Extubation failure is a common event in intensive care units. Corticosteroids are effective in pr... more Extubation failure is a common event in intensive care units. Corticosteroids are effective in preventing failure in adults, but no consensus has been reached on this matter in pediatrics. We assessed the efficacy of intravenous dexamethasone in mechanically ventilated children and adolescents for more than 48 hours, with at least one risk factor for failure. Extubations were scheduled 24 hours in advance when possible, and patients were randomly assigned into two groups: one group received a loading dose followed by up to four doses of dexamethasone, and the other group received no corticosteroids. Need for reintubation and length of stay in the pediatric intensive care unit were similar in both groups, and frequency of reintubation was 12.9%.
JUSTIFICATIVA E OBJETIVOS: As indicações de transfusão de eritrócitos não estão bem estabelecidas... more JUSTIFICATIVA E OBJETIVOS: As indicações de transfusão de eritrócitos não estão bem estabelecidas em crianças gravemente enfermas. O objetivo deste estudo foi descrever a prática da transfusão de eritrócitos na UTI Pediátrica do Hospital de Clínicas da Universidade Estadual Paulista (HC-UNESP). MÉTODO: Estudo retrospectivo observacional realizado durante o ano de 2003. RESULTADOS: Setenta e cinco pacientes receberam transfusão, havendo registro de 105 indicações. Mais da metade dos pacientes (53,3%) tinha menos que um ano de idade. Taquipnéia (75,2%), palidez (65,7%) e hipotensão (51,4%) foram os registros mais freqüentemente observados antes da transfusão. Além disso, a gasometria evidenciou acidose metabólica (68,08%) e hipoxemia (63,8%). Dos 93 registros de valores de hemoglobina (Hb), 54 (58,1%) estavam entre 7 e 10 g/dL e dos 90 registros de hematócrito (Ht) observou-se que 66 (73,3%) apresentavam valores entre 21% e 30%. As principais indicações de transfusão foram anemia em 7...
Introduction: The effectiveness of noninvasive positive-pressure ventilation (NIV) in preventing ... more Introduction: The effectiveness of noninvasive positive-pressure ventilation (NIV) in preventing reintubation due to respiratory failure is still unproven in children. The objective was to compare NIV and inhaled oxygen (nasal cannula or face mask) in the first 48 hours of post-extubation respiratory failure children in terms of reintubation rate and length of stay in pediatric intensive care unit (PICU). Methods: Children aged between 28 days and three years undergoing invasive mechanical ventilation for >= 48 hours, were prospectively enrolled and randomly divided into noninvasive positive-pressure ventilation by (NIVG, n-55) and inhaled oxygen groups (OXG, n=53). Vital signs were recorded one hour after extubation and thereafter once a day to complete 48 hours. In the case of reintubation, its cause and vital signs were recorded. Normally distributed data were compared with t test and Mann-Whitney test otherwise. Other variables were compared by Goodman test. Significance of 5...
JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi rever a literatura sobre a utilização de ó... more JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi rever a literatura sobre a utilização de óxido nítrico inalatório em crianças com síndrome do desconforto respiratório agudo. CONTEÚDO: Revisão bibliográfica e seleção de publicações mais relevantes sobre óxido nítrico inalatório, utilizando a base de dados MedLine e Cochrane de Revisões Sistemáticas. A revisão incluiu descrição de aspectos da definição, fisiopatologia e tratamento ventilatório da síndrome do desconforto respiratório agudo, assim como o metabolismo, efeitos biológicos e aplicação clínica do óxido nítrico inalatório, comentando dose, administração e retirada do gás, precações, efeitos adversos e contra-indicações. CONCLUSÕES: O óxido nítrico, vasodilatador pulmonar seletivo, tem efeitos benéficos sobre as trocas gasosas e ventilação em crianças com hipóxia grave. É seguro quando administrado em ambiente de tratamento intensivo sob rigorosa monitorização. Estudos aleatórios e controlados devem enfocar a administra...
