Utilidad del ácido láctico en líquido pleural para la clasificación de la gravedad del derrame pleural paraneumónico en pediatría

Introducción: La indicación de drenaje pleural en derrame pleural paraneumónico (DPPN) sigue siendo controvertida. El pH del líquido pleural (LP) es ampliamente utilizado como indicador de la necesidad de drenaje pleural. Nuestra hipótesis es que el lactato de LP tiene una buena correlación con el pH y, por lo tanto, podría ser una herramienta valiosa para determinar la necesidad de drenaje pleural en los DDPN pediátricos. Materiales y métodos: Realizamos un estudio prospectivo descriptivo reclutando secuencialmente a aquellos pacientes pediátricos pacientes ingresados en un Hospital Universitario de tercer nivel con un DDPN entre 2008 y 2018. Los pacientes se clasificaron en dos grupos: DDPN drenables (pH 7). La correlación con el pH, el área bajo la curva (AUC), y los valores de sensibilidad y especificidad para el lactato y otros parámetros (glucosa y LDH) fueron analizados también. Resultados: se incluyeron 72 pacientes con una mediana de edad de 4 años (rango intercuartílico 2,25-6). Ambos grupos fueron homogéneos. Los niveles de lactato fueron más altos en el grupo de DPPN drenable (p < 0,001). Se observó una correlación inversa fuerte entre pH y lactato (r: -0.7; p < 0.001). Un valor de corte de lactato de 60,5 mmol/L presentó un AUC de 0,86 con una sensibilidad del 70% y una alta especificidad (97,9%) para predecir un pH < 7. Conclusiones: Nuestros datos indican que el lactato en LP presenta una fuerte correlación con el pH y podría potencialmente servir como un biomarcador altamente específico de la necesidad de drenaje pleural.Introduction: The indication of pleural drainage in parapneumonic pleural effusion (PPE) is still controversial. Pleural fluid’s (PF) pH is widely used as an indicator of the need for pleural drainage. We hypothesized that PF’s lactate will have a high concordance with pH, and thus, may be a valuable tool to determine the need for pleural drainage in pediatric PPE. Materials and methods: We performed a descriptive, prospective study sequentially enrolling those pediatric patients admitted to a tertiary University Hospital with a PPE between 2008 and 2018. Patients were classified in two groups: drainable PPE (pH < 7) and non-drainable PPE (pH > 7). Correlation with the pH, the area under the curve (AUC), and the sensitivity and specificity values for lactate and other parameters (glucose, and LDH) were analysed too. Results: 72 patients with a median age of 4 years (interquartile range 2.25–6) were included. Both groups were homogeneous. Lactate levels were higher in the drainable PPE group (p < 0.001), and a strong inverse correlation between pH and lactate was found (r: - 0.7; p < 0.001). A lactate cut-off value of 60.5 mmol/L, exhibit an AUC of 0.86 with a sensitivity of 70% and a high specificity (97.9%) to predict a pH < 7. Conclusions: Our data indicates that lactate in PF presents a strong correlation with pH and could potentially serve as a highly specific biomarker of the need for pleural drainage.123 página

Characterization of Cardiopulmonary Interactions and Exploring Their Prognostic Value in Acute Bronchiolitis: A Prospective Cardiopulmonary Ultrasound Study

We aimed to delineate cardiopulmonary interactions in acute bronchiolitis and to evaluate the capacity of a combined cardiopulmonary ultrasonography to predict the need for respiratory support. This was a prospective observational single-center study that includes infants &lt;12 month of age admitted to a hospital due to acute bronchiolitis. All the included patients underwent clinical, laboratory and cardiopulmonary ultrasonographic evaluation at the same time point within 24 h of hospital admission. The existence of significant correlation between cardiac and respiratory parameters was the primary outcome. The association of different cardiopulmonary variables with the need of respiratory support higher than O2, the length of stay hospitalization, the PICU stay and the duration of respiratory support were a secondary outcome. We enrolled 112 infants (median age 1 (0.5&ndash;3) months; 62% males) hospitalized with acute bronchiolitis. Increased values of the pulmonary variables (BROSJOD score, pCO2 and LUS) showed moderate correlations with NT-proBNP and all echocardiographic parameters indicative of pulmonary hypertension and myocardial dysfunction (Tei index). Up to 36 (32%) infants required respiratory support during the hospitalization. This group presented with higher lung ultrasound score (p &lt; 0.001) and increased values of NT-proBNP (p &lt; 0.001), the Tei index (p &lt; 0.001) and pulmonary artery pressures (p &lt; 0.001). All the analyzed respiratory and cardiac variables showed moderate-to-strong correlations with the LOS of hospitalization and the time of respiratory support. Lung ultrasound and echocardiography showed a moderate-to-strong predictive accuracy for the need of respiratory support in the ROC analysis, with the AUC varying from 0.74 to 0.87. Those cases of bronchiolitis with a worse pulmonary status presented with a more impaired cardiac status. Cardiopulmonary ultrasonography could be a useful tool to easily identify high-risk populations for complicated acute bronchiolitis hospitalization

Correlation between urinary and serum NT-proBNP in acute bronchiolitis: A pilot study.

We aimed to analyze the correlation of urinary with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and its association with severity in acute bronchiolitis. A pilot observational study was conducted between October 1, 2021 and March 31, 2022 including acute bronchiolitis cases who attended our institution. Serum and urinary NT-proBNP concentrations were determined using the Alere i NT-proBNP assay in time-matched urine and blood samples. The Mann-Whitney U test, Spearman's correlations, and simple linear regression were utilized to analyze the association of urine NT-proBNP levels with serum NT-proBNP and with variables indicative of severe bronchiolitis. Seventeen infants (median age 68 [IQR: 36-91] days) with 36 time-matched samples were included. The urine NT-proBNP was positively and strongly correlated with the serum NT-proBNP concentrations (Spearman's ρ = 0.81 & R2  coefficient = 0.751; p  The urinary NT-proBNP concentrations could be a reliable surrogate for serum NT-proBNP levels and resulted elevated in cases of acute bronchiolitis with complicated evolution, suggesting a potential as a noninvasive tool to assess severity in this setting