12 research outputs found
Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain
Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients
Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain
Background
Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia.
Methods
A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared.
Results
Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (pâ=â0.002): 9.4 years (IQR 5.5â11.8) vs 3.4 years (IQR 0.4â9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, pâ=â0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, pâ<â0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, pâ<â0.001), diarrhea (66.7% vs 11.5%, pâ<â0.001), vomits (71.1% vs 23.1%, pâ=â0.001), fatigue (65.9% vs 36%, pâ=â0.016), shock (84.4% vs 13.8%, pâ<â0.001) and cardiac dysfunction (53.3% vs 10.3%, pâ=â0.001). MIS-C group had a lower lymphocyte count (pâ<â0.001) and LDH (pâ=â0.001) but higher neutrophil count (pâ=â0.045), neutrophil/lymphocyte ratio (pâ<â0.001), C-reactive protein (pâ<â0.001) and procalcitonin (pâ<â0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, pâ=â0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, pâ<â0.001), corticosteroids (80% vs 44.8%, pâ=â0.003) and immunoglobulins (51.1% vs 6.9%, pâ<â0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5â8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group.
Conclusions
MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprungâs disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprungâs disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36â39) and median bodyweight at presentation was 2·8 kg (2·3â3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
pâ€0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88â4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59â2·79], p<0·0001), sepsis at presentation (1·20
[1·04â1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4â5 vs ASA 1â2, 1·82 [1·40â2·35], p<0·0001; ASA 3 vs ASA 1â2, 1·58, [1·30â1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02â1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41â2·71], p=0·0001; parenteral nutrition 1·35, [1·05â1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47â0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50â0·86], p=0·0024) or percutaneous central line (0·69 [0·48â1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
MediciĂłn de la satisfacciĂłn de los pacientes ingresados en la Unidad de Cuidados Intensivos y sus familiares
RESUMEN: IntroducciĂłn: Los pacientes ingresados en las Unidades de Cuidados Intensivos (UCIs), muchas veces por su patologĂa o por su situaciĂłn de gravedad, no estĂĄn lo suficientemente conscientes como para participar activamente en el proceso asistencial, por lo que gran parte de las decisiones son trasladadas a sus familiares.
Objetivos: Conocer el grado de satisfacciĂłn de los pacientes dados de alta de la UCI y de sus familiares y determinar la concordancia entre las respuestas de ambos grupos pertenecientes a un mismo nĂșcleo familiar.
MĂ©todo:
Instrumento: encuesta Family Satisfaction Intensive Care Unit (FS-ICU 34) para familiares de pacientes ingresados en UCI (que sobrevivieron o no) y adaptaciĂłn de la misma en cuanto a cuidados se refiere, para el propio paciente.
Resultados: Se obtuvieron un total de 385 encuestas, 192 de familiares de supervivientes, 31 de familiares de fallecidos y 162 de pacientes. La mayor parte de los familiares encuestados estaban satisfechos con los cuidados recibidos y el proceso de decisiones (supervivientes: 83,46±11,83 y 79,42±13,58, respectivamente; fallecidos: 80,41±17,27 y 79.61±16,93, respectivamente). Los pacientes encuestados estaban muy satisfechos con los cuidados recibidos (84,71±12,85 ). No existe buena concordancia entre las respuestas de los pacientes y sus familiares.
Conclusiones: El grado de satisfacciĂłn de los familiares y de los propios pacientes ingresados en UCI es elevado. AĂșn asĂ existen varios puntos que deberĂan ser mejorados como el ambiente de la sala de espera y el ambiente propio de la UCI en cuanto a ruido, intimidad e iluminaciĂłn se refiere.
Cuando el paciente estĂĄ en condiciones de ser encuestado, debemos recurrir a Ă©l para conocer sus necesidades y expectativas. Si el paciente no es competente, debemos acudir a sus familiares porque, teĂłricamente, son los que mejor los conocen.ABSTRACT: ABSTRACT
Objective. To determine the level of satisfaction of family members with care and decision making process and to know the level of satisfaction of patients discharged from ICU.
Design. Prospective, observational and descriptive study during 5 months.
Setting. ICU of the University Hospital Marqués de Valdecilla, Santander.
Subjects. Family of adult patients admitted in ICU and patients who were discharged to the ward.
Intervention. Instrument: Family Satisfaction Intensive Care Survey (FS-ICU 34) to family members of patients discharged to the ward. We adapted a questionnaire from FS-ICU 34 to the own patients.
Results. 385 questionnaires were obtained, 192 from families of survivors and 162 from patients. 31 from relatives of non-survivors. The majority of relatives were satisfied with overall care and overall decision making (survivors: 83,46±11,83 and 79,42±13,58, respectively; non-survivors: 80,41±17,27 and 79.61±16,93, respectively). Patients were very satisfied with care (84,71±12,85).
There is not good agreement between patients and their family.
