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Objectivethe biomarkers’ performance for diagnosis and severity stratification of sepsis has not been properly evaluated anew using the SEPSIS-3 criteria introduced in 2016. We evaluated the accuracy of 21 biomarkers classically tested in sepsis research to identify infection, sepsis, and septic shock in surgical patients classified using SEPSIS-3.Methodsfour groups of adult surgical patients were compared: post-surgical patients with no infection, patients with infection but no sepsis, patients with sepsis, and patients with septic shock were recruited prospectively from the surgery departments and surgical ICUs from four Spanish hospital. The area under the curve (AUC) to differentiate between groups was calculated for each biomarker.ResultsA total of 187 patients were recruited (50 uninfected post-surgery controls, 50 patients with infection, 47 with sepsis and 40 with septic shock). The AUCs indicated that none of the biomarkers tested was accurate enough to differentiate those patients with infection from the uninfected controls. In contrast, procalcitonin, lipocalin 2, pentraxin 3, IL-15, TNF-α, IL-6, angiopoietin 2, TREM-1, D-dimer and C-reactive protein yielded AUCs > 0.80 to discriminate the patients with sepsis or septic shock from those with no infection. C-reactive protein and IL-6 were the most accurate markers to differentiate plain infection from sepsis (AUC = 0.82). Finally, our results revealed that sepsis and septic shock shared similar profiles of biomarkers.ConclusionRevaluation in the “SEPSIS-3 era” identified the scenarios where biomarkers do and do not provide useful information to improve the management of surgical patients with infection or sepsis.

Background: The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those who received TCZ. Methods: A retrospective single-center study was performed on consecutive hospitalized patients with severe COVID-19 between 1 March and 23 April 2020. Patients treated with either TCZ (400–600 mg, one to two doses) and methylprednisolone pulses (MPD-TCZ group) or TCZ alone were analyzed for the occurrence of a combined endpoint of death and need for invasive mechanical ventilation during admission. The independence of both treatment groups was tested using machine learning classifiers, and relevant variables that were potentially different between the groups were measured through a mean decrease accuracy algorithm. Results: An earlier date of admission was significantly associated with worse outcomes regardless of treatment type. Twenty patients died (27.0%) in the TCZ group, and 33 (44.6%) died or required intubation (n = 74), whereas in the MPD-TCZ group, 15 (11.0%) patients died and 29 (21.3%) patients reached the combined endpoint (n = 136; p = 0.006 and p < 0.001, respectively). Machine learning methodology using a random forest classifier confirmed significant differences between the treatment groups. Conclusions: MPD and TCZ improved outcomes (death and invasive mechanical ventilation) among hospitalized COVID-19 patients, but confounding variables such as the date of admission during the COVID-19 pandemic should be considered in observational studies.

Introduction and objective: The adenotonsillar hypertrophy is the fundamental cause of childhood obstructive sleep apnea syndrome (OSAS), a frequent pathology that can cause a series of important complications. In certain circumstances, it can be diagnosed without the need of complex tests and treated effectively, with adenotonsillectomy being the choice; since, with the current resources, assuming all the recommendations of the main guidelines are impractical, the number of children that would require referral for diagnostic polysomnography (PSG) and adenotonsillectomy would exceed our capacity. Limiting the guidelines to available means would significantly ignore the health repercussions of childhood OSA, making it difficult to recognize children at risk, as well as being able to offer adequate treatment. Our objective is to establish the recommendations based on the best available scientific evidence to increase, in an efficient way, the diagnosis of pediatric OSAS and to establish the adequate surgical recomendation as well as the safety in the perioperative procedure. Sections: Review of the bibliography of national and international guidelines on the management of childhood OSAS and assessment of own experience derived from clinical practice and prospective follow-up studies of operated patients. Summary of the evidence on childhood OSAS. Resolution of disagreements between scientific evidence and current clinical practice with proposals to minimize them. Recommendations for the diagnostic procedure and the surgical procedure. Perioperative management scheme and post-surgical follow-up. Conclusions: The application of the suggested changes regarding the management of children with suspected OSAS will allow: 1) greater prominence in the process of Primary and Secondary Care provided by general pediatricians to consider adenotonsillectomy; 2) the widespread use of specific questionnaires for the detection of OSAS, nocturnal oximetry and video recording during sleep as assessment tools; and 3) greater availability of complex sleep studies (PSG) to meet international standards for certain conditions.

