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Bert-Dulanto A, Alarcón-Braga EA, Castillo-Soto A, Escalante-Kanashiro R. Predicting mortality in pulmonary tuberculosis: A systematic review of prognostic models. Indian J Tuberc 2022; 69:432-440. [PMID: 36460372 DOI: 10.1016/j.ijtb.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/11/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Pulmonary tuberculosis is a highly prevalent disease in low-income countries; clinical prediction tools allow healthcare personnel to catalog patients with a higher risk of death in order to prioritize medical attention. METHODOLOGY We conducted a literature search on prognostic models aimed to predict mortality in patients diagnosed with pulmonary tuberculosis. We included prospective and retrospective studies where prognostic models predicting mortality were either developed or validated in patients diagnosed with pulmonary tuberculosis. Three reviewers independently assessed the quality of the included studies using the PROBAST tool (Prediction model study Risk of Bias Assessment Tool). A narrative review of the characteristics of each model was conducted. RESULTS Six articles (n = 3553 patients) containing six prediction models were included in the review. Most studies (5 out of 6) were retrospective cohorts, only one study was a prospective case-control study. All the studies had a high risk of bias according to the PROBAST tool in the overall assessment. Regarding the applicability of the prediction models, three studies had a low concern of applicability, two high concern and one unclear concern. Five studies developed new prediction rules. In general, the presented models had a good discriminatory ability, with areas under the curve fluctuating between 0.65 up to 0.91. CONCLUSION None of the prognostic models included in the review accurately predict mortality in patients with pulmonary tuberculosis, due to great heterogeneity in the population and a high risk of bias.
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Affiliation(s)
- Aimée Bert-Dulanto
- Peruvian University of Applied Sciences, Lima - Perú, Av Alameda San Marcos 11, Chorrillos 15067, Lima, Peru
| | - Esteban A Alarcón-Braga
- Peruvian University of Applied Sciences, Lima - Perú, Av Alameda San Marcos 11, Chorrillos 15067, Lima, Peru.
| | - Ana Castillo-Soto
- Peruvian University of Applied Sciences, Lima - Perú, Av Alameda San Marcos 11, Chorrillos 15067, Lima, Peru
| | - Raffo Escalante-Kanashiro
- Peruvian University of Applied Sciences, Lima - Perú, Av Alameda San Marcos 11, Chorrillos 15067, Lima, Peru; Intensive Care Unit, Instituto Nacional de Salud Del Niño, Av. Brasil 600, Breña 15083, Lima, Peru
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2
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Arriola-Montenegro L, Escalante-Kanashiro R. Sepsis in Children in Latin America: Gaps, Inequities, and Improvement Strategies. Pediatr Emerg Care 2022; 38:564-567. [PMID: 36173432 DOI: 10.1097/pec.0000000000002582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pediatric sepsis is a worldwide public health issue because of its high mortality rate, which increases even more in low-income countries. In this article, we review the Latin American background, the burdens of pediatric sepsis in Latin America, and the Caribbean, as well as some strategies that could help improve the outcomes of sepsis in these regions from a public health view.
