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Introduction. spontaneous breathing trial (SBT) in weaning from pediatric invasive mechanical ventilation (IMV) is an endorsed practice, its positivity is based on clinical parameters; however, its results could be better documented. Objective. To describe the results of the SBT in the IMV weaning process. Population and methods. Retrospective analysis. Patients with ≥48 h in IMV from March 1, 2022 to January 31, 2024. Results. A total of493 SBT were analyzed in 304 patients; 71% (348) were positive, and 87% (302) resulted in successful extubations. The causes of negative SBT were increased work of breathing (70%), respiratory rate (57%), and heart rate (27%). In univariate analysis, respiratory distress as the reason for admission, peak inspiratory pressure before SBT and T-tube use, were predictors of negative SBT. In multivariate analysis, this association persisted for admission for respiratory cause, the higher programmed respiratory rate in IMV, as the T-tube modality. Those with negative SBT stayed more days in IMV (9 [7-12] vs. 7 [4-10]) and in PICU (11 [9-15] vs. 9 [7-12]). Conclusion. Positive SBT predicted successful extubation in a high percentage of cases. Respiratory distress on admission, higher programmed respiratory rate, and a higher proportion of T-tube mode were negative predictors of the test. Negative SBT was associated with more extended stays in IMV and PICU., (Sociedad Argentina de Pediatría.)

Introduction. Adequate sedation and analgesia is essential in the management of patients requiring mechanical ventilation (MV). The implementation of protocols and their monitoring is recommended; mixed results on adherence and impact have been reported. Objectives. To assess the impact of the implementation of a sedation and analgesia protocol on the use of benzodiazepines, opioids, and evolution in the pediatric intensive care unit (PICU) in patients requiring MV for more than 72 hours. Methods. Before-and-after, uncontrolled study in the PICU of a children’s hospital. The study was developed in 3 stages: pre-intervention for situational diagnosis (from April to September 2019), intervention,and post-intervention for implementation of a sedation and analgesia protocol, education on use, and monitoring of adherence and impact (from October 2019 to October 2021). Results. A total of 99 and 92 patients were included in the study in the pre- and post-intervention stages, respectively. Patients had a more severe condition, were younger, and had a lower weight in the preintervention period. After adjusting for severity and age, the group comparison in the post-intervention stage showed a reduction in days of continuous infusion of opioids (6 ± 5.2 versus 7.6–5.8, p = 0.018) and days of continuous infusion of benzodiazepines (3.3 ± 3.5 versus 7.6 ± 6.8, p = 0.001). No significantdifferences were observed in days of MV and total days of benzodiazepine use. Conclusion. The implementation of a sedation and analgesia protocol resulted in a reduction in the use of continuous infusion of drugs., (Sociedad Argentina de Pediatría)

The pandemic caused by the SARS-CoV-2 virus declared by the WHO in March 11th 2020, affects a small number of pediatric patients, who mostly present mild respiratory compromise and favorable evolution. However began to be observed in previously healthy children, an increase in cases defined as "Multisystemic Inflammatory Syndrome" (MIS-C) or "Kawasaki-like" post-COVID 19 (KLC) that evolve to shock and require hospitalization in the Pediatric Intensive Care Unit. MIS-C and KL-C are characterized by fever; signs of inflammation, gastrointestinal symptoms, and cardiovascular dysfunction, associated with sever forms of presentation with higher incidence of hypotension and/or shock. In the laboratory, markers of inflammation, hypercoagulability and myocardial damage are observed. Firstline drug treatment consists of intravenous immunoglobulin plus oral acetylsalicylic acid. A multidisciplinary approach is recommended for an accurate diagnosis and an early and effective treatment, in order to reduce morbidity and mortality., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Multisystem inflammatory syndrome in children related to COVID-19 is defined as the presence of persistent fever, inflammation, and organ dysfunction, with evidence of past or recent severe acute respiratory syndrome coronavirus 2 infection, and excluding other microbial causes. It overlaps with other inflammatory diseases (Kawasaki disease and toxic shock syndrome) and shares some features with hypercytokinemia conditions (hemophagocytic lymphohistiocytosis and macrophage activation syndrome). It differs from these and severe acute COVID-19 in its clinical presentation and laboratory parameters. It has a potentially severe course and may occur with cardiovascular failure; mortality is low (2 %). Here we provide an update on this syndrome and describe the presentation of two clinical cases with cardiovascular dysfunction who required vasoactive support and invasive ventilation. Serum lab tests showed inflammation parameters. Both patients were treated with intravenous immunoglobulin and systemic corticosteroids and had a favorable course., Competing Interests: None, (Sociedad Argentina de Pediatría.)