Conclusions. The level of satisfaction of the relatives of patients admitted to ICU is high and also is high the degree of patient satisfaction. Still, there are several points that should be improved as the waiting room environment and the atmosphere of the ICU in terms of noise, privacy, and lighting. When patients are competent, intensivists must resort to them in order to know which their feelings, symptoms, experiences, and also their complaints are. When patients are not able to answer we must ask their family members. Then, they may serve as surrogate to assess appropriateness of care because they are the ones who really know them
Admission, discharge and triage guidelines for paediatric intensive care units in Spain
La unidad de cuidados intensivos pediĂĄtricos (UCIP) es una unidad fĂsica asistencial hospitalaria independiente especialmente diseñada para el tratamiento de pacientes pediĂĄtricos quienes debido su gravedad o condiciones potencialmente letales requieren observaciĂłn y asistencia mĂ©dica intensiva integral y continua por un equipo mĂ©dico que haya obtenido competencia especial en medicina intensiva pediĂĄtrica. La aplicaciĂłn oportuna de terapia intensiva a los pacientes crĂticos reduce la mortalidad, el tiempo de estancia y los costes asistenciales. Con los objetivos de respetar el derecho del niño al disfrute del mĂĄs alto nivel posible de salud y a servicios para el tratamiento de las enfermedades y la rehabilitaciĂłn de la salud y de garantizar la calidad asistencial y la seguridad de los pacientes pediĂĄtricos crĂticos, la AsociaciĂłn Española de PediatrĂa (AEP), la Sociedad Española de Cuidados Intensivos PediĂĄtricos (SECIP) y la Sociedad Española de Medicina Intensiva, CrĂtica y Unidades Coronarias (SEMICYUC) han desarrollado y aprobado las guĂas de ingreso, alta y triage para las UCIP en España. Mediante la aplicaciĂłn de estas guĂas se puede optimizar el uso de las UCIP españolas de forma que los pacientes pediĂĄtricos reciban el nivel de cuidados mĂ©dicos mĂĄs apropiado para su situaciĂłn clĂnicaA paediatric intensive care unit (PICU) is a separate physical facility or unit specifically designed for the treatment of paediatric patients who, because of the severity of illness or other life-threatening conditions, require comprehensive and continuous inten-sive care by a medical team with special skills in paediatric intensive care medicine. Timely and personal intervention in intensive care reduces mortality, reduces length of stay, and decreases cost of care. With the aim of defending the right of the child to receive the highest attainable standard of health and the facilities for the treatment of illness and rehabilitation, as well as ensuring the quality of care and the safety of critically ill paediatric patients, the Spanish Association of Paediatrics (AEP), Spanish Society of Paediatric Intensive Care (SECIP) and Spanish Society of Critical Care (SEMICYUC) have approved the guidelines for the admission, discharge and triage for Spanish PICUs. By using these guidelines, the performance of Spanish paediatric intensive care units can be optimised and paediatric patients can receive the appropriate level of care for their clinical conditio
Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain
Background
Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia.
Methods
A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared.
Results
Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (pâ=â0.002): 9.4 years (IQR 5.5â11.8) vs 3.4 years (IQR 0.4â9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, pâ=â0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, pâ<â0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, pâ<â0.001), diarrhea (66.7% vs 11.5%, pâ<â0.001), vomits (71.1% vs 23.1%, pâ=â0.001), fatigue (65.9% vs 36%, pâ=â0.016), shock (84.4% vs 13.8%, pâ<â0.001) and cardiac dysfunction (53.3% vs 10.3%, pâ=â0.001). MIS-C group had a lower lymphocyte count (pâ<â0.001) and LDH (pâ=â0.001) but higher neutrophil count (pâ=â0.045), neutrophil/lymphocyte ratio (pâ<â0.001), C-reactive protein (pâ<â0.001) and procalcitonin (pâ<â0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, pâ=â0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, pâ<â0.001), corticosteroids (80% vs 44.8%, pâ=â0.003) and immunoglobulins (51.1% vs 6.9%, pâ<â0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5â8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group.
Conclusions
MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients
The risk of COVID-19 death is much greater and age dependent with type I IFN autoantibodies
International audienceSignificance There is growing evidence that preexisting autoantibodies neutralizing type I interferons (IFNs) are strong determinants of life-threatening COVID-19 pneumonia. It is important to estimate their quantitative impact on COVID-19 mortality upon SARS-CoV-2 infection, by age and sex, as both the prevalence of these autoantibodies and the risk of COVID-19 death increase with age and are higher in men. Using an unvaccinated sample of 1,261 deceased patients and 34,159 individuals from the general population, we found that autoantibodies against type I IFNs strongly increased the SARS-CoV-2 infection fatality rate at all ages, in both men and women. Autoantibodies against type I IFNs are strong and common predictors of life-threatening COVID-19. Testing for these autoantibodies should be considered in the general population