions. The final logistic model established an independent relationship of failure between the hospital (OR 2.78, 95%CI 1.48-5.21) and the initial respiratory rate (OR 1.56, 95%CI 1.21-2.01). Conclusions HFNCs afford good clinical response, with few complications and a low failure rate. The differences found between institutions suggest a subjective relationship in the decision of therapy failure. (AU)

Parental role alteration strongly influences depressive symptoms in mothers of preoperative infants with congenital heart disease.

BACKGROUND: Mothers of infants with congenital heart disease are at risk for depression. OBJECTIVES: This study explored the influence on maternal depressive symptoms of several known factors for mothers in the pediatric cardiac intensive care unit, including perceived stressors, attachment, and anxiety. METHODS: This study was a secondary analysis of 30 mothers of infants awaiting cardiac surgery. Linear regressions were calculated to determine the relationships between perceived stressors, maternal attachment, anxiety, and maternal depressive symptoms. RESULTS: Nearly half of mothers reported depressive symptoms above the measure cut-off score, indicating they were at risk for likely clinical depression. Subscales of perceived stress explained 61.7% of the variance in depressive symptoms (F = 11.815, p<0.0001) with parental role alteration subscale as the strongest predictor (standardized beta=0.694, p = 0.03). CONCLUSIONS: Findings underscore the importance of mental health screening and instituting nursing practices to enhance parental role for mothers of infants awaiting cardiac surgery.

[Factors associated to high-flow nasal cannula treatment failure in pediatric patients with respiratory failure in two pediatric intensive care units at high altitude]. / Factores asociados al fracaso de la terapia con cánulas nasales de alto flujo en pacientes pediátricos con insuficiencia respiratoria en dos unidades de cuidados críticos pediátricos a gran altitud.

INTRODUCTION: Acute respiratory failure is the leading cause of hospitalization in pediatrics. High-flow nasal cannulas (HFNCs) offer a new alternative, but the evidence and indications are still debated. The performance of HFNCs at high altitude has not been described to date. OBJECTIVE: To describe the use of HFNCs in pediatric patients admitted with respiratory failure and explore the factors associated with treatment failure. METHODOLOGY: A prospective cohort study was carried out in patients between 1 month and 18 years of age managed with HFNCs. The demographic and treatment response data were recorded at baseline and after 1, 6 and 24hours. The number of failures was determined, as well as the length of stay, complications and mortality. Patients with treatment failure were compared with the rest. RESULTS: A total of 539 patients were enrolled. Infants (70.9%) of male sex (58.4%) and airway diseases such as asthma and bronchiolitis (61.2%) were more frequent. There were 53 failures (9.8%), with 21 occurring in the first 24hours. The median length of stay was 4 days (IQR 4); there were 5 deaths (0.9%) and 13 adverse events (epistaxis) (2.2%). Improvement was observed in vital signs and severity over time, with differences in the group that failed, but without interactions. The final logistic model established an independent relationship of failure between the hospital (OR 2.78, 95%CI 1.48-5.21) and the initial respiratory rate (OR 1.56, 95%CI 1.21-2.01). CONCLUSIONS: HFNCs afford good clinical response, with few complications and a low failure rate. The differences found between institutions suggest a subjective relationship in the decision of therapy failure.

Epidemiologia da sepse em crianças internadas em unidades de terapia intensiva pediátrica da América Latina / Epidemiology of sepsis in children admitted to Pediatric Intensive Care Units in Latin America

A sepse, ou resposta inflamatória do organismo à infecção, é uma das principais doenças da infância, consome parcela substancial dos recursos financeiros das unidades de terapia intensiva, sendo causa comum de óbito em crianças. Essa doença é considerada um problema de saúde pública em expansão, negligenciada por muitos setores da sociedade. Objetivo: Descrever a prevalência e mortalidade por sepse em crianças admitidas em Unidades de Terapia Intensiva Pediátrica (UTIP) da América Latina. Desenho: Estudo prospectivo, multicêntrico, observacional. Ambiente: Vinte e uma UTIPs de cinco países da América Latina. Pacientes: Todas as crianças com idades entre 29 dias e 17 anos admitidas nas UTIPs participantes no período de 1 de junho a 30 de setembro de 2011. Características clínicas, demográficas e dados laboratoriais das primeiras 24 horas de internação na UTIP foram registrados. As crianças foram acompanhadas até a alta da UTIP ou óbito. Sepse foi definida de acordo com a International Pediatric Sepsis Consensus Conference (2005). Intervenções: Nenhuma. Resultados: Dos 1090 pacientes incluídos, 464 preenchiam os critérios de sepse. A prevalência de sepse, sepse grave e choque séptico foi de 42,6%, 25,9% e 19,8%, respectivamente. A mediana de idade dos pacientes com sepse foi de 11,6 meses (IQR: 3,2 - 48,7), 43% tinham uma ou mais doenças crônicas. A prevalência de sepse foi maior nas crianças menores de 1 ano de idade e caiu drasticamente nos adolescentes (50,4 vs 1,9%; p < 0,001). A mortalidade global por sepse foi de 14,2% e foi consistentemente maior com o aumento da gravidade da doença: 4,4% para sepse, 12,3% para sepse grave e 23,1% para choque séptico. Vinte e cinco por cento dos óbitos ocorreram durante as primeiras 24 horas de internação na UTIP. A análise multivariada demonstrou que os escores PRISM (OR 1,06, IC 95% 1,02 - 1,11; p= 0,005) e PELOD (OR 1,06, IC 95% 1,02 - 1,11; p= 0,001), a presença de duas ou mais doenças crônicas...

Sepsis, or the systemic inflammatory response to infection, is a major childhood disease, wastes a substantial amount of the intensive care units' financial resources and is a common cause of death in children. The disease is considered a growing public health problem, often overlooked by several sections of our community. Objective: To report the sepsis-related prevalence and mortality among critically ill children admitted to Pediatric Intensive Care Units (PICUs) in Latin America. Design: A prospective, multicenter cohort study. Setting: Twenty-one PICUs, located in five Latin America countries. Patients: All children from 29 days to 17 years old admitted to the participating PICUs from June to September, 2011. Clinical, demographic and laboratory data were registered within the first 24 hours of admission. Outcomes were registered at PICU discharge or death. Sepsis was defined according to the International Pediatric Sepsis Consensus Conference (2005). Results: Among 1090 included patients, 464 had sepsis. The prevalence of sepsis, severe sepsis and septic shock was 42.6%, 25.9% and 19.8%, respectively. The median age of sepsis patients was 11.6 months (IQR 3.2-48.7), 43% of whom had one or more prior chronic conditions. The prevalence of sepsis was higher in children under 1 year and very low in adolescents (50.4 vs 1.9%, p= 0.001). Sepsis-related mortality was 14.2% and was consistently higher with increasing sepsis severity: 4.4% for sepsis, 12.3% for severe sepsis and 23.1% for septic shock. Twenty-five percent of the deaths occurred within the first 24 hours of admission. Multivariate analysis showed that PRISM (OR 1.06, 95% CI 1.02 - 1.11, p= 0.005) and PELOD scores (OR 1.06, 95% CI 1.02 - 1.11, p= 0.001), the presence of two or more chronic conditions (OR 2.74, 95% CI 1.40 - 5.36, p= 0.003) and admission from pediatric wards (OR 2.44, 95% CI 1.19 - 5.01, p= 0.015) were independently associated with...