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3
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Meza-Contreras AI, Galdos-Bejar MN, Escalante-Kanashiro R. Multisystem Inflammatory Syndrome in Children Associated with COVID-19 Infection: A Comprehensive Review. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1748903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractThe Multisystem Inflammatory Syndrome in Children (MIS-C) is a postinfectious syndrome associated with coronavirus disease 2019 (COVID-19) disease in children. The aim of this study is to conduct a thorough review to assist health care professionals in diagnosis and management of this complication of COVID-19 disease in children. A thorough systematic review was conducted through an on-line search based on MIS-C with the primary focus on epidemiology, clinical characteristics, diagnosis, pathophysiology, management, and long-term follow-up. This syndrome is characterized by an exaggerated and uncontrolled release of proinflammatory cytokines involving dysfunction of both innate and adaptive immunity. In this review, a summary of observational studies and case reports was conducted, in which we found that MIS-C generates multiple-organ failure frequently presenting with hemodynamic instability further characterized by Kawasaki-like symptoms (such as persistent high fever, polymorphic rash, and bilateral conjunctivitis) and predominance of gastrointestinal and cardiovascular signs and symptoms. Keys to effective management involve early diagnosis, timely treatment and re-evaluation following hospital discharge. Diagnosis is marked by significant elevation of inflammatory biomarkers, laboratory evidence of COVID-19 infection or history of recent exposure, and absence of any other plausible explanation for the associated signs, symptoms, and presentation. Management includes hemodynamic stabilization, empiric antibiotic therapy (de-escalation if cultures and polymerase chain reaction studies indicate no bacterial co-infection), immunomodulatory therapy (methylprednisolone, intravenous immunoglobulin, anakinra, tocilizumab, siltuximab, Janus kinase inhibitors, tumor necrosis factor-α inhibitors), antivirals (remdesivir), and anticoagulation (acetylsalicylic acid, unfractionated or low-molecular-weight heparin or new oral anticoagulants). In addition, we identified poor prognostic risk factors to include concurrent comorbidities, blood-component consumption and marrow suppression (lymphopenia, thrombocytopenia), depletion of homeostatic components (hypoalbuminemia), and marked evidence of a hyperinflammatory response to include elevated values of ferritin, C-reactive protein, and D-dimer. MIS-C constitutes a postinfectious syndrome characterized by a marked cytokine storm, characterized by fever, bilateral conjunctivitis, and multiple organ dysfunction. Promoting future research and long-term follow-up will be essential for the development of guidelines and recommendations leading to effective identification and management of MIS-C.
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Affiliation(s)
| | | | - Raffo Escalante-Kanashiro
- Medical School, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú
- Department of Intensive Care Unit - Instituto Nacional de Salud del Niño, Lima, Perú
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4
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Galdós Béjar MN, Meza-Contreras A, Escalante-Kanashiro R. [Discrepancies in Severity Predictive Parameters in Multisystemic Pediatric Inflamma tory Syndrome Associated with SARS-CoV 2]. Andes Pediatr 2021; 92:980-981. [PMID: 35506815 DOI: 10.32641/andespediatr.v92i6.4001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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5
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Coronado-Muñoz Á, Escalante-Kanashiro R. Pediatric acute respiratory distress syndrome: How to protect the lungs during mechanical ventilation? Bol Med Hosp Infant Mex 2021; 78:181-190. [PMID: 34167144 DOI: 10.24875/bmhim.20000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pediatric acute respiratory distress syndrome (PARDS) is a frequent diagnosis in critical care. This inflammatory process has different stages characterized by mild-to-severe hypoxia, and the management will vary according to the severity. New definitions for pediatric patients were published in 2015; new epidemiological evidence revising those definitions has helped understand the mortality associated with PARDS and the impact on ventilation. The strategies to protect the lungs during mechanical ventilation have been successful in reducing mortality and complications. In clinical situations where high levels of critical support are limited, other therapies with a lower level of evidence can be attempted to gain time without worsening the ongoing pulmonary injury. We offer a complete narrative revision of this syndrome, with the critical management of these patients as a priority.