BackgroundSome patients infected by SARS-CoV-2 in the recent pandemic have required critical care, becoming one of the main limitations of the health systems. Our objective has been to identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia.MethodsWe retrospectively collected and analyzed data from electronic medical records of patients with laboratory-confirmed SARS-CoV-19 infection by real-time RT-PCR. A comparison was made between patients staying in the hospitalization ward with those who required critical care. Univariable and multivariable logistic regression methods were used to identify risk factors predicting critical care need.FindingsBetween March 15 and April 15, 2020, 150 patients under the age of 75 were selected (all with laboratory confirmed SARS-CoV-19 infection), 75 patients requiring intensive care assistance and 75 remaining the regular hospitalization ward. Most patients requiring critical care were males, 76% compared with 60% in the non-critical care group (pInterpretationPatients COVID-19 positive presenting at admission with high SOFA score ≥2 combined with CRP ≥ 9,1 mg/mL could help clinicians to identify them as a group that will more likely require critical care so further actions might be implemented to improve their prognosis.

Study objective Clinical repercussions of perioperative treatment with ACEIs/ARBs. Design Systematic review according to PRISMA statement. Setting Perioperative period. Patients 29 studies 11 cases/cases series, 12 observational studies and 6 randomized studies. Measurements Arterial blood pressure differences, refractory hypotension, other comorbidities. Main results The studies show different results regarding the topics measured. They are divided in the results regarding blood pressure, long term morbidities and effects in neuraxial anesthesia. Conclusions Withholding AECI/ARBs on the morning prior to surgery could be recommended as a potentially effective measure, with a low level of evidence, in order to reduce the appearance of hypotension in the perioperative period of non-cardiac surgery.

Introduction and objective: The adenotonsillar hypertrophy is the fundamental cause of childhood obstructive sleep apnea syndrome (OSAS), a frequent pathology that can cause a series of important complications. In certain circumstances, it can be diagnosed without the need of complex tests and treated effectively, with adenotonsillectomy being the choice; since, with the current resources, assuming all the recommendations of the main guidelines are impractical, the number of children that would require referral for diagnostic polysomnography (PSG) and adenotonsillectomy would exceed our capacity. Limiting the guidelines to available means would significantly ignore the health repercussions of childhood OSA, making it difficult to recognize children at risk, as well as being able to offer adequate treatment. Our objective is to establish the recommendations based on the best available scientific evidence to increase, in an efficient way, the diagnosis of pediatric OSAS and to establish the adequate surgical recomendation as well as the safety in the perioperative procedure. Sections: Review of the bibliography of national and international guidelines on the management of childhood OSAS and assessment of own experience derived from clinical practice and prospective follow-up studies of operated patients. Summary of the evidence on childhood OSAS. Resolution of disagreements between scientific evidence and current clinical practice with proposals to minimize them. Recommendations for the diagnostic procedure and the surgical procedure. Perioperative management scheme and post-surgical follow-up. Conclusions: The application of the suggested changes regarding the management of children with suspected OSAS will allow: 1) greater prominence in the process of Primary and Secondary Care provided by general pediatricians to consider adenotonsillectomy; 2) the widespread use of specific questionnaires for the detection of OSAS, nocturnal oximetry and video recording during sleep as assessment tools; and 3) greater availability of complex sleep studies (PSG) to meet international standards for certain conditions. Introducción y objetivo: La hipertrofia adenoamigdalar es la causa fundamental del SAOS infantil, patología frecuente que puede causar complicaciones importantes. En determinadas circunstancias, puede ser diagnosticado sin necesidad de pruebas complejas y tratado eficazmente, siendo de elección la adenoamigdalectomía, ya que, con los recursos actuales, asumir todas las recomendaciones de las principales guías resulta impracticable, pues el número de niños que requerirían derivación para polisomnografía (PSG) diagnóstica y adenoamigdalectomía superarían nuestra capacidad. Nuestro objetivo es establecer las recomendaciones basadas en la mejor evidencia científica disponible para incrementar, de manera eficiente, el diagnóstico del SAOS pediátrico, adecuar la indicación quirúrgica así como la seguridad en el procedimiento perioperatorio./nSecciones: Revisión de bibliografía de guías nacionales e internacionales de manejo de SAOS infantil y valoración de experiencia propia derivada de práctica clínica y estudios prospectivos de seguimiento de pacientes intervenidos. Síntesis de la evidencia sobre el SAOS infantil. Recomendaciones para el procedimiento diagnóstico y el procedimiento quirúrgico. Resolución de discordancias entre la evidencia científica y la práctica clínica actual con propuestas para minimizarlas. /nConclusiones: La aplicación de los cambios sugeridos permitirá: 1) mayor protagonismo en el proceso de la Atención Primaria y Secundaria proporcionada por los pediatras generales para la consideración de adenoamigdalectomía; 2) el uso generalizado de cuestionarios específicos para la detección de SAOS, de la oximetría nocturna y de la videograbación durante el sueño como herramientas de evaluación; y 3) mayor disponibilidad de estudios de sueño complejos (PSG) para cumplir con los estándares internacionales para ciertas condiciones.