The objective of this study was to review the literature on inhaled nitric oxide to children with... more The objective of this study was to review the literature on inhaled nitric oxide to children with acute respiratory distress syndrome. A review of literature and selection of the most important publications on inhaled nitric oxide, using the MedLine and Cochrane Systematic Review Databases. This review was organized as follows: introduction; metabolism and biological effects; clinical applications; dosage, gas administration and weaning process; warnings and side-effects. Inhaled nitric oxide use was described in acute respiratory distress syndrome. Inhaled nitric oxide as the first vasodilator to produce selective pulmonary vasodilation has beneficial effects on gas exchange and ventilation, improving outcome in children with severe hypoxia. It is safe when administered in intensive care units under strict surveillance and monitoring. Further studies should be concentrated on early treatment, when acute respiratory distress syndrome is potentially reversible.
Indications of red blood cell transfusion in critically ill children are not very well determined... more Indications of red blood cell transfusion in critically ill children are not very well determined. This study aims to describe red blood cells transfusion practice at the PICU of UNESP-Botucatu Medical School. Retrospective observational study of all patients who received transfusion during 2003. Seventy five patients received transfusion and 105 indications were recorded. 53.3% of the patients were less than one year of age. Increased respiratory rate (75.2%), paleness (65.7%), and hypotension (51.4%) were the alterations more frequently recorded, before transfusion. Also, metabolic acidosis (68.08%) e and hipoxemia (63.8%) were very frequently observed. From 93 hemoglobin (Hb) values recorded, 54 (58.1%) varied from 7 to 10 g/dL and from 90 records of hematocrit (Ht) 66 (73.3%) varied from 21% to 30%. The main indications of the transfusion were anemia, in 75 children (71.4%), and active bleeding in 26 (24.7%). The mean value of Hb before transfusion was 7.82 ± 2.82 g/dL. Seven tr...
To establish a protocol for the early introduction of inhaled nitric oxide (iNO) therapy in child... more To establish a protocol for the early introduction of inhaled nitric oxide (iNO) therapy in children with acute respiratory distress syndrome (ARDS) and to assess its acute and sustained effects on oxygenation and ventilator settings. Ten children with ARDS, aged 1 to 132 months (median, 11 months), with arterial saturation of oxygen <88% while receiving a fraction of inspired oxygen (FiO2) >or=0.6 and a positive end-expiratory pressure of >or=10 cm H2O were included in the study. The acute response to iNO was assessed in a 4-hour dose-response test, and positive response was defined as an increase in the PaO2/FiO2 ratio of 10 mm Hg above baseline values. Conventional therapy was not changed during the test. In the following days, patients who had shown positive response continued to receive the lowest iNO dose. Hemodynamics, PaO2/FiO2, oxygenation index, gas exchange, and methemoglobin levels were obtained when needed. Inhaled nitric oxide withdrawal followed predetermined...
RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi rever a literatura sobre a utilizaç... more RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi rever a literatura sobre a utilização de óxido nítrico inalatório em crianças com síndrome do desconforto respiratório agudo. CONTEÚDO: Revisão bibliográfica e seleção de publicações mais relevantes sobre óxido nítrico inalatório, utilizando a base de dados MedLine e Cochrane de Revisões Sistemáticas. A revisão incluiu descrição de aspectos da definição, fisiopatologia e tratamento ventilatório da síndrome do desconforto respiratório agudo, assim como o metabolismo, efeitos biológicos e aplicação clínica do óxido nítrico inalatório, comentando dose, administração e retirada do gás, precações, efeitos adversos e contra-indicações.
To compare intermittent mandatory ventilation (IMV) with synchronized intermittent mandatory vent... more To compare intermittent mandatory ventilation (IMV) with synchronized intermittent mandatory ventilation plus pressure support (SIMV+PS) in terms of time on mechanical ventilation, duration of weaning and length of stay in a pediatric intensive care unit (PICU). This was a randomized clinical trial that enrolled children aged 28 days to 4 years who were admitted to a PICU between October of 2005 and June of 2007 and put on mechanical ventilation (MV) for more than 48 hours. These patients were allocated to one of two groups by drawing lots: IMV group (IMVG; n = 35) and SIMV+PS group (SIMVG; n = 35). Children were excluded if they had undergone tracheotomy or had chronic respiratory diseases. Data on oxygenation and ventilation were recorded at admission and at the start of weaning. There were no statistical differences between the groups in terms of age, sex, indication for MV, PRISM score, Comfort scale, use of sedatives or ventilation and oxygenation parameters. The median time on...
