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OBJECTIVES: Ventilator-associated pneumonia (VAP) is the second most common healthcare-associated infection in children. The aim of this study was to determine the risk factors for VAP in children and to create a risk score for developing VAP (RISVAP score). STUDY DESIGN: It was a prospective observational study, including children who required mechanical ventilation (MV), registered in the multicentre ENVIN-HELICS database from 2014 to 2019. The regression coefficients of each independent risk factor for VAP were used to create the RISVAP score. Each factor scored 0 if it was absent, or, if it was present, an assigned value from 1 to 7, according to the regression coefficient. RESULTS: A total of 3798 patients were included, 97(2.5%) developing VAP. The independent risk factors for VAP were: female (odds ratio [OR]: 1.642, p = 0.024), MV > 4 days (OR: 26.79, p < 0.001), length in pediatric intensive care unit > 7 days (OR: 11.74, p < 0.001), and previous colonisation (OR: 4.18, p < 0.001). The RISVAP was calculated for each patient as the sum of all the independent risk factors. Three risk groups were obtained: low (0-5 points), intermediate (6-12 points), and high risk for VAP (13-16 points). The area under the curve for the final score was 0.905 (95%confidence interval: 0.888-0.923, p < 0.001). CONCLUSIONS: The RISVAP is the first risk score for VAP in pediatric populations. Using this predictive score, might be helpful to detect vulnerable patients and therefore implement preventative strategies.

Background Bacterial infection (BI), both community-acquired (CA-BI) and hospital-acquired (HAI), might present as a severe complication in patients with bronchiolitis. This study aimed to describe BI in children with severe bronchiolitis, and to define risk factors for BI. Methods This was a prospective, descriptive study that included infants admitted to the pediatric intensive care unit (PICU) due to bronchiolitis between 2011 and 2017. The BROSJOD score was calculated to rate the severity of bronchiolitis. Results Inclusion of 675 patients, with a median age of 47 days (IQR 25-99). 175 (25.9%) patients developed BI, considered HAI in 36 (20.6%). Patients with BI had higher BROSJOD score, PRISM III, and required invasive mechanical ventilation and inotropic support more frequently (p < 0.001). BI was independently associated with BROSJOD higher than 12 (OR 2.092, 95%CI 1.168-3.748) CA-BI was associated to BROSJOD > 12 (OR 2.435, 95%CI 1.379-4.297) and bacterial co-infection (OR 2.294 95%CI 1.051-5.008). Concerning HAI, an independent association was shown with mechanical ventilation longer than 7 days (OR 5.139 95%CI 1.802-14.652). Infants with BI had longer PICU and hospital stay (p < 0.001), Mortality was higher in patients with HAI. Conclusions A quarter of infants with severe bronchiolitis developed BI. A BROSJOD > 12 may alert the presence of CA-BI, especially pneumonia. Patients with BI have higher morbidity and mortality.

Background: Bronchiolitis is the most common viral infection of the lower respiratory tract in infants under 2 years of age. The aim of this study was to analyze and compare the seasonal bronchiolitis peaks before and during the SARS-CoV-2 pandemic. Methods: Descriptive, prospective, and observational study. Patients with severe bronchiolitis admitted to the Pediatric Intensive Care Unit (PICU) of a referral tertiary hospital between September 2010 and June 2021 were included. Demographic data were collected. Viral laboratory-confirmation was carried out. Each season was analyzed and compared. The daily average temperature was collected. Results: 1116 patients were recruited, 58.2% of them males. The median age was 49 days. Respiratory syncytial virus (RSV) was isolated in 782 cases (70.1%). In April 2021, the first and only case of bronchiolitis caused by SARS-CoV-2 was identified. The pre- and post-pandemic periods were compared. There were statistically significant differences regarding: age, 47 vs. 73 days (p = 0.006), PICU and hospital length of stay (p = 0.024 and p = 0.001, respectively), and etiology (p = 0.031). The peak for bronchiolitis in 2020 was non-existent before week 52. A delayed peak was seen around week 26/2021. The mean temperature during the epidemic peak was 10 degrees C for the years of the last decade and is 23 degrees C for the present season. Conclusion: The COVID-19 pandemic outbreak has led to a clearly observable epidemiological change regarding acute bronchiolitis, which should be studied in detail. The influence of the environmental temperature does not seem to determine the viral circulation.

