Browsing by Autor "Pablo Cruces"

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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).
Estrategias y recomendaciones para enfrentar la enfermedad por virus respiratorio sincicial el año 2024
(Sociedad Chilena de Pediatría, 2024) Enrique Paris; Paula Daza; Lorena Tapia; Juan Pablo Díaz; Pablo Cruces; Andrés Castillo; Cecilia González González; María Luz Endeiza; Leonor Jofré; Fabíola Monteiro de Castro
During the winter of 2023, Chile faced a complex situation related to the respiratory syncytial virus (RSV). After experiencing a decline in RSV circulation during the years of the SARS-CoV-2 pandemic, a late outbreak was observed in the spring of 2022 and an early onset of the outbreak in 2023, with a significant increase in the number of serious cases. The ineffectiveness of strategic planning and risk communication contributed to the complexity of the situation. To avoid the above next winter, measures such as active surveillance, unification of definitions for acute respiratory infections, identification of RSV variants, public education about infections and advance preparation regarding hospital beds and health personnel are suggested. The importance of immunization and intersectoral collaboration to acquire new preventive alternatives is highlighted, as well as the need for early communication about the importance of immunization and identification of high-risk groups, improvement in training of medical personnel and strategic planning of the Ministry of Health. seeking a proactive and collaborative approach to address the complex RSV situation in future winters. The Chilean Immunization Advisory Committee has already carried out an analysis and recommendation on a new prevention alternative. This working group will support any decision of the Ministry of Health in public policies that attempt a change in the paradigm of control of this disease for the health of the children of our country.
P0408 / #1101: RISK FACTORS AND OUTCOMES OF CHILDREN WITH ACUTE RESPIRATORY FAILURE AND TREATED WITH NON-INVASIVE OR INVASIVE VENTILATION
(Lippincott Williams & Wilkins, 2021) M.E. Cespedes Lesczinsky; Franco Díaz; Pablo Cruces; Alejandro Donoso; Regina Grigolli César; Sebastián González‐Dambrauskas; Roberto Jabornisky; Juan Camilo Jaramillo-Bustamante; Luis Martínez Arroyo; Nicolás Monteverde-Fernández
Aims & Objectives: To determine risk factors of non-invasive ventilation techniques (NIV) failure in children admitted with acute respiratory failure (ARF) and to compare their outcomes with children treated successfully or with invasive ventilation alone (IMV). Methods: Retrospective analysis within LARed Network ARF multicenter registry. We included all PICU encounters for ARF treated with high flow nasal cannula(HFNC), continuous or bilevel positive pressure ventilation (CPAP/BIPAP) or IMV alone between May 2017- October 2019. NIV failure was defined as need of IMV after a NIV device. Results: Of 4615 patients, we evaluated 3 groups: NIV failure (392); NIV success (3269); only IMV (954). As shown in figure 1, HFNC failure was 10.6% (248/2084), BiPAP 10.8% (140/1160) (p= 0.353), and CPAP failure was 27.3%; (75/200) (p<0.01). We found differences in age, admission diagnosis, viral or bacterial suspected infections and pim3%. After a mixed logistic regression model to adjust for center, NIV failure had higher rates of health acquired infections (HAI) and longer PICU length of stay compared to IMV alone or NIV success. Morbidity and mortality were lower in NIV success group (0.2 and 0.4%) compare to failures (4.8% each), but not compared to IMV alone (3.9 and 5.2%).Conclusions: In this multicenter study, NIV failure rate is low in children admitted to PICU for ARF. Younger age, suspected bacterial co-infection and admission diagnosis are risk factors for NIV failure. NIV failure has more HAIs and longer PICU LOS.
Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis
(Elsevier BV, 2020) Jesús Alberto Serra; Sebastián González‐Dambrauskas; Pablo Vásquez‐Hoyos; Cristóbal Carvajal; Alejandro Donoso; Pablo Cruces; Alicia Ruth Fernández; Luis Martínez Arroyo; María Piedad Sarmiento; Marı́a José Núñez
The objective of this study was to describe the management of infants with acute bronchiolitis admit ted to 20 pediatric intensive care units (PICU) members of LARed in 5 Latin American countries. Pa tients and Method: Retrospective, multicenter, observational study of data from the Latin American Registry of Acute Pediatric Respiratory Failure. We included children under 2 years of age admitted to the PICU due to community-based acute bronchiolitis between May and September 2017. Demo graphic and clinical data, respiratory support, therapies used, and clinical results were collected. A subgroup analysis was carried out according to geographical location (Atlantic v/s Pacific), type of insurance (Public v/s Private), and Academic v/s non-Academic centers. Results: 1,155 patients were included in the registry which present acute respiratory failure and 6 were excluded due to the lack of information in their record form. Out of the 1,147 patients, 908 were under 2 years of age, and out of those, 467 (51.4%) were diagnosed with acute bronchiolitis, which was the main cause of admission to the PICU due to acute respiratory failure. The demographic and severity characteristics among the centers were similar. The most frequent maximum ventilatory support was the high-flow nasal can nula (47%), followed by non-invasive ventilation (26%) and invasive mechanical ventilation (17%), with a wide coefficient of variation (CV) between centers. There was a great dispersion in the use of treatments, where the use of bronchodilators, antibiotics, and corticosteroids, representing a CV up to 400%. There were significant differences in subgroup analysis regarding respiratory support and treatments used. One patient of this cohort passed away. Conclusion: we detected wide variability in respiratory support and treatments among Latin American PICUs. This variability was not explained by demographic or clinical differences. The heterogeneity of treatments should encourage collabora tive initiatives to reduce the gap between scientific evidence and practice.