To study the behavior of procalcitonin and to verify whether it can be used to differentiate chil... more To study the behavior of procalcitonin and to verify whether it can be used to differentiate children with septic conditions. Methods: Children were enrolled prospectively from among those aged 28 days to 14 years, admitted between January 2004 and December 2005 to the pediatric intensive care unit at Universidade Estadual Paulista UNESP with sepsis or septic shock. The children were classified as belonging to one of two groups: the sepsis group (SG; n = 47) and the septic shock group (SSG; n = 43). Procalcitonin was measured at admission (T0) and again 12 hours later (T12h), and the results classed as: < 0.5 ng/mL = sepsis unlikely; ≥ 0.5 to < 2 = sepsis possible; ≥ 2 to < 10 = systemic inflammation and ≥ 10 = septic shock.
Resumo Objetivos: Estudar o comportamento da procalcitonina e verificar se é capaz de diferenciar... more Resumo Objetivos: Estudar o comportamento da procalcitonina e verificar se é capaz de diferenciar crianças com quadros sépticos. Métodos: Crianças de 28 dias a 14 anos de idade, admitidas de 01/2004 a 12/2005 na unidade de tratamento intensivo pediátrica da UNESP com sepse ou choque séptico, foram incluídas prospectivamente. Dois grupos foram constituídos: grupo sepse (GS; n = 47) e grupo choque séptico (GCS; n = 43). Procalcitonina foi medida à admissão (T0) e depois de 12 h (T12h), e os resultados apresentados em classes: < 0,5 ng/mL = sepse improvável; ≥ 0,5 a < 2 = sepse possível; ≥ 2 a < 10 = inflamação sistêmica e ≥ 10 = choque séptico. Resultados: No T0, foi maior a freqüência de pacientes do GCS na classe mais alta de procalcitonina, comparada às crianças do GS [GCS: 30 (69,7%) > GS: 14 (29,8%); p < 0,05]. Para o GCS, a freqüência de pacientes que ocupou a classe mais elevada foi maior que a de pacientes em outras classes (≥ 10 = 69,7%; ≥ 2 a < 10 = 18,6%; ≥ 0,5 a < 2 = 11,6%; < 0,5 = 0,0%; p < 0,05). No T12h, o comportamento da procalcitonina foi semelhante ao T0. O escore pediatric risk of mortality (PRISM) dos pacientes do GCS na classe mais alta de procalcitonina foi mais elevado que o das crianças do GS [GCS: 35,15 (40,5-28,7) versus GS: 18,6 (21,4-10,2); p < 0,05]. Conclusão: Procalcitonina permite diferenciar sepse de choque séptico, pode auxiliar no diagnóstico de quadros sépticos em crianças e pode estar relacionada à gravidade dos pacientes. J Pediatr (Rio J). 2007;83(4):323-328: Procalcitonina, sepse, choque séptico, crianças, cuidados intensivos. Abstract Objectives: To study the behavior of procalcitonin and to verify whether it can be used to differentiate children with septic conditions. Methods: Children were enrolled prospectively from among those aged 28 days to 14 years, admitted between January 2004 and December 2005 to the pediatric intensive care unit at UNESP with sepsis or septic shock. The children were classified as belonging to one of two groups: the sepsis group (SG; n = 47) and the septic shock group (SSG; n = 43). Procalcitonin was measured at admission (T0) and again 12 hours later (T12h), and the results classed as: < 0.5 ng/mL = sepsis unlikely; ≥ 0.5 to < 2 = sepsis possible; ≥ 2 to < 10 = systemic inflammation and ≥ 10 = septic shock. Results: At T0 there was a greater proportion of SSG patients than SG patients in the highest PCT class [SSG: 30 (69.7%) > SG: 14 (29.8%); p < 0.05]. The proportion of SSG patients in this highest PCT class was greater than in all other classes (≥ 10 = 69.7%; ≥ 2 to < 10 = 18.6%; ≥ 0.5 to < 2 = 11.6%; < 0.5 = 0.0%; p < 0.05). The behavior of procalcitonin at T12h was similar to at T0. The pediatric risk of mortality (PRISM) scores for the SSG patients in the highest procalcitonin class were more elevated than for children in the SG [SSG: 35.15 (40.5-28.7) vs. SG: 18.6 (21.4-10.2); p < 0.05]. Conclusions: Procalcitonin allows sepsis to be differentiated from septic shock, can be of aid when diagnosing septic conditions in children and may be related to severity. J Pediatr (Rio J). 