During the pandemic caused by the novel coronavirus (COVID-19), lung ultrasound has been used to diagnose and monitor respiratory condition. The aim of the study was to describe lung ultrasound findings in children with a COVID-19 infection. Patients younger than 18 years old and positive for COVID-19, admitted to pediatric tertiary referral hospital were included. They were divided into two groups depending on the presence of respiratory symptoms. Lung ultrasound results were categorized into four degrees according to Soldati et al. score (J Ultrasound Med 39:1-7, 2020) and it was also described the presence and type of consolidation. Sixteen patients were recruited. The median age was 11 years old (IQR 2.8-12). Four children (25%) required admission to the intensive care unit. Six patients (37.5%) presented with respiratory symptoms. Most of them showed S.score of 2 and subpleural consolidations were observed in four cases (66.6%). Ten patients (62.5%) presented with non-respiratory symptoms, lung ultrasound showed S.score from 0 to 2. Three (30%) were diagnosed of multisystem inflammatory syndrome and lung ultrasounds showed S.score of 2 with bilateral pleural effusion.Conclusions: Children with COVID-19 and respiratory symptoms mostly showed a S.score of 2 and 3 with subpleural consolidations, upon the lung ultrasound assessment. What is Known: • Lung ultrasound is a useful tool for monitoring patients with respiratory symptoms in both adults and children. Lung ultrasounds are altered in adult patients with COVID-19. What is New: • Lung ultrasound might improve COVID-19 assessment, it could be a useful tool to diagnose and monitor patients throughout the COVID-19 pandemic. Even COVID-19 patients with non-respiratory symptoms have lung alterations that are visible on lung ultrasound.

Primary ciliary dyskinesia (PCD) is an airways ciliary defect, making them unable to beat normally. Hence, there is an increase in the incidence of respiratory recurrent infections leading to multiple atelectasis from different lung lobes during the first months of life repeat chest X-ray (CXR) controls with increase of radiation exposure in this younger population. We report the lung ultrasound follow-up of two newborn diagnosed with PCD. The illness in these cases was suspected during the first days of life due to worsening of respiratory distress on previous healthy newborns. Both patients cases show the ability of bedside lung ultrasound (LUS) to confirm clinical suspicion of atelectasis or pneumonia. Using LUS for the diagnosis and follow-up may help in avoiding routine CXR, thus reducing the huge amount of ionizing radiation in these patients.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has collapsed health systems worldwide. In adults, the virus causes severe acute respiratory distress syndrome (ARDS), while in children the disease seems to be milder, although a severe multisystem inflammatory syndrome (MIS-C) has been described. The aim was to describe and compare the characteristics of the severe COVID-19 disease in adults and children. METHODS: This prospective observational cohort study included the young adults and children infected with SARS-CoV-2 between March-June 2020 and admitted to the paediatric intensive care unit. The two populations were analysed and compared focusing on their clinical and analytical characteristics and outcomes. RESULTS: Twenty patients were included. There were 16 adults (80%) and 4 children (20%). No mortality was recorded. All the adults were admitted due to ARDS. The median age was 32 years (IQR 23.3-41.5) and the most relevant previous pathology was obesity (n = 7, 43.7%). Thirteen (81.3%) needed mechanical ventilation, with a median PEEP of 13 (IQR 10.5-14.5). Six (37.5%) needed inotropic support due to the sedation. Eight (50%) developed a healthcare-associated infection, the most frequent of which was central line-associated bloodstream infection (n = 7, 71.4%). One patient developed a partial pulmonary thromboembolism, despite him being treated with heparin. All the children were admitted due to MIS-C. Two (50%) required mechanical ventilation. All needed inotropic support, with a median vasoactive-inotropic score of 27.5 (IQR 17.5-30). The difference in the inotropic requirements between the two populations was statistically significant (37.5% vs. 100%, p < 0.001). The biomarker values were higher in children than in adults: mid-regional pro-adrenomedullin 1.72 vs. 0.78 nmol/L (p = 0.017), procalcitonin 5.7 vs. 0.19 ng/mL (p = 0.023), and C-reactive protein 328.2 vs. 146.9 mg/L (p = 0.005). N-terminal pro-B-type natriuretic peptide and troponins were higher in children than in adults (p = 0.034 and p = 0.039, respectively). CONCLUSIONS: Adults and children had different clinical manifestations. Adults developed severe ARDS requiring increased respiratory support, whereas children presented MIS-C with greater inotropic requirements. Biomarkers could be helpful in identifying susceptible patients, since they might change depending on the clinical features.

