Browsing by Autor "Casson, Nils"

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Pediatric Critical Care Transport: Survey of Current State in Latin America. Latin American Society of Pediatric Intensive Care Transport Committee.
(2022) Yock-Corrales, Adriana; Casson, Nils; Sosa-Soto, Giordano; Orellana, Renan A
METHODS: An electronic, anonymous, multicenter survey housed by Monkey Survey was sent to physicians in LA and included questions about hospital and pediatric critical transport, resources available and level of car. Nineteen Latin-American countries were asked to complete the survey. RESULTS: A total of 212 surveys were analyzed, achieving a representativity of 19 LA countries, being most participants (59.4%, n = 126) from South America (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay and Venezuela). Most surveys were conducted by physicians of tertiary level centers (60.8%, n = 129), most of the institutions were classified by the participants as public health care centers (81.6%, n = 173). Most of the surveyed physicians (63.7%, n = 135) reported that there is a coordination center for critical care transport (CCT). In most cases, physicians report that a unified transport system for pediatric critical patients does not exist in their countries (67.45%, n = 143). Only 59 (30.7%) surveys reported the use of an exclusively pediatric critical care transport system. Most of these transport systems are described as a mixture of public and private efforts (51.56%, n = 99), but there is also a considerable involvement of government-funded critical transport systems (43.75%, n = 84). Specific training for personnel devoted to transportation of critically ill patients is reported in 55.6% (90), and the medical equipment necessary to carry out the transport is available in 67.7%. The majority (83.95%, n = 136) mentioned that access to advanced life support courses is possible. Training in triage and disaster is available in 44.1%. Physicians and registered nurse were identified as the transport providers in 41.5%, and only one third were made by pediatricians-pediatric nurse. The main reasons for transfers were respiratory illness, neonatal pathologies, trauma, infectious diseases, and neurological conditions. Overall, pediatric transport was reported as insufficient (70.19%, n = 148) by the surveyed physicians in LA and nonexisting by some of them (6.83%, n = 15). There were no regulations or laws in the majority of the surveyed countries (63.13%), and in the places where physicians reported regulatory laws, there were no dissemination (84.9%) by the local authorities. CONCLUSIONS: In LA, there is a great variability in personnel training, equipment for pediatric-neonatal transport, transport team composition, and characterization of critical care transport systems. Continued efforts to improve conditions in our countries by generating documents that standardize practices and generating scientific information on the epidemiology of pediatric transfers, especially of critically ill patients, may help reduce patient morbidity and mortality.
Sepsis Bundle Adherence and Early Vasopressor Administration in Pediatric Septic Shock: Secondary Analysis of Outcomes in a 2023 Multicenter Cohort in Bolivia.
(2026) Copana-Olmos, Raul; Casson, Nils; Diaz-Villalobos, Willmer; Urquieta-Clavel, Victor; Tejerina-Ortiz, Mary; Cespedes-Lesczinsky, Miguel; Aguilera-Avendaño, Vladimir; Fernández-Vidal, Maricruz; Forest-Yepez, Mariel; Blanco-Espejo, Danny; Rivera-Murguia, Ibeth; Castro-Auza, Claudia; Gamboa-Lanza, Milenka; Paco-Barral, Jhovana E; Choque-Osco, Gustavo; Vera-Dorado, Betzhi; Mendoza-Montoya, Carol; Cuellar-Gutierrez, Magbely; Fernandez-Sarmiento, Jaime
OBJECTIVES: In a cohort of children with septic shock, we evaluated the association between vasoactive agent use within 1 hour of starting our sepsis bundle and mortality. Secondarily, we assessed the relationship between sepsis bundle adherence and mortality and other outcomes. DESIGN: Nonpreplanned, secondary analysis of a national multicenter dataset collected in a resource-limited setting. SETTING: Dataset from 14 centers in Bolivia collected between January 2023 and December 2023. PATIENTS: Children under 15 years old with sepsis or septic shock defined using altitude-adjusted Phoenix criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 268 patients in this secondary analysis, with median (interquartile range [IQR]) age 17 months (IQR, 6-63 mo). The sepsis bundle was used within 3 hours in 131 of 268 patients (49%). Vasopressors were used in 102 of 268 patients (38%) and 85 of 102 (83%) had received peripheral administration within the 1 hour of persistent hypotension, without any record of adverse events. Early vasopressor use within 1 hour of septic shock recognition, and antibiotic administration within 1 hour of sepsis recognition, were independently associated with lower odds (using adjusted odds ratio [aOR] and 95% CI) of mortality, respectively: 0.49 (95% CI, 0.28-0.89) and 0.41 (95% CI, 0.24-0.71; both p = 0.001). Failure to complete the sepsis bundle within 3 hours was associated with greater odds of mortality (aOR, 3.61 [95% CI, 1.64-7.91]; p = 0.001) and greater odds of longer interval before emergency consultation (aOR, 1.04 [95% CI, 1.01-1.07]; p = 0.023). CONCLUSIONS: Early initiation of vasoactive agents in children with septic shock and timely sepsis bundle completion were independently associated with lower hazard of mortality. Historically, in Bolivia in 2023, bundle adherence was suboptimal, yet feasible interventions were associated with greater odds of better outcomes in pediatric sepsis and septic shock.
SIRS y qSOFA como Predictores de Mortalidad en Sepsis Pediátrica
(Gac Med Bol, 2021) Copana, Raúl; Díaz, Willmer; Martínez, Alejandro; Tejerina, Mary; Urquieta, Víctor; Casson, Nils; Vasquez, Alejandra
Introducción: La sepsis pediátrica continúa siendo una causa importante de mortalidad en países de bajos y medianos ingresos, su reconocimiento temprano en emergencias requiere del uso de criterios que nos permitan predecir anticipadamente la gravedad del paciente. Objetivo: nuestro estudio pretende comparar los criterios de SIRS y qSOFA en cuanto a su capacidad discriminatoria en mortalidad en sepsis pediátrica. Métodos: realizamos un estudio multicéntrico, prospectivo en servicios de emergencias incluyendo niños con sospecha de sepsis subsecuentemente ingresados a UTIP, en los cuales se evaluaron los puntajes en SIRS y qSOFA comparándolos con los resultados al egreso. Resultados: se enrolaron 64 pacientes, admitidos en estadios de Sepsis (19%), Shock Séptico (20,6%) y con Disfunción Multiorgánica (60,4%), con una mortalidad respectivamente de 9,5%, 14,3% y 76,2%; en 33,9% de los casos se pudo rescatar algún germen. Evaluando los criterios SIRS vemos que la ausencia de ellos se asocia con mayor sobrevivencia (p=0,044; OR 0,618: IC95% 0,5020,761), Por otro lado, 2 o más criterios qSOFA se asocia con mayor mortalidad (p=0,047; OR 3,52: IC95% 1,090-11,371). Conclusión: ambos criterios utilizados para definir sepsis en pediatría demostraron su utilidad, el uso del score qSOFA dada a su estrecha relación con la mortalidad puede emplearse para anticipar alteraciones orgánicas potencialmente mortales.