2007;83(4):323-328: Procalcitonin, sepsis, septic shock, children, intensive care. Artigo submetido em 21.11.06, aceito em 28.02.07. Apoio financeiro: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), processo nº 04/03776-0. Fernanda de C. Borin é bolsista de Iniciação Científica da FAPESP, processo nº 2004/09783-9. Como citar este artigo: Fioretto JR, Borin FC, Bonatto RC, Ricchetti SM, Kurokawa CS, de Moraes M, et al. Procalcitonin in children with sepsis and septic shock.
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, Jan 31, 2014
The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to ... more The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain. A pilot study was designed to evaluate the frequency of extubation failure, develop a randomization approach, and analyze the feasibility of a powered randomized trial to compare noninvasive positive-pressure ventilation and standard oxygen therapy post extubation for preventing reintubation within 48 hours in children with respiratory failure. Prospective pilot study. PICU at a university-affiliated hospital. Children aged between 28 days and 3 years undergoing invasive mechanical ventilation for greater than or equal to 48 hours with respiratory failure after programmed extubation. Patients were prospectively enrolled and randomly assigned into noninvasive positive-pressure ventilation group and inhaled oxygen group after programmed extubation from May 2012 to May 2013. Length of stay in PICU and hospital, oxygenation index, blood gas ...
Extubation failure is a common event in intensive care units. Corticosteroids are effective in pr... more Extubation failure is a common event in intensive care units. Corticosteroids are effective in preventing failure in adults, but no consensus has been reached on this matter in pediatrics. We assessed the efficacy of intravenous dexamethasone in mechanically ventilated children and adolescents for more than 48 hours, with at least one risk factor for failure. Extubations were scheduled 24 hours in advance when possible, and patients were randomly assigned into two groups: one group received a loading dose followed by up to four doses of dexamethasone, and the other group received no corticosteroids. Need for reintubation and length of stay in the pediatric intensive care unit were similar in both groups, and frequency of reintubation was 12.9%.
JUSTIFICATIVA E OBJETIVOS: As indicações de transfusão de eritrócitos não estão bem estabelecidas... more JUSTIFICATIVA E OBJETIVOS: As indicações de transfusão de eritrócitos não estão bem estabelecidas em crianças gravemente enfermas. O objetivo deste estudo foi descrever a prática da transfusão de eritrócitos na UTI Pediátrica do Hospital de Clínicas da Universidade Estadual Paulista (HC-UNESP). MÉTODO: Estudo retrospectivo observacional realizado durante o ano de 2003. RESULTADOS: Setenta e cinco pacientes receberam transfusão, havendo registro de 105 indicações. Mais da metade dos pacientes (53,3%) tinha menos que um ano de idade. Taquipnéia (75,2%), palidez (65,7%) e hipotensão (51,4%) foram os registros mais freqüentemente observados antes da transfusão. Além disso, a gasometria evidenciou acidose metabólica (68,08%) e hipoxemia (63,8%). Dos 93 registros de valores de hemoglobina (Hb), 54 (58,1%) estavam entre 7 e 10 g/dL e dos 90 registros de hematócrito (Ht) observou-se que 66 (73,3%) apresentavam valores entre 21% e 30%. As principais indicações de transfusão foram anemia em 7...