The objective was to evaluate the use of procalcitonin (PCT) and C-reactive protein (CRP) for the diagnosis of bacterial infection in bronchiolitis patients. A prospective, single-centre, descriptive, and comparative observational study was carried out on patients with severe bronchiolitis admitted to the paediatric intensive care unit (PICU), from January 2011 to July 2017. Two cohorts were compared: patients with invasive bacterial infection (IBI) and patients with no bacterial infection (NBI). We included 675 patients, 399 of whom were males (59.1%), with median age of 47 days (IQR 25-100.3). Of them, 181 patients were diagnosed with IBI (26.8%). Seventy-two had sepsis (10.7%), 106 had pneumonia (15.7%), and 41 had a urinary tract infection (6.1%). PCT and CRP values were significantly higher in patients with IBI. ROC curves compared the ability of PCT and CRP to diagnose IBI at admission, 24 h, and 48 h. PCT showed a better AUC for diagnosing IBI, with statistically significant differences at all time points (p < 0.001). The best PCT cut-off for IBI diagnosis at admission was 1.4 ng/mL, with a sensitivity of 69% (95% CI 58.4-74.9) and a specificity of 91% (95% CI 88.1-92.5). Procalcitonin showed a better AUC for diagnosing both sepsis and pneumonia, which makes it an excellent predictor.Conclusion: We present PCT as a novel test in comparison with the traditional CRP screening test to discern which bronchiolitis patients have IBI. We highlight the importance of PCT for the diagnosis of pneumonia and sepsis, as it proved to be more sensitive and specific than CRP, with statistically significant differences. What is Known: • Bronchiolitis should be treated with antibiotics only when a bacterial infection is present. • The rate of antibiotic prescription in severe bronchiolitis is extremely high, so diagnostic tools are needed. What is New: • PCT is a good biomarker to discern which bronchiolitis patients have IBI, specially for pneumonia and sepsis diagnoses. It is more sensitive and specific than CRP, with statistically significant differences. • Implementation of PCT cut-off values may prevent unnecessary antibiotic use.

AIM: Our aim was to determine the effectiveness and safety of a procalcitonin-guided protocol to decrease antibiotic use in infants with severe bronchiolitis. METHODS: This prospective, observational study was conducted at the Hospital Sant Joan de Déu from 2010 to 2017. Patients under the age of one were included if they were diagnosed with bronchiolitis, had a suspected bacterial infection and were admitted to the paediatric intensive care unit. A procalcitonin-guided protocol was established in 2014, and two cohorts were compared before and after implementation: 340 in 2010-2014 and 366 in 2015-2017. RESULTS: We recruited 706 patients (58.6% male) with a median age of 47 days and an interquartile range of 25.0-100.2. The rate for antibiotic use was 79.9%, and this differed before and after implementation (88.2% vs 72.1%, P = .003). Antibiotic stewardship and withdrawal decisions were higher after implementation (22.3% vs 36.4%, P = .005). The length of antibiotic treatment was also different between the two periods (8.65 ± 4.8 days vs 5.05 ± 3.18 days, P = .023). No adverse outcomes were observed due to the implementation of the protocol. CONCLUSION: The implementation of a procalcitonin-guided protocol seems to lead to a safe and general decrease in antibiotic use in paediatric patients with severe bronchiolitis.

