Browsing by Autor "Tejerina-Ortiz, Mary"

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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.
Sepsis in Critically Ill Children in Bolivia: Multicenter Retrospective Evaluation of the Phoenix Criteria for Sepsis in a 2023 Cohort.
(2025) Copana-Olmos, Raul; Casson-Rodriguez, Nils; Diaz-Villalobos, Willmer; Urquieta-Clavel, Victor; Tejerina-Ortiz, Mary; Mendoza-Montoya, Carol; Fernandez-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; Cuellar-Gutierrez, Magbely; Sarmiento-Zurita, Alan J; Carrillo-Vargas, Michelle G; Ledezma-Hurtado, Brisa W; Sanchez-Pinto, L Nelson
OBJECTIVES: We evaluated the Phoenix criteria and the Phoenix Sepsis Score in a multicenter retrospective cohort of critically ill children with a clinical diagnosis of sepsis or septic shock in Bolivia. In addition, we aimed to assess whether management in a PICU at high altitude in the Bolivian Andes was associated with the performance of the respiratory dysfunction component in the Phoenix Sepsis Score. DESIGN: Multicenter retrospective cohort study. SETTING: Fourteen PICUs in Bolivia. PATIENTS: Children admitted to the PICU with a clinical diagnosis of sepsis or septic shock from January 2023 to December 2023. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 273 patients with a diagnosis of sepsis in 2023, of which 257 (94.1%) met the 2024 Phoenix criteria for sepsis, and 166 (60.8%) met the systemic inflammatory response syndrome (SIRS)-based criteria for sepsis. Among the 257 patients meeting Phoenix sepsis criteria, 86 died (33.5%). Of the patients with Phoenix-based sepsis, there were 100 of 257 (38.9%) who were SIRS-negative, and 27 of 100 died (27.0%). After correcting the oxygenation indices for altitude, 149 of 273 patients (54.6%) had a lower Phoenix respiratory score and an associated mortality more consistent with the expected mortality of the newly derived subscore. Patients at higher altitudes had higher hemoglobin levels and higher estimated oxygen carrying capacity, and these data were independently associated with lower odds of mortality after controlling for altitude-corrected Phoenix score. CONCLUSIONS: In this 2023, retrospective cohort of PICU patients with sepsis in Bolivia, we have found that the majority met the 2024 Phoenix sepsis criteria, but less than two-thirds met the SIRS-based criteria for diagnosis. However, the respiratory score in the Phoenix criteria overestimated the severity of respiratory dysfunction in more than half of the cohort, likely because the score does not take account of the Andean adaptation to high altitude, with higher oxygen carrying capacity.