7 research outputs found
Use of High-Flow Cannula in Pediatric Patients With Respiratory Failure: A Prospective Cohort Study in Three High-Altitude Hospitals
BACKGROUND AND AIMS: Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals.
METHODS: It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow-up was carried out at 1, 6, and 48âh after starting the management.
RESULTS: Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6âh. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%.
CONCLUSION: The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies
Remdesivir and three other drugs for hospitalised patients with COVID-19: final results of the WHO Solidarity randomised trial and updated meta-analyses.
BACKGROUND
World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19).
METHODS
We randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry.
RESULTS
At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; Pâ=â0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; Pâ=â0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; Pâ=â0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; Pâ=â0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration.
CONCLUSIONS
These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.)
Sociedad del conocimiento, ocio y cultura : un enfoque interdisciplinar
Resumen basado en la publicaciĂłnSe plantean las aportaciones realizadas en el programa de doctorado Sociedad del Conocimiento, Ocio y Cultura: un enfoque interdisciplinar, desarrollado en la Universidad de Oviedo durante el bienio 2002-2004. Desde este programa se trata de responder a unas necesidades formativas de los licenciados en PedagogĂa y de otras titulaciones afines que, de alguna manera, podĂan recoger las demandas de la sociedad, altamente impregnada por la tecnologĂa, y que posee una mayor cantidad de tiempo libre para emplear en actividades de ocio y cultura. Las diferentes aportaciones que se realizan se agrupan entorno a tres grandes apartados: 1) El primero hace referencia a los aspectos metodolĂłgicos de las TecnologĂas de la InformaciĂłn y la ComunicaciĂłn, en dĂłnde se adjuntan seis trabajos incluido el del CatedrĂĄtico de TecnologĂa Educativa de la Universidad de Sevilla, Juan de Pablo Pons. 2) El segundo agrupa aquellos trabajos que hacen referencia a planteamientos generales sobre cultura y ocio, temas fundamentales que sirven de marco para contextualizar otros planteamientos mĂĄs prĂĄcticos y aplicados. 3) Finalmente, el apartado mĂĄs amplio, que bajo el epĂgrafe de Ocio y Cultura en las DidĂĄcticas Especiales, recoge aplicaciones concretas llevadas a cabo desde puntos de vista distintos orientados, casi siempre, a las actividades de ocio.Universidad de Oviedo. Facultad de Ciencias de la EducaciĂłn; Calle Aniceto Sela s. n.; 33005 Oviedo; +34985103215; 985103214;ES
Use of highâflow cannula in pediatric patients with respiratory failure: A prospective cohort study in three highâaltitude hospitals
Abstract Background and Aims Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a highâflow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of highâflow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals Methods It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The followâup was carried out at 1, 6, and 48âh after starting the management. Results Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6âh. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%. Conclusion The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies
Repurposed Antiviral Drugs for Covid-19 : Interim WHO Solidarity Trial Results
BACKGROUND
World Health Organization expert groups recommended mortality trials of four
repurposed antiviral drugs â remdesivir, hydroxychloroquine, lopinavir, and interferon
beta-1a â in patients hospitalized with coronavirus disease 2019 (Covid-19).
METHODS
We randomly assigned inpatients with Covid-19 equally between one of the trial
drug regimens that was locally available and open control (up to five options, four
active and the local standard of care). The intention-to-treat primary analyses examined
in-hospital mortality in the four pairwise comparisons of each trial drug
and its control (drug available but patient assigned to the same care without that
drug). Rate ratios for death were calculated with stratification according to age
and status regarding mechanical ventilation at trial entry.
RESULTS
At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750
were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir
(without interferon), 2063 to interferon (including 651 to interferon plus lopinavir),
and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment,
with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death,
day 8; interquartile range, 4 to 14). The KaplanâMeier 28-day mortality was 11.8%
(39.0% if the patient was already receiving ventilation at randomization and 9.5%
otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303
of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to
1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of
906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of
1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio,
1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon
and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39;
P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced
initiation of ventilation or hospitalization duration.
CONCLUSIONS
These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little
or no effect on hospitalized patients with Covid-19, as indicated by overall mortality,
initiation of ventilation, and duration of hospital stay. (Funded by the World
Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov
number, NCT04315948.)Medicine, Faculty ofNon UBCPediatrics, Department ofReviewedFacultyResearche