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Affiliation(s)
- Álvaro Coronado-Muñoz
- Department of Pediatrics, University of Texas Health Science Center, Houston, Texas, USA.,Pediatric Critical Care, Children's Memorial Hermann Hospital, Houston, Texas, USA
| | - Raffo Escalante-Kanashiro
- Departamento de Emergencias y Áreas Críticas, Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru.,Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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6
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Zubieta-Calleja G, Merino-Luna A, Zubieta-DeUrioste N, Armijo-Subieta NF, Soliz J, Arias-Reyes C, Escalante-Kanashiro R, Carmona-Suazo JA, López-Bascope A, Calle-Aracena JM, Epstein M, Maravi E. Re: "Mortality Attributed to COVID-19 in High-Altitude Populations" by Woolcott and Bergman. High Alt Med Biol 2021; 22:102-104. [PMID: 33567217 DOI: 10.1089/ham.2020.0195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gustavo Zubieta-Calleja
- High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), Pulmonary Department, La Paz, Bolivia
| | | | | | | | - Jorge Soliz
- High Altitude Pulmonary and Pathology Institute (HAPPI-IPPA), Pulmonary Department, La Paz, Bolivia.,Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Québec, Canada
| | - Christian Arias-Reyes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Québec, Canada
| | - Raffo Escalante-Kanashiro
- Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Perú.,Unidad de Cuidados Intensivos Instituto Nacional de Salud del Niño, Lima, Perú
| | | | | | | | - Murray Epstein
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Enrique Maravi
- Prof. Emeritus, Intensive Care, Complejo Hospitalario de Navarra-O, Universidad de Navarra, Pamplona, España
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7
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Topjian AA, Scholefield BR, Pinto NP, Fink EL, Buysse CMP, Haywood K, Maconochie I, Nadkarni VM, de Caen A, Escalante-Kanashiro R, Ng KC, Nuthall G, Reis AG, Van de Voorde P, Suskauer SJ, Schexnayder SM, Hazinski MF, Slomine BS. P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in Children: An Advisory Statement From the International Liaison Committee on Resuscitation. Resuscitation 2021; 162:351-364. [PMID: 33515637 DOI: 10.1016/j.resuscitation.2021.01.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Studies of pediatric cardiac arrest use inconsistent outcomes, including return of spontaneous circulation and short-term survival, and basic assessments of functional and neurological status. In 2018, the International Liaison Committee on Resuscitation sponsored the COSCA initiative (Core Outcome Set After Cardiac Arrest) to improve consistency in reported outcomes of clinical trials of adult cardiac arrest survivors and supported this P-COSCA initiative (Pediatric COSCA). The P-COSCA Steering Committee generated a list of potential survival, life impact, and economic impact outcomes and assessment time points that were prioritized by a multidisciplinary group of healthcare providers, researchers, and parents/caregivers of children who survived cardiac arrest. Then expert panel discussions achieved consensus on the core outcomes, the methods to measure those core outcomes, and the timing of the measurements. The P-COSCA includes assessment of survival, brain function, cognitive function, physical function, and basic daily life skills. Survival and brain function are assessed at discharge or 30 days (or both if possible) and between 6 and 12 months after arrest. Cognitive function, physical function, and basic daily life skills are assessed between 6 and 12 months after cardiac arrest. Because many children have prearrest comorbidities, the P-COSCA also includes documentation of baseline (ie, prearrest) brain function and calculation of changes after cardiac arrest. Supplementary outcomes of survival, brain function, cognitive function, physical function, and basic daily life skills are assessed at 3 months and beyond 1 year after cardiac arrest if resources are available.
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8
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Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, Bhanji F, Wyllie J, Zideman D, Neumar RW, Perkins GD, Castrén M, Morley PT, Montgomery WH, Nadkarni VM, Billi JE, Merchant RM, de Caen A, Escalante-Kanashiro R, Kloeck D, Wang TL, Hazinski MF. Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S2-S27. [PMID: 33084397 DOI: 10.1161/cir.0000000000000890] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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9
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Nolan JP, Maconochie I, Soar J, Olasveengen TM, Greif R, Wyckoff MH, Singletary EM, Aickin R, Berg KM, Mancini ME, Bhanji F, Wyllie J, Zideman D, Neumar RW, Perkins GD, Castrén M, Morley PT, Montgomery WH, Nadkarni VM, Billi JE, Merchant RM, de Caen A, Escalante-Kanashiro R, Kloeck D, Wang TL, Hazinski MF. Executive Summary 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A1-A22. [PMID: 33098915 PMCID: PMC7576314 DOI: 10.1016/j.resuscitation.2020.09.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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10