BACKGROUND: The purpose of this paper is to describe how end-of-life care is managed when life-support limitation is decided in a Pediatric Intensive Care Unit and to analyze the influence of the further development of the Palliative Care Unit. METHODS: A 15-year retrospective study of children who died after life-support limitation was initiated in a pediatric intensive care unit. Patients were divided into two groups, pre- and post-palliative care unit development. Epidemiological and clinical data, the decision-making process, and the approach were analyzed. Data was obtained from patient medical records. RESULTS: One hundred seventy-five patients were included. The main reason for admission was respiratory failure (86/175). A previous pathology was present in 152 patients (61/152 were neurological issues). The medical team and family participated together in the decision-making in 145 cases (82.8%). The family made the request in 10 cases (9 vs. 1, p = 0.019). Withdrawal was the main life-support limitation (113/175), followed by withholding life-sustaining treatments (37/175). Withdrawal was more frequent in the post-palliative group (57.4% vs. 74.3%, p = 0.031). In absolute numbers, respiratory support was the main type of support withdrawn. CONCLUSIONS: The main cause of life-support limitation was the unfavourable evolution of the underlying pathology. Families were involved in the decision-making process in a high percentage of the cases. The development of the Palliative Care Unit changed life-support limitation in our unit, with differences detected in the type of patient and in the strategy used. Increased confidence among intensivists when providing end-of-life care, and the availability of a Palliative Care Unit may contribute to improvements in the quality of end-of-life care.

The last years an increase of severe cases of invasive disease (ID) due to Streptococcus pyogenes or streptococcus b-hemolytic group A (SGA) had been detected. The aim of this study was to analyze the epidemiology and the clinical features of ID due to SGA in a tertiary Pediatric Hospital.

OBJECTIVES: Procalcitonin is a useful biomarker for predicting bacterial infection after cardiac surgery. However, sometimes procalcitonin rises following cardiac surgery without a confirmation of bacterial infection. The aim was to analyse procalcitonin levels in children without a bacterial infection after cardiac surgery. STUDY DESIGN: This is a prospective, observational study of children