Introduction: The effectiveness of noninvasive positive-pressure ventilation (NIV) in preventing ... more Introduction: The effectiveness of noninvasive positive-pressure ventilation (NIV) in preventing reintubation due to respiratory failure is still unproven in children. The objective was to compare NIV and inhaled oxygen (nasal cannula or face mask) in the first 48 hours of post-extubation respiratory failure children in terms of reintubation rate and length of stay in pediatric intensive care unit (PICU). Methods: Children aged between 28 days and three years undergoing invasive mechanical ventilation for >= 48 hours, were prospectively enrolled and randomly divided into noninvasive positive-pressure ventilation by (NIVG, n-55) and inhaled oxygen groups (OXG, n=53). Vital signs were recorded one hour after extubation and thereafter once a day to complete 48 hours. In the case of reintubation, its cause and vital signs were recorded. Normally distributed data were compared with t test and Mann-Whitney test otherwise. Other variables were compared by Goodman test. Significance of 5...
JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi rever a literatura sobre a utilização de ó... more JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi rever a literatura sobre a utilização de óxido nítrico inalatório em crianças com síndrome do desconforto respiratório agudo. CONTEÚDO: Revisão bibliográfica e seleção de publicações mais relevantes sobre óxido nítrico inalatório, utilizando a base de dados MedLine e Cochrane de Revisões Sistemáticas. A revisão incluiu descrição de aspectos da definição, fisiopatologia e tratamento ventilatório da síndrome do desconforto respiratório agudo, assim como o metabolismo, efeitos biológicos e aplicação clínica do óxido nítrico inalatório, comentando dose, administração e retirada do gás, precações, efeitos adversos e contra-indicações. CONCLUSÕES: O óxido nítrico, vasodilatador pulmonar seletivo, tem efeitos benéficos sobre as trocas gasosas e ventilação em crianças com hipóxia grave. É seguro quando administrado em ambiente de tratamento intensivo sob rigorosa monitorização. Estudos aleatórios e controlados devem enfocar a administra...
The objective of this study was to review the literature on inhaled nitric oxide to children with... more The objective of this study was to review the literature on inhaled nitric oxide to children with acute respiratory distress syndrome. A review of literature and selection of the most important publications on inhaled nitric oxide, using the MedLine and Cochrane Systematic Review Databases. This review was organized as follows: introduction; metabolism and biological effects; clinical applications; dosage, gas administration and weaning process; warnings and side-effects. Inhaled nitric oxide use was described in acute respiratory distress syndrome. Inhaled nitric oxide as the first vasodilator to produce selective pulmonary vasodilation has beneficial effects on gas exchange and ventilation, improving outcome in children with severe hypoxia. It is safe when administered in intensive care units under strict surveillance and monitoring. Further studies should be concentrated on early treatment, when acute respiratory distress syndrome is potentially reversible.
Indications of red blood cell transfusion in critically ill children are not very well determined... more Indications of red blood cell transfusion in critically ill children are not very well determined. This study aims to describe red blood cells transfusion practice at the PICU of UNESP-Botucatu Medical School. Retrospective observational study of all patients who received transfusion during 2003. Seventy five patients received transfusion and 105 indications were recorded. 53.3% of the patients were less than one year of age. Increased respiratory rate (75.2%), paleness (65.7%), and hypotension (51.4%) were the alterations more frequently recorded, before transfusion. Also, metabolic acidosis (68.08%) e and hipoxemia (63.8%) were very frequently observed. From 93 hemoglobin (Hb) values recorded, 54 (58.1%) varied from 7 to 10 g/dL and from 90 records of hematocrit (Ht) 66 (73.3%) varied from 21% to 30%. The main indications of the transfusion were anemia, in 75 children (71.4%), and active bleeding in 26 (24.7%). The mean value of Hb before transfusion was 7.82 ± 2.82 g/dL. Seven tr...