The COVID-19 pandemic has grabbed worldwide attention. The different national governments are making an effort to optimize resources and provide effective treatments inasmuch as they are supported by the evidence, at a rate of production in line with the pressing needs. In the field of pediatrics, COVID-19 has a low severity rate compared to the adult population. Approximately 6 % of cases present with a severe course, accounting for patients younger than 1 year and/or with underlying conditions. The therapeutic approach to pediatric patients with COVID-19 is unclear. The small number of pediatric cases hinders the possibility of making evidence-based recommendations for criticallyill patients. The objective of this review is to summarize the different current publications about the clinical course of COVID-19 and its management in critically-ill pediatric patients., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Introduction: Failures in communication are common during patient handoffs between physicians, which predisposes to errors. Few articles have been published on this topic in Argentina. For this reason, our objective was to confirm whether using a structured handoff (I-PASS), which has been successfully used in the USA by Doctor Starmer, may reduce the omission of key data without prolonging its duration at our department., Poulation and Methods: The study was conducted at a private facility in the Autonomous City of Buenos Aires between June 15th, 2017 and March 31st, 2018. It had a quasi-experimental, uncontrolled, before-and-after design. Pre- and post-intervention handoffs were assessed. The intervention included training physicians on how to use a structured handoff mnemonic (I-PASS: illness severity, patient summary, action list, situation awareness and contingency planning, synthesis by receiver), training on team work, written computerized handoff document, feedback observations, and simulation., Results: A total of 158 and 124 pre- and postintervention assessments were done respectively. The pre- and post-intervention comparison showed a significant improvement in most of the handoff key points. The time used for the handoff was 199 seconds (174-225) before the intervention and 210 seconds (190-230) after the intervention, p = 0.523; interruptions also decreased significantly., Conclusion: Introducing the I-PASS program reduced key data omission without prolonging handoffs. Interruptions were also reduced., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Introduction: Among children hospitalized in the intensive care unit who have pressure ulcers (PUs), more than 50% are related to the sustained pressure from a device or equipment. PUs are an indirect indicator of the quality of health care. Objective. To assess the impact of a health care quality improvement intervention on the development of PUs at the pediatric intensive care unit. Materials and methods. Uncontrolled, before and after study. Pre-intervention: measurement of PUs; post-intervention: implementation of a bundle of measures (staff training, identification of patients at risk, and pressure relief by using antibedsore mattresses and polymer gel positioners) and the same measurements., Results: A total of 152 patients were included: 74 before the intervention and 78 after the intervention. A significant reduction was observed in the incidence of PUs (preintervention: 50.60%; post-intervention: 23.08%; p= 0.001). A higher risk score was seen in the post-intervention group (pre-intervention: 12.4 ± 1.9; post-intervention: 13.7 ± 2.1; p= 0.001). No differences were observed in the risk score on the day of PU onset and the number of PUs. The risk-stratified analysis maintained the significant difference in the incidence of PUs (PIM2 < 5: 47.37%; 19.23%; p= 0.004; and PIM2 ≥ 5: 55.56%; 30.77%; p= 0.053)., Conclusion: A lower incidence of PUs was observed after the implementation of the health care quality improvement intervention. No changes were detected in the number of PUs or the severity staging., (Sociedad Argentina de Pediatría.)