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Topjian AA, Scholefield BR, Pinto NP, Fink EL, Buysse CM, Haywood K, Maconochie I, Nadkarni VM, de Caen A, Escalante-Kanashiro R, Ng KC, Nuthall G, Reis AG, Van de Voorde P, Suskauer SJ, Schexnayder SM, Hazinski MF, Slomine BS. P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in Children: An Advisory Statement From the International Liaison Committee on Resuscitation. Circulation 2020; 142:e246-e261. [DOI: 10.1161/cir.0000000000000911] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Studies of pediatric cardiac arrest use inconsistent outcomes, including return of spontaneous circulation and short-term survival, and basic assessments of functional and neurological status. In 2018, the International Liaison Committee on Resuscitation sponsored the COSCA initiative (Core Outcome Set After Cardiac Arrest) to improve consistency in reported outcomes of clinical trials of adult cardiac arrest survivors and supported this P-COSCA initiative (Pediatric COSCA). The P-COSCA Steering Committee generated a list of potential survival, life impact, and economic impact outcomes and assessment time points that were prioritized by a multidisciplinary group of healthcare providers, researchers, and parents/caregivers of children who survived cardiac arrest. Then expert panel discussions achieved consensus on the core outcomes, the methods to measure those core outcomes, and the timing of the measurements. The P-COSCA includes assessment of survival, brain function, cognitive function, physical function, and basic daily life skills. Survival and brain function are assessed at discharge or 30 days (or both if possible) and between 6 and 12 months after arrest. Cognitive function, physical function, and basic daily life skills are assessed between 6 and 12 months after cardiac arrest. Because many children have prearrest comorbidities, the P-COSCA also includes documentation of baseline (ie, prearrest) brain function and calculation of changes after cardiac arrest. Supplementary outcomes of survival, brain function, cognitive function, physical function, and basic daily life skills are assessed at 3 months and beyond 1 year after cardiac arrest if resources are available.
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11
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Considine J, Gazmuri RJ, Perkins GD, Kudenchuk PJ, Olasveengen TM, Vaillancourt C, Nishiyama C, Hatanaka T, Mancini ME, Chung SP, Escalante-Kanashiro R, Morley P. Chest compression components (rate, depth, chest wall recoil and leaning): A scoping review. Resuscitation 2019; 146:188-202. [PMID: 31536776 DOI: 10.1016/j.resuscitation.2019.08.042] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/18/2019] [Accepted: 08/31/2019] [Indexed: 12/20/2022]
Abstract
AIM To understand whether the science to date has focused on single or multiple chest compression components and identify the evidence related to chest compression components to determine the need for a full systematic review. METHODS This review was undertaken by members of the International Liaison Committee on Resuscitation and guided by a specific methodological framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). Studies were eligible for inclusion if they were peer-reviewed human studies that examined the effect of different chest compression depths or rates, or chest wall or leaning, on physiological or clinical outcomes. The databases searched were MEDLINE complete, Embase, and Cochrane. RESULTS Twenty-two clinical studies were included in this review: five observational studies involving 879 patients examined both chest compression rate and depth; eight studies involving 14,285 patients examined chest compression rate only; seven studies involving 12001 patients examined chest compression depth only, and two studies involving 1848 patients examined chest wall recoil. No studies were identified that examined chest wall leaning. Three studies reported an inverse relationship between chest compression rate and depth. CONCLUSION This scoping review did not identify sufficient new evidence that would justify conducting new systematic reviews or reconsideration of current resuscitation guidelines. This scoping review does highlight significant gaps in the research evidence related to chest compression components, namely a lack of high-level evidence, paucity of studies of in-hospital cardiac arrest, and failure to account for the possibility of interactions between chest compression components.
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Affiliation(s)
- Julie Considine
- Deakin University, School of Nursing and Midwifery/Centre for Quality and Patient Safety Research, 1 Gheringhap St, Geelong, Victoria, 3220, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, 5 Arnold St, Box Hill, Victoria, 3128, Australia; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States.