Xarxa territorial; Cartera de serveis; Prestacions Red territorial; Cartera de servicios; Prestaciones Territorial network; Portfolio of services; Benefits El CatSalut, amb el suport de Antares Consulting, ha realitzat recentment un estudi per avançar cap a una planificació basada en xarxes i cartera de serveis per territoris (i no tant per nivells hospitalaris). Per donar continuïtat s’ha avançat en dues línies que tenen per objecte: 1. Definir els instruments i les eines per a la gestió de xarxes territorials 2. Definició dels criteris d’ordenació de la cartera de serveis en una xarxa hospitalària El primer punt ha de permetre definir els elements estructurals de les futures xarxes territorials: − L’estructura jurídica de la xarxa, amb característiques supraorganitzatives que respectin la naturalesa de les organitzacions que la integren. − El model de govern de la xarxa. − Les condicions de mobilitat dels professionals dins la xarxa. El segon punt ha de permetre definir el model de cartera de serveis: − Establir els criteris d’ordenació de les prestacions assistencials a nivell d’hospital, de xarxa i de supraxarxa. − Definir la cartera de serveis dels hospitals comarcals. − Caracteritzar el model de funcionament entre la xarxa hospitalària (territorial i horitzontal) amb els altres nivells assistencials (local i de coordinació vertical).:ca_ES El CatSalut, con el apoyo de Antares Consulting, ha realizado recientemente un estudio para avanzar hacia una planificación basada en redes y cartera de servicios por territorios (y no tanto por niveles hospitalarios). Para dar continuidad se ha avanzado en dos líneas que tienen por objeto: 1. Definir los instrumentos y herramientas para la gestión de redes territoriales 2. Definición de los criterios de ordenación de la cartera de servicios en una red hospitalaria El primer punto debe permitir definir los elementos estructurales de las futuras redes territoriales: − La estructura jurídica de la red, con características supraorganizativas que respeten la naturaleza de las organizaciones que la integran. − El modelo de gobierno de la red. − Las condiciones de movilidad de los profesionales dentro de la red. El segundo punto debe permitir definir el modelo de cartera de servicios: - Establecer los criterios de ordenación de las prestaciones asistenciales a nivel de hospital, red y suprared. − Definir la cartera de servicios de los hospitales comarcales. − Caracterizar el modelo de funcionamiento entre la red hospitalaria (territorial y horizontal) con los otros niveles asistenciales (local y de coordinación vertical). CatSalut, with the support of Antares Consulting, has recently carried out a study to move towards planning based on networks and portfolio of services by territory (and not so much by hospital level). In order to provide continuity, progress has been made in two lines whose purpose is: 1. Define the instruments and tools for the management of territorial networks 2. Definition of the criteria for organizing the portfolio of services in a hospital network The first point it must allow the structural elements of future territorial networks to be defined: − The legal structure of the network, with supra-organizational characteristics that respect the nature of the organizations that make it up. - The governance model of the network. - The mobility conditions of professionals within the network. The second point must make it possible to define the model of the portfolio of services: − Establish the criteria for ordering healthcare services at hospital, network and super-network level. - Define the service portfolio of regional hospitals. − Characterize the operating model between the hospital network (territorial and horizontal) with the other care levels (local and vertical coordination).

Nounats; Planificació; Cartera de serveis; Centres hospitalaris; SISCAT Recién nacidos; Planificación; Cartera de servicios; Centros hospitalarios; SISCAT Newborns; Planning; Portfolio of services; Hospital centers; SISCAT El CatSalut proposa com a objectiu principal actualitzar els criteris operatius de planificació i cartera de serveis establerts en relació amb l’atenció dels nounats als centres hospitalaris del SISCAT de Catalunya prenent com a referència principal el Pla estratègic d'ordenació de l’atenció maternoinfantil de l’any 2008. Per tal d’aconseguir aquest propòsit, es defineixen els objectius específics següents: Actualitzar els nivells d’atenció neonatal i la prestació de serveis associada a cada nivell. Actualitzar els indicadors i criteris d’activitat associat a cada nivell. Valorar els criteris d’organització i recursos en relació amb les cures intensives i intermèdies.

Unitats del dolor; Hospitals; Cartera de serveis; SISCAT Unidades del dolor; Hospitales; Cartera de servicios; SISCAT Pain units; Hospitals; Portfolio of services; SISCAT Les unitats del dolor són unitats de tipus funcional pròpies de l’àmbit hospitalari, on diferents professionals d’un mateix centre sanitari treballen conjuntament per a l’abordatge del pacient amb dolor. Aquestes presten l’atenció en l’àmbit hospitalari i, dins d’aquest, majoritàriament, en l’entorn de les consultes externes hospitalàries o de l’hospital de dia o àrees de tècniques especials. A més, els procediments més complexos s’han de realitzar en entorns de tipus quiròfan. Així, es fa palesa la necessitat de disposar d’una major concreció en la cartera de serveis de les unitats del dolor i recomanacions per al maneig del dolor a Catalunya, garantint en tot moment la qualitat i seguretat d’aquesta prestació, amb l’objectiu de millorar la qualitat de vida de les persones que pateixen dolor i garantir l’equitat d’accés per a la població, tot ordenant els fluxos quan sigui necessari. Per assolir aquests objectius, cal establir una codificació correcta de les diferents tècniques i/o procediments