Introduction: Children in pediatric intensive care units (PICUs) are exposed to experiencing pain, stress and anxiety due to their disease, treatment or care setting. Adequate sedation and analgesia are key to their care, particularly in patients requiring mechanical ventilation (MV)., Objective: To determine the usual practice in sedation and analgesia management in patients requiring MV in PICUs in Argentina., Material and Methods: Descriptive, crosssectional, multi-center study conducted by means of e-mailed surveys., Results: A total of 45 PICUs were surveyed, 18% (N= 8) of which follow a sedation and analgesia protocol strictly, while 58% (N= 26) follow an "implied" protocol based on routine practice. The most commonly used drugs were midazolam, for sedation, and fentanyl, for analgesia. In 31% (N= 14) of the PICUs, sedation was monitored through assessment scales (modified Ramsay and/or Comfort scales). In 4% (N= 2) of units, daily, scheduled interruptions of sedation was implemented. In patients who are difficult to sedate, dexmedetomidine was the most commonly used adjuvant. In 73% (N= 33) of the units, neuromuscular blocking agents were used in compliance with precise guidelines and under clinical monitoring. In 20% (N= 9) of the PICUs there was a sedation and analgesia weaning protocol in place, and morphine and lorazepam are the most commonly used drugs., Conclusion: Only a low percentage of surveyed PICUs had a protocol in place for the routine management of sedation and analgesia in patients on MV., (Sociedad Argentina de Pediatría.)

Brain death (BD) is a condition determined by the complete and irreversible absence of brain functions. Maintenance of vital functions creates an opportunity for organ donation. A retrospective study was carried out in 7 pediatric intensive care units of Argentina (from 1/1/2013 to 9/30/2016) to determine the incidence of clinical and certified BD, and the proportion of effective transplantations. Among deceased patients, 19.14% (147/768) met the clinical requirements for BD, and the main cause of BD was multiple trauma. BD was certified in 13.4% of deceased patients (103); an electroencephalogram and an apnea test were the most commonly used ancillary methods. Organ maintenance time was 24 hours. A total of 87 families were approached for donation; 59 were rejected (they were not suitable or refused). Effective donors accounted for 25% (26/103) of patients with certified BD and 72 patients received solid organs., (Sociedad Argentina de Pediatría.)

Pertussis is a contagious disease that in patients under 1 year of age may evolve to a highly lethal course characterized by hypoxemia and refractory pulmonary hypertension, being this responsible for cardiovascular collapse. Pulmonary hypertension occurs by direct action of bacteria and its toxins, responsible for the vascular tone alteration associated with hyperviscosity syndrome and arteriolar thrombosis due to hyperleukocytosis. Since 2004, leucodepletion has been proposed as a treatment option; there are currently 18 publications on leucodepletion in patients with severe Pertussis, with a total of 288 patients, 68 cytoreduction procedures and a mortality rate of 28% in those exposed to the mentioned treatment. Published studies have design limitations, so the evidence for using leukoreduction in patients with severe pertussis remains low.

Unlabelled: Medical prescribing errors (MPEs) are one of the most common causes of adverse events. Intensive care units are a high-risk setting for their occurrence., Objectives: To describe the incidence and types of MPEs in our Pediatric Intensive Care Unit. To assess whether the implementation of an improvement strategy on MPEs affects their incidence in the short- and long-term., Population and Methods: Prospective, uncontrolled, before-after study. Universe and sample. All medical prescriptions for patients hospitalized in the Pediatric Intensive Care Unit of the Hospital General de Niños Pedro de Elizalde from July-December, 2013 and from July-August, 2014., Results: In the pre-intervention period, MPEs rate was 13.9%, the most common being the absence of the time a given medication was modified, followed by missing a dose or medication. The medication most frequently involved in MPEs was the sedation and continuous analgesia group. After the implementation of an improvement program on MPEs, the incidence decreased to 6.3 errors every 100 prescriptions. The MPE type which showed the greatest reduction was the absence of the time of modification. Except for parenteral hydration and electrolyte supplementation, the rest of the analyzed medication groups showed a marked reduction. One year after having reviewed the situation, the MPE rate was 5.8%, and values remained similar to those of the immediate postintervention period., Conclusion: Managing an improvement program on MPEs resulted in a decrease in its incidence.

Staphylococcus aureus frequently affects human beings. Among clinical manifestations, necrotizing pneumonia is associated with a high mortality rate. Our objective is to describe the progress of severe Staphylococcus aureus infections in three intensive care units and analyze cases ofnecrotizing pneumonia in the period ranging from January 2011 to March 2013. Forty-three patients were studied, 76.7% had a community-acquired infection, and 31 had community-acquired methicillin-resistant Staphylococcus aureus. The main reason for admission was respiratory failure. Bacteremia was confirmed in 55.8% of cases. Mechanical ventilation was required in 86% of admitted patients, while 27 patients developed septic shock. The length of stay in the intensive care unit was 13 (5-25) days, and the mortality rate was 14%. Necrotizing pneumonia was observed in 51% of cases. Conclusion. A high rate of community-acquired infection was identified. Necrotizing pneumonia was associated with a worse clinical course.