| | - Raúl J Gazmuri
- Resuscitation Institute, Rosalind Franklin University of Medicine and Science, United States; Captain James A. Lovell Federal Health Care Center, 3001 Green Bay Road, North Chicago, IL, United States; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
| | - Peter J Kudenchuk
- Division of Cardiology/Electrophysiology Services, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195-6422, United States; King County Medic One, Public Health, Seattle & King County, WA, United States; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
| | - Theresa M Olasveengen
- Department of Anesthesiology, Oslo University Hospital, PO Box 4956 Nydalen, Oslo 0424, Norway; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
| | - Christian Vaillancourt
- Emergency Medicine, University of Ottawa, United States; Ottawa Hospital Research Institute, Civic Campus, Clinical Epidemiology Unit, Rm F649, 1053 Carling Ave., Ottawa, Ontario, K1Y 4E9, Canada; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
| | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
| | - Tetsuo Hatanaka
- Emergency Life-Saving Technique Academy, 3-8-1 Oura, Yahatanishi, Kitakyushu, 800-0213 Fukuoka, Japan; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
| | - Mary E Mancini
- The University of Texas at Arlington, College of Nursing and Health Innovation, 411 S. Nedderman Drive, Box 19407, Arlington, TX 76019-0407, United States; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
| | - Sung Phil Chung
- Emergency Medicine, Gangnam Severance Hospital, Yonsei University, 211 Eonju-ro, Gangnam-gu, Seoul, Republic of Korea; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
| | - Raffo Escalante-Kanashiro
- Departamento de Emergencias y Áreas Críticas, Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru; InterAmerican Heart Foundation/Emergency Cardiovascular Care, Peru; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
| | - Peter Morley
- Intensive Care, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria, 3050, Australia; Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia; International Liaison Committee on Resuscitation, Basic Life Support Task Force, Dallas, TX, United States
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12
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Toro-Polo LM, Ortiz-Lozada RY, Chang-Grozo SL, Hernandez AV, Escalante-Kanashiro R, Solari-Zerpa L. Glycemia upon admission and mortality in a pediatric intensive care unit. Rev Bras Ter Intensiva 2019; 30:471-478. [PMID: 30672971 PMCID: PMC6334488 DOI: 10.5935/0103-507x.20180068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/26/2018] [Indexed: 12/03/2022] Open
Abstract
Objectives To analyze the association between glycemia levels upon pediatric intensive
care unit admission and mortality in patients hospitalized. Methods A retrospective cohort of pediatric intensive care unit patients admitted to
the Instituto Nacional de Salud del Niño between
2012 and 2013. A Poisson regression model with robust variance was used to
quantify the association. Diagnostic test performance evaluation was used to
describe the sensitivity, specificity, positive predictive value, negative
predictive value and likelihood ratios for each range of glycemia. Results In total, 552 patients were included (median age 23 months, age range 5
months to 79.8 months). The mean glycemia level upon admission was
121.3mg/dL (6.73mmol/L). Ninety-two (16.6%) patients died during
hospitalization. In multivariable analyses, significant associations were
found between glycemia < 65mg/dL (3.61mmol/L) (RR: 2.01, 95%CI 1.14 -
3.53), glycemia > 200mg/dL (> 11.1mmol/L) (RR: 2.91, 95%CI 1.71 -
4.55), malnutrition (RR: 1.53, 95%CI 1.04 - 2.25), mechanical ventilation
(RR: 3.71, 95%CI 1.17 - 11.76) and mortality at discharge. There was low
sensitivity (between 17.39% and 39.13%) and high specificity (between 49.13%
and 91.74%) for different glucose cut-off levels. Conclusion There was an increased risk of death at discharge in patients who developed
hypoglycemia and hyperglycemia upon admission to the pediatric intensive
care unit. Certain glucose ranges (> 200mg/dL (> 11.1mmol/L) and <
65mg/dL (3.61mmol/L)) have high specificity as predictors of death at
discharge.