To establish a protocol for the early introduction of inhaled nitric oxide (iNO) therapy in child... more To establish a protocol for the early introduction of inhaled nitric oxide (iNO) therapy in children with acute respiratory distress syndrome (ARDS) and to assess its acute and sustained effects on oxygenation and ventilator settings. Ten children with ARDS, aged 1 to 132 months (median, 11 months), with arterial saturation of oxygen <88% while receiving a fraction of inspired oxygen (FiO2) >or=0.6 and a positive end-expiratory pressure of >or=10 cm H2O were included in the study. The acute response to iNO was assessed in a 4-hour dose-response test, and positive response was defined as an increase in the PaO2/FiO2 ratio of 10 mm Hg above baseline values. Conventional therapy was not changed during the test. In the following days, patients who had shown positive response continued to receive the lowest iNO dose. Hemodynamics, PaO2/FiO2, oxygenation index, gas exchange, and methemoglobin levels were obtained when needed. Inhaled nitric oxide withdrawal followed predetermined...
RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi rever a literatura sobre a utilizaç... more RESUMO JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi rever a literatura sobre a utilização de óxido nítrico inalatório em crianças com síndrome do desconforto respiratório agudo. CONTEÚDO: Revisão bibliográfica e seleção de publicações mais relevantes sobre óxido nítrico inalatório, utilizando a base de dados MedLine e Cochrane de Revisões Sistemáticas. A revisão incluiu descrição de aspectos da definição, fisiopatologia e tratamento ventilatório da síndrome do desconforto respiratório agudo, assim como o metabolismo, efeitos biológicos e aplicação clínica do óxido nítrico inalatório, comentando dose, administração e retirada do gás, precações, efeitos adversos e contra-indicações.
To compare intermittent mandatory ventilation (IMV) with synchronized intermittent mandatory vent... more To compare intermittent mandatory ventilation (IMV) with synchronized intermittent mandatory ventilation plus pressure support (SIMV+PS) in terms of time on mechanical ventilation, duration of weaning and length of stay in a pediatric intensive care unit (PICU). This was a randomized clinical trial that enrolled children aged 28 days to 4 years who were admitted to a PICU between October of 2005 and June of 2007 and put on mechanical ventilation (MV) for more than 48 hours. These patients were allocated to one of two groups by drawing lots: IMV group (IMVG; n = 35) and SIMV+PS group (SIMVG; n = 35). Children were excluded if they had undergone tracheotomy or had chronic respiratory diseases. Data on oxygenation and ventilation were recorded at admission and at the start of weaning. There were no statistical differences between the groups in terms of age, sex, indication for MV, PRISM score, Comfort scale, use of sedatives or ventilation and oxygenation parameters. The median time on...
To study the behavior of procalcitonin and to verify whether it can be used to differentiate chil... more To study the behavior of procalcitonin and to verify whether it can be used to differentiate children with septic conditions. Methods: Children were enrolled prospectively from among those aged 28 days to 14 years, admitted between January 2004 and December 2005 to the pediatric intensive care unit at Universidade Estadual Paulista UNESP with sepsis or septic shock. The children were classified as belonging to one of two groups: the sepsis group (SG; n = 47) and the septic shock group (SSG; n = 43). Procalcitonin was measured at admission (T0) and again 12 hours later (T12h), and the results classed as: < 0.5 ng/mL = sepsis unlikely; ≥ 0.5 to < 2 = sepsis possible; ≥ 2 to < 10 = systemic inflammation and ≥ 10 = septic shock.