Introduction. High frequency oscillatory ventilation (HFOV) is a rescue therapy for hypoxemic patients who deteriorate in conventional mechanical ventilation and/or for the air-leak syndrome treatment. A recent meta analysis showed that HFOV might have reduced mortality in pediatric and adult patients compared with conventional ventilation. In this context it's important to evaluate the effectiveness of this method in everyday use. Objectives. Main: To analize the effectiveness of HFOV in everyday practice in a center without extra corporeal membrane oxygenation (ECMO) capabilities. Secondary: To describe demographics and causes of severe respiratory failure of patients requiring HFOV. To assess the relationship between potential predictors and the occurrence of mortality. Population and methods. Retrospective study analyzing medical records of all patients that required HFOV in a tertiary care pediatric hospital pediatric intensive care units between march 1st 2008 and july 1st 2010. Results. Sixty-nine patients received 76 HFOV treatments. Eighty percent were diagnosed with acute lower respiratory infection or sepsis and 62.3% (n= 43) had preexisting chronic co-morbidities. The majority of HFOV treatments were because refractory hypoxemia (93.4%). Non survivors patients had worse clinical status at PICU admission, higher multiorgan failure, worse oxygenation and pulmonary condition. Conclusions. Everyday use of HFOV in a population with high incidence of chronic, oncologic and/or immunocompromised patients was associated with a survival of 33.4%. More prognostic studies are needed for a more effective selection of HFOV candidates.

Cardiac tamponade is an uncommon disorder in pediatric patients. We report a case of cardiac tamponade secondary to accumulation of cerebrospinal fluid due to ventriculo-atrial derivation (VAD) disfunction. An 11-month-old girl was assisted because of respiratory distress and tachycardia, without fever. She had a ventriculoatrial derivation, because of hydro-cephalus since two month earlier. The echocardiogram showed a pericardial effusion and the distal VAD located inside the right cardiac ventricle. The distal VAD was retired and replaced between superior cava vein and right atrium. The patient recovered ad integrum without pericardial effusion. In cases of patients with VAD presenting a clinical disorder, it should be ruled out VAD dysfunction or inappropriate placement.

Patient safety is one of the dimensions of care. Medical advances have made assistance processes more and more complex, and there is usually a combination of circumstances that converge for errors to occur. Adverse events constitute a serious public health problem, causing damages of varying degrees to the patient and his family, which also leads to an increase in the cost of the care process and hospital stay. Most of the adverse events occur in hospitals because their complexity is subject to a greater risk associated with care. That is why we present this consensus with the aim of offering tools whose implementation can contribute to provide a safer healthcare., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)

Introduction: Prescription errors are the most common cause of preventable errors. Electronic prescription (EP) systems may help to reduce errors and improve the quality of care., Objectives: To assess the effect of EP on the prevalence of prescription errors and related adverse events (AE) among hospitalized pediatric patients. To assess EP adherence, acceptability, and suitability among users., Methods: Hybrid, descriptive, and quasi-experimental, before-and-after design. Prescriptions made to hospitalized patients were included, estimating the prevalence of prescription errors and related AE in the pre- and post- EP implementation periods at a children's hospital (CH) and a general hospital (GH) used as control. Adherence was assessed based on the proportion of EP among all prescriptions registered in the post-implementation period. The acceptability and suitability of EP implementation was assessed via a user survey., Results: The prevalence of prescription errors pre- and post-EP implementation at the CH was compared and a statistically significant reduction was observed in both hospitals: CH: 29.1 versus 19.9 prescription errors/100 prescriptions (OR: 1.65; 95% CI: 1.34-2.02; p < 0.01). GH: 24.9 versus 13.6 prescription errors/100 prescriptions (OR: 2.1; 95% CI: 1.5-2.8; p < 0.01). The rate of overall adherence to EP was 83%. The implementation of EP was adequately acceptable and suitable., Conclusion: The prevalence of prescription errors reduced 30% after the implementation of EP. The overall adherence to EP was adequate.