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Affiliation(s)
- Luis Miguel Toro-Polo
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru.,Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru
| | | | | | - Adrian V Hernandez
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru.,Evidence-Based Practice Center, Hartford Hospital, University of Connecticut -Hartford, United States
| | - Raffo Escalante-Kanashiro
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru.,Instituto Nacional de Salud del Niño - Lima, Peru
| | - Lely Solari-Zerpa
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas - Lima, Peru
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13
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Yesquen P, Herrera-Perez E, Escalante-Kanashiro R. Clinical and epidemiological characteristics of whooping cough in hospitalized patients of a tertiary care hospital in Peru. Rev Bras Ter Intensiva 2019; 31:129-137. [PMID: 31141085 PMCID: PMC6649206 DOI: 10.5935/0103-507x.20190029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Describe the clinical and epidemiological characteristics of patients under 2 years of age hospitalized with whooping cough in a tertiary care children's hospital in Peru. METHODS This was a case series of patients under 2 years of age who were hospitalized with a diagnosis of whooping cough in 2012. RESULTS A total of 121 patients were hospitalized. Diagnostic testing (direct immunofluorescence, polymerase chain reaction, culture) was carried out in 53.72% of patients. Overall, 23.15% (n = 28) were confirmed cases, all of whom were patients less than 10 months old, and none of whom had received 3 doses of whooping cough vaccine. A total of 96.43% (n = 27) of cases were under 6 months of age, 42.86% (n = 12) were younger than 3 months, and 10.71% (n = 3) were admitted to the intensive care unit. Of these cases, all were younger than 2 months old, and one patient died. The most common symptoms in the confirmed cases were coughing (96.43%), facial redness (96.43%), paroxysmal coughing (92.86%), and coughing-related cyanosis (78.57%). The most frequent probable epidemiological contact was the mother (17.86%), and the majority of cases occurred in the summer (46.43%). CONCLUSION Whooping cough is a cause of morbidity and mortality, especially in those younger than 6 months of age and in those who are not immunized or only partially immunized. Vaccination rates should be improved and case confirmation encouraged to prevent the underdiagnosis of this disease.
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Affiliation(s)
| | | | - Raffo Escalante-Kanashiro
- Instituto Nacional de Salud del Niño - Lima,
Perú
- Universidad Peruana de Ciencias Aplicadas - Lima,
Perú
- Universidad Nacional Federico Villarreal - Lima, Perú
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14
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Silva-Cruz AL, Velarde-Jacay K, Carreazo NY, Escalante-Kanashiro R. Risk factors for extubation failure in the intensive care unit. Rev Bras Ter Intensiva 2018; 30:294-300. [PMID: 30304083 PMCID: PMC6180477 DOI: 10.5935/0103-507x.20180046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/11/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To determine the risk factors for extubation failure in the intensive care unit. METHODS The present case-control study was conducted in an intensive care unit. Failed extubations were used as cases, while successful extubations were used as controls. Extubation failure was defined as reintubation being required within the first 48 hours of extubation. RESULTS Out of a total of 956 patients who were admitted to the intensive care unit, 826 were subjected to mechanical ventilation (86%). There were 30 failed extubations and 120 successful extubations. The proportion of failed extubations was 5.32%. The risk factors found for failed extubations were a prolonged length of mechanical ventilation of greater than 7 days (OR = 3.84, 95%CI = 1.01 - 14.56, p = 0.04), time in the intensive care unit (OR = 1.04, 95%CI = 1.00 - 1.09, p = 0.03) and the use of sedatives for longer than 5 days (OR = 4.81, 95%CI = 1.28 - 18.02; p = 0.02). CONCLUSION Pediatric patients on mechanical ventilation were at greater risk of failed extubation if they spent more time in the intensive care unit and if they were subjected to prolonged mechanical ventilation (longer than 7 days) or greater amounts of sedative use.
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Affiliation(s)
| | - Karina Velarde-Jacay
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas - Lima, Perú
| | - Nilton Yhuri Carreazo
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas - Lima, Perú
| | - Raffo Escalante-Kanashiro
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas - Lima, Perú.,Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño - Lima, Perú
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Tuya XL, Escalante-Kanashiro R, Tinco C, Pons MJ, Petrozzi V, Ruiz J, del Valle J. Possible vertical transmission of Bartonella bacilliformis in Peru. Am J Trop Med Hyg 2014; 92:126-8. [PMID: 25371184 DOI: 10.4269/ajtmh.14-0098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A 22-day-old male was admitted with a 2-day history of irritability, dyspnea, jaundice, fever, and gastrointestinal bleeding. A thin blood smear was performed, which showed the presence of intraerythrocyte bacteria identified as Bartonella bacilliformis, and subsequently, the child was diagnosed with Carrion's disease. The diagnosis was confirmed by specific polymerase chain reaction. The child was born in a non-endemic B. bacilliformis area and had not traveled to such an area before hospitalization. However, the mother was from an endemic B. bacilliformis area, and posterior physical examination showed the presence of a wart compatible with B. bacilliformis in semi-immune subjects. These data support vertical transmission of B. bacilliformis.
