7 research outputs found
COVID-19 PICU guidelines: for high- and limited-resource settings
BACKGROUND: Fewer children than adults have been affected by the COVID-19 pandemic, and the clinical manifestations are
distinct from those of adults. Some children particularly those with acute or chronic co-morbidities are likely to develop critical
illness. Recently, a multisystem inflammatory syndrome (MIS-C) has been described in children with some of these patients
requiring care in the pediatric ICU.
METHODS: An international collaboration was formed to review the available evidence and develop evidence-based guidelines for
the care of critically ill children with SARS-CoV-2 infection. Where the evidence was lacking, those gaps were replaced with
consensus-based guidelines.
RESULTS: This process has generated 44 recommendations related to pediatric COVID-19 patients presenting with respiratory
distress or failure, sepsis or septic shock, cardiopulmonary arrest, MIS-C, those requiring adjuvant therapies, or ECMO. Evidence to
explain the milder disease patterns in children and the potential to use repurposed anti-viral drugs, anti-inflammatory or antithrombotic
therapies are also described.
CONCLUSION: Brief summaries of pediatric SARS-CoV-2 infection in different regions of the world are included since few registries
are capturing this data globally. These guidelines seek to harmonize the standards and strategies for intensive care that critically ill
children with COVID-19 receive across the worl
COVID-19 and children: many questions yet to be answered
sem informação49852752
Uso de biomarcadores na sepse pediátrica: revisão de literatura
RESUMO A despeito dos avanços nos últimos anos, a sepse ainda é uma das principais causas de internação e mortalidade em lactentes e crianças. A presença de biomarcadores na resposta a um insulto infeccioso resulta em seu uso na triagem, no diagnóstico, no prognóstico (estratificação de risco), na monitorização da resposta terapêutica e no uso racional de antibióticos (duração adequada, por exemplo). Os estudos sobre biomarcadores na sepse em crianças são ainda relativamente escassos. Esta revisão aborda o uso de biomarcadores na sepse em pacientes pediátricos, com ênfase em proteÃna C-reativa, procalcitonina, interleucinas 6, 8 e 18, gelatinase dos neutrófilos humanos e proadrenomedulina, que podem ser úteis na abordagem da sepse pediátrica
Association between fluid overload and mortality in children with sepsis: a systematic review and meta-analysis
Background Sepsis is one of the main causes of morbidity and mortality worldwide. Fluid resuscitation is among the most common interventions and is associated with fluid overload (FO) in some patients. The objective of this systematic review and meta-analysis was to summarise the available evidence on the association between FO and morbimortality in children with sepsis.Methods A systematic search was carried out in PubMed/Medline, Embase, Cochrane and Google Scholar up to December 2022 (PROSPERO 408148), including studies in children with sepsis which reported more than 10% FO 24 hours after admission to intensive care. The risk of bias was assessed using the Newcastle-Ottawa scale. Heterogeneity was assessed using I2, considering it absent if <25% and high if >75%. A sensitivity analysis was run to explore the impact of the methodological quality on the size of the effect. Mantel-Haenszel’s model of random effects was used for the analysis. The primary outcome was to determine the risk of mortality associated with FO and the secondary outcomes were the need for mechanical ventilation (MV), multiple organ dysfunction syndrome (MODS) and length of hospital stay associated with FO.Results A total of 9 studies (2312 patients) were included, all of which were observational. Children with FO had a higher mortality than patients without overload (46% vs 26%; OR 5.06; 95% CI 1.77 to 14.48; p<0.01). We found no association between %FO and the risk of MODS (OR: 0.97; 95% CI 0.13 to 7.12; p=0.98). Children with FO required MV more often (83% vs 47%; OR: 4.78; 95% CI 2.51 to 9.11; p<0.01) and had a longer hospital stay (8 days (RIQ 6.5–13.2) vs 7 days (RIQ 6.1–11.5); p<0.01).Conclusion In children with sepsis, more than 10% FO 24 hours after intensive care admission is associated with higher mortality, the need for MV and length of hospital stay