Resumo Objetivos: Estudar o comportamento da procalcitonina e verificar se é capaz de diferenciar... more Resumo Objetivos: Estudar o comportamento da procalcitonina e verificar se é capaz de diferenciar crianças com quadros sépticos. Métodos: Crianças de 28 dias a 14 anos de idade, admitidas de 01/2004 a 12/2005 na unidade de tratamento intensivo pediátrica da UNESP com sepse ou choque séptico, foram incluídas prospectivamente. Dois grupos foram constituídos: grupo sepse (GS; n = 47) e grupo choque séptico (GCS; n = 43). Procalcitonina foi medida à admissão (T0) e depois de 12 h (T12h), e os resultados apresentados em classes: < 0,5 ng/mL = sepse improvável; ≥ 0,5 a < 2 = sepse possível; ≥ 2 a < 10 = inflamação sistêmica e ≥ 10 = choque séptico. Resultados: No T0, foi maior a freqüência de pacientes do GCS na classe mais alta de procalcitonina, comparada às crianças do GS [GCS: 30 (69,7%) > GS: 14 (29,8%); p < 0,05]. Para o GCS, a freqüência de pacientes que ocupou a classe mais elevada foi maior que a de pacientes em outras classes (≥ 10 = 69,7%; ≥ 2 a < 10 = 18,6%; ≥ 0,5 a < 2 = 11,6%; < 0,5 = 0,0%; p < 0,05). No T12h, o comportamento da procalcitonina foi semelhante ao T0. O escore pediatric risk of mortality (PRISM) dos pacientes do GCS na classe mais alta de procalcitonina foi mais elevado que o das crianças do GS [GCS: 35,15 (40,5-28,7) versus GS: 18,6 (21,4-10,2); p < 0,05]. Conclusão: Procalcitonina permite diferenciar sepse de choque séptico, pode auxiliar no diagnóstico de quadros sépticos em crianças e pode estar relacionada à gravidade dos pacientes. J Pediatr (Rio J). 2007;83(4):323-328: Procalcitonina, sepse, choque séptico, crianças, cuidados intensivos. Abstract Objectives: To study the behavior of procalcitonin and to verify whether it can be used to differentiate children with septic conditions. Methods: Children were enrolled prospectively from among those aged 28 days to 14 years, admitted between January 2004 and December 2005 to the pediatric intensive care unit at UNESP with sepsis or septic shock. The children were classified as belonging to one of two groups: the sepsis group (SG; n = 47) and the septic shock group (SSG; n = 43). Procalcitonin was measured at admission (T0) and again 12 hours later (T12h), and the results classed as: < 0.5 ng/mL = sepsis unlikely; ≥ 0.5 to < 2 = sepsis possible; ≥ 2 to < 10 = systemic inflammation and ≥ 10 = septic shock. Results: At T0 there was a greater proportion of SSG patients than SG patients in the highest PCT class [SSG: 30 (69.7%) > SG: 14 (29.8%); p < 0.05]. The proportion of SSG patients in this highest PCT class was greater than in all other classes (≥ 10 = 69.7%; ≥ 2 to < 10 = 18.6%; ≥ 0.5 to < 2 = 11.6%; < 0.5 = 0.0%; p < 0.05). The behavior of procalcitonin at T12h was similar to at T0. The pediatric risk of mortality (PRISM) scores for the SSG patients in the highest procalcitonin class were more elevated than for children in the SG [SSG: 35.15 (40.5-28.7) vs. SG: 18.6 (21.4-10.2); p < 0.05]. Conclusions: Procalcitonin allows sepsis to be differentiated from septic shock, can be of aid when diagnosing septic conditions in children and may be related to severity. J Pediatr (Rio J). 2007;83(4):323-328: Procalcitonin, sepsis, septic shock, children, intensive care. Artigo submetido em 21.11.06, aceito em 28.02.07. Apoio financeiro: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), processo nº 04/03776-0. Fernanda de C. Borin é bolsista de Iniciação Científica da FAPESP, processo nº 2004/09783-9. Como citar este artigo: Fioretto JR, Borin FC, Bonatto RC, Ricchetti SM, Kurokawa CS, de Moraes M, et al. Procalcitonin in children with sepsis and septic shock.
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, Jan 31, 2014
The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to ... more The effectiveness of noninvasive positive-pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain. A pilot study was designed to evaluate the frequency of extubation failure, develop a randomization approach, and analyze the feasibility of a powered randomized trial to compare noninvasive positive-pressure ventilation and standard oxygen therapy post extubation for preventing reintubation within 48 hours in children with respiratory failure. Prospective pilot study. PICU at a university-affiliated hospital. Children aged between 28 days and 3 years undergoing invasive mechanical ventilation for greater than or equal to 48 hours with respiratory failure after programmed extubation. Patients were prospectively enrolled and randomly assigned into noninvasive positive-pressure ventilation group and inhaled oxygen group after programmed extubation from May 2012 to May 2013. Length of stay in PICU and hospital, oxygenation index, blood gas ...
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