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Affiliation(s)
- Ximena L Tuya
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru; Barcelona Centre for International Health Research (Hospital Clinic, Universitat de Barcelona), Barcelona, Spain
| | - Raffo Escalante-Kanashiro
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru; Barcelona Centre for International Health Research (Hospital Clinic, Universitat de Barcelona), Barcelona, Spain
| | - Carmen Tinco
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru; Barcelona Centre for International Health Research (Hospital Clinic, Universitat de Barcelona), Barcelona, Spain
| | - Maria J Pons
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru; Barcelona Centre for International Health Research (Hospital Clinic, Universitat de Barcelona), Barcelona, Spain
| | - Verónica Petrozzi
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru; Barcelona Centre for International Health Research (Hospital Clinic, Universitat de Barcelona), Barcelona, Spain
| | - Joaquim Ruiz
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru; Barcelona Centre for International Health Research (Hospital Clinic, Universitat de Barcelona), Barcelona, Spain
| | - Juana del Valle
- Facultad de Ciencias de la Salud, Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Unidad de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru; Barcelona Centre for International Health Research (Hospital Clinic, Universitat de Barcelona), Barcelona, Spain
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16
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Lister P, Mola CLD, Arroyo E, Solórzano J, Escalante-Kanashiro R, Matos-Iberico G. Uso do desfibrilador automático externo no ambiente pré-hospitalar peruano: melhorando a resposta a emergências na América Latina. Rev Bras Ter Intensiva 2009. [DOI: 10.1590/s0103-507x2009000300015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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17
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Lister P, Loret de Mola C, Arroyo E, Solórzano J, Escalante-Kanashiro R, Matos-Iberico G. Use of automated external defibrillator in Peruvian out-of-hospital environment: improving emergency response in Latin America. Rev Bras Ter Intensiva 2009; 21:332-335. [PMID: 25303557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 08/05/2009] [Indexed: 06/04/2023] Open
Abstract
This case report relates out-of-hospital care to a patient with risk factors treated in the out-of-hospital services after cardiac arrest and ventricular fibrillation. The patient was treated according to the standards of basic life support and advanced cardiovascular life support; by applying an automated external defibrillator (AED) with favorable outcome and successful recovery of the patient from his risk of life condition. This is the first documented report with a favorable outcome in Peru, in out-of-hospital services and stresses the desirability of adopting policies for public access to early defibrillation.
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Abstract
OBJECTIVE To determine if samples obtained from arterial and capillary sources are comparable in children with diverse pathologic conditions during their stay in a pediatric intensive care unit. STUDY DESIGN Prospective, descriptive study in patients admitted to a multidisciplinary pediatric intensive care unit. INTERVENTIONS Seventy-five simultaneous paired samples (arterial and capillary) were obtained from patients with different degrees of capillary reperfusion, hemodynamic stability, blood pressure, and temperature. Both samples were analyzed < or =5 mins after collection. MEASUREMENTS AND MAIN RESULTS The average correlations between arterial and capillary samples were 0.87 for pH, 0.86 for CO2, and 0.65 for oxygen. Neither poor perfusion nor low temperature altered the correlation for pH or CO2. The only condition that significantly affected the correlation was hypotension. CONCLUSION Capillary blood sampling is a useful alternative to gasometric evaluation of critically ill children, even in the presence of hypothermia or hypoperfusion, provided that hypotension is not present.
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Affiliation(s)
- R Escalante-Kanashiro
- Intensive Care Unit, Instituto de Salud del Niño, Department of Pediatrics, Universidad Nacional Federico Villarreal, Lima, Perú.
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