Browsing by Autor "A Donoso"

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    Characteristics of Medically Transported Critically Ill Children with Respiratory Failure in Latin America: Implications for Outcomes
    (Thieme Medical Publishers (Germany), 2021) Jesús Alberto Serra; Franco Díaz; Pablo Cruces; Cristóbal Carvajal; Marı́a José Núñez; A Donoso; J.A. Bravo-Serrano; Marina Carbonell; C. Courtie; Ariel Fernández
    Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute respiratory failure to identify risk factors for mortality. We analyzed data from 2,692 patients admitted to 28 centers in the Pediatric Collaborative Network of Latin America Acute Respiratory Failure Registry. Among patients referred from another facility (773, 28%), nonurban transports were independently associated with mortality (adjusted odds ratio = 9.4; 95% confidence interval: 2.4-36.3).
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    P0407 / #1095: INVASIVE MECHANICAL VENTILATION PRACTICES IN 35 LATIN AMERICAN PICUS: ANALYSIS OF 1334 EVENTS FROM A MULTINATIONAL ACUTE RESPIRATORY FAILURE REGISTRY
    (Lippincott Williams & Wilkins, 2021) Regina Grigolli César; Pablo Vásquez‐Hoyos; A Donoso; Allison Serra; Franco Díaz; Juan Camilo Jaramillo-Bustamante; J. Seabra; L. Faleiros; Luis Martínez Arroyo; Roberto Jabornisky
    Aims & Objectives: to describe contemporary invasive mechanical ventilation (IMV) practices in children admitted to Latin American PICUs with acute respiratory failure (ARF). Methods: Retrospective analysis within LARed Network ARF Registry. We analyzed all children who were prescribed IMV between May 2017 and October 2019. Data described as median (IQR) or frequencies, adjusted by mixed logistic regression model. Results: Of the 5397 patients, 1334 (25.2%) received IMV for 121 h (70-197). Age 5mo (2-14), 61% male, 38% comorbidities. Diagnosis: Bronchiolitis 55% (62% RSV); Pneumonia 34%; pediatric acute respiratory distress syndrome (pARDS) 25%, Sepsis, 24%. Mode: Assisted controlled (AC) (53% Pressure; 15% Volume), Dual mode (17%), Synchronized Intermittent Mandatory ventilation (13%). Maximal settings: positive end-expiratory pressure: 7 cmH2O (6,8), tidal volume:8ml/kg (4.2,14.2), Peak inspiratory pressure (PIP): 26 cmH2O (22,29), plateau pressure: 25 cmH2O (20,28), MAP: 13 cmH2O (11,15). IMV related complications (41/1000 IMV days): withdrawal syndrome (55%), weaning failure (23%), ventilator-associated pneumonia (15%). IMV free days: 24 (20-27), PICU LOS: 9 days (6,13). Mortality: 4.2%, PICU acquired morbidity: 7.8%. pARDS was associated to: longer IMV (Days OR 1.07; 1.05-1.10), more IMV complications (OR 4.05; 2.82-5.82) and nosocomial infections (OR 3.08; 1.84-5.15), and more hypoxemia rescue therapies use (OR 9.16; 6.27-13.38). Conclusions: In this Latin American cohort, 1/4 of children with ARF needed IMV. AC was the predominant ventilation mode and RSV bronchiolitis the most common disease. The great variability detected on ventilator settings along with the rate of IMV-related complications shows plenty of room for quality improvement initiatives.