Browsing by Autor "Roberto Jabornisky"

Now showing 1 - 5 of 5

Ingreso en cuidados intensivos debido a bronquiolitis grave en Colombia: ¿dónde nos encontramos en relación con el resto de Latinoamérica?
(Elsevier BV, 2020) Pablo Vásquez‐Hoyos; Rosalba Pardo-Carrero; Juan Camilo Jaramillo-Bustamante; Sebastián González‐Dambrauskas; Cristóbal Carvajal; Franco Díaz; Analía Fernández; Roberto Jabornisky; Silvina Muzzio; Evelin Cidral
P0375 / #530: EPIDEMIOLOGY, PATTERNS OF CARE AND OUTCOMES FOR CHILDREN WITH ACUTE RESPIRATORY FAILURE IN 35 PICUS FROM LATIN AMERICA: INSIGHTS FROM A PROSPECTIVE COLLABORATIVE CLINICAL REGISTRY.
(Lippincott Williams & Wilkins, 2021) Pablo Vásquez‐Hoyos; Franco Díaz; Roberto Jabornisky; Alberto Serra; Regina Grigolli César; Nicolás Monteverde-Fernández; P. Pietroboni; M. Céspedes-Lesczinsky; Adriana Wegner; Pablo del Pino
Aims & Objectives: To describe the epidemiology, therapeutic management and outcomes of children admitted to pediatric ICU (PICU) for acute respiratory failure (ARF) in a contemporary multinational PICU cohort. Methods: Retrospective analysis using prospectively collected clinical data within the LARed Network ARF clinical registry (35 hospitals, 8 Latin-American countries). We analyzed all PICU encounters for ARF that included any respiratory support from May 2017 to October 2019. Demographics, comorbidities, clinical data (including retrieval support and admission severity scores), etiology, PICU respiratory support, adjuvant therapies, and outcomes were described and expressed as median (interquartile percentiles) or relative (percentage) frequencies. Results: Final analysis included 5297 PICU admissions. The main findings are presented in the table. The median age was 5 months (2, 14), 58.1% were males and Bronchiolitis was the most common diagnosis (50.2%) with RSV the most frequent etiology (40.0%). Noninvasive ventilation (NIMV) was the maximal respiratory support in almost 2/3 of encounters from the cohort (61.8%), being high flow nasal cannula (HFNC) and bilevel positive ventilation (BiPAP) the 2 most commonly used techniques. NIMV related complications were low whereas Invasive MV related complications were 21.6%. Although global mortality was low (1.2%), we detected 3.0% of new morbidities at PICU discharge (> 3 change in Functional Status Scale).Conclusions: We present contemporary relevant clinical data regarding ARF epidemiology and patterns of care across Latin-American PICUs. These data provide benchmarks for hospitals to identify current regional practices, assess their performance and guide quality improvement initiatives.
P0380 / #692: PROLONGED MECHANICAL VENTILATION IN CHILDREN ADMITTED WITH ACUTE RESPIRATORY FAILURE TO 33 LATINAMERICAN PEDIATRIC INTENSIVE CARE UNITS: RISK FACTORS AND OUTCOMES.
(Lippincott Williams & Wilkins, 2021) P. Pietroboni; Sebastián González‐Dambrauskas; Franco Díaz; Pablo Vásquez‐Hoyos; Alberto Serra; Nicolás Monteverde-Fernández; M. Céspedes-Lesczinsky; Regina Grigolli César; Roberto Jabornisky
Aims & Objectives: To determine risk factors and outcomes for prolonged invasive mechanical ventilation (pIMV) in infants admitted to pediatric ICU (PICU) due to acute respiratory failure (ARF). Methods: Retrospective analysis using prospectively collected data within LARed Network ARF registry (33 hospitals, 8 countries). All PICU encounters in children younger than 2yo which needed invasive MV (IMV) from May 2017 to October 2019 were included. We defined pIMV as the closest day to the p75 percentile. Demographics, etiology, clinical data and discharge outcomes, late mortality (after 5th day) and PICU acquired morbidity measured with Functional Status Score (FSS). Variables were described and expressed as median (p25, p75) or frequencies (percentage) and adjusted through mixed logistic regression model. Results: Final analysis included 1140 children. Duration of IMV was 111 hours (44, 187). A cut off for pIMV was set at 8 days. Risk factors identified for pIMV were age (OR: 0.96, 0.93-0.99), bronchopulmonary dysplasia (BPD) (OR: 1.96, 1.15-3.35) and home O2 dependency (OR: 2.36, 1.11-5.00). pIMV group had more IMV related complications (OR: 5.13, 3.17-8.30), healthcare-acquired infections (OR: 5.44, 3.11-9.53), and longer PICU length of stay (LOS) (OR: 1.14, 1.11-1.17). Although overall and late mortality were initially not significantly different, when we combine late mortality and new morbidity (change in FSS >3 points), they became significant (OR: 2.55, 1.48-4.37). Conclusions: Age, BPD and O2 dependency are risk factors for pIMV. pIMV was associated with worst patient important outcomes. Reducing IMV time should be a quality improvement metric in our network.
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.
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.