Lector ocular; Sistemes de comunicació augmentativa; Cartera serveis; SISCAT Lector ocular; Sistemas de comunicación aumentativa; Cartera servicios; SISCAT Eye reader; Augmentative communication systems; Services portfolio; SISCAT Amb l’objectiu de facilitar a les persones amb determinades característiques i capacitats un sistema de comunicació que els permeti comunicar-se amb l’entorn, durant el 2017 la Comissió de Prestacions, Assegurament i Finançament (CPAF), dependent del Consell Interterritorial del Ministeri de Sanitat i Consum, va impulsar un grup de treball amb professionals experts per elaborar una proposta d’indicació i el procediment de reutilització de sistemes de comunicació considerats productes sanitaris. Posteriorment, l’Ordre SCB/480/2019, de 26 de abril, per la qual es modifiquen els annexos I, II, III i VI del Reial decret 1030/2006, de 15 de setembre, pel qual s’estableix la cartera de serveis comuns del Sistema Nacional de Salut i el seu procediment d’actualització, va incloure la modificació següent a l’apartat 1.4 de l’annex III, sobre els sistemes de comunicació alternativa com a part dels productes sanitaris.

Cirurgia de columna vertebral; Hospitals públics; Organització Cirugía de columna vertebral; Hospitales públicos; Organización Spinal surgery; Public hospitals; Organization Els objectius d'aques document son: 1. Consensuar els criteris d’indicació de la cirurgia de columna vertebral en diferents situacions clíniques. 2. Analitzar i definir els diferents nivells quirúrgics segons complexitat de la cirurgia de columna vertebral en la població de Catalunya. 3. Establir els criteris i requeriments mínims dels centres hospitalaris per proveir cirurgia de columna vertebral segons els nivells de complexitat a Catalunya.

Cirugía bariátrica; Hospitales públicos; Adultos Bariatric surgery; Public hospitals; Adults Cirurgia bariàtrica; Hospitals públics; Adults L'objectiu és definir les indicacions de cirurgia bariàtrica en població adulta i disminuir la variabilitat entre centres hospitalaris; analitzar i definir els diferents nivells quirúrgics segons la complexitat de la cirurgia bariàtrica en població adulta; definir el seguiment a curt/mitjà i llarg termini de la postcirurgia bariàtrica en població adulta i establir els criteris i requeriments mínims dels centres hospitalaris per dur a terme cirurgia bariàtrica en població adulta. L’àmbit d’aplicació del consens és el Sistema sanitari integral d’utilització pública de Catalunya (SISCAT). El objetivo es definir las indicaciones de cirugía bariátrica en población adulta y disminuir la variabilidad entre centros hospitalarios; analizar y definir los diferentes niveles quirúrgicos segundos la complejidad de la cirugía bariátrica en población adulta; definir el seguimiento a corto/medio y largo plazo de la postcirugía bariátrica en población adulta y establecer los criterios y requerimientos mínimos de los centros hospitalarios para llevar a cabo cirugía bariátrica en población adulta. El ámbito de aplicación del consenso es el Sistema sanitario integral de utilización pública de Cataluña (SISCAT). The aim is to define the indications for bariatric surgery in the adult population and to decrease the variability between hospitals; analyze and define the different surgical levels according to the complexity of bariatric surgery in the adult population; define the short / medium and long-term follow-up of bariatric surgery in the adult population and establish the minimum criteria and requirements for hospitals to carry out bariatric surgery in the adult population. The scope of the consensus is the Comprehensive Health System for Public Use in Catalonia (SISCAT).

Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Servei de cardiologia; Desconfinament; Mesures de protecció Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Servicio de cardiología; Desconfinamiento; Medidas de protección Coronavirus SARS-CoV-2; COVID-19; 2019-nCoV; Cardiology service; No confinement; Protection measures Aquest document recull les recomanacions de les societats científiques i professionals, per encàrrec del CatSalut i sota la coordinació del Pla Director de Malalties de l’Aparell Circulatori, pel retorn d’activitat de la pràctica clínica en els serveis de cardiologia en l’escenari actual de brot de COVID-19.