Author Of 3 Presentations
PAEDIATRIC NEUROVASCULAR MALFORMATIONS IN INTENSIVE CARE: REPORT OF 44 CASES
Abstract
Background
Ruptured vascular malformations are the most common cause of intracerebral haemorrhage in children, causing significant morbidity and mortality.
Objectives
To describe the therapeutic approach and neurological outcome in patients admitted to a paediatric intensive care unit (PICU) with arteriovenous malformations (AVMs) and cerebral aneurysms (CAs).
Methods
Retrospective chart review of patients admitted to PICU with AVMs and CAs between January 2008 and December 2018. Neurologic outcome was assessed using King’s Outcome Scale for Childhood Head Injury (KOSCHI), considering good recovery KOSCHI 4-5; vegetative/ severe disability KOSCHI 2-3.
Results
28 cases of AVMs (64%) and 16 CAs (36%) were included: mean age 8.9 years (+/-5.1). Brain CT scan showed subarachnoid hemorrhage in 63% of CAs and parenchymatous haemorrhage in 64% of AVMs. All patients had neurocritical care, fifty-percent of patients underwent neurosurgery and 23% neuroradiological intervention. Seizures were more common in the AVM group (29 vs 6%), unlike vasospasm (11 vs 25%). Rebleeding rate was similar between groups (18 vs 19%), but occurred earlier and with higher mortality in CAs (2/3 within 48h of admission, both died) than AVMs (5/5 after the first week, one died). Another patient died, from ruptured CA (brain death on admission). On transfer from PICU, incidence of neurologic sequelae was similar (57% in AVMs vs 50% in CAs group). At present time: 75% of AVMs vs 69% of ACs show good recovery; 39% of AVMs vs 6,25% of CAs have severe disability.
Conclusion
Early rebleeding had a dismal outcome in our series, justifying a prompt intervention in cases of CAs.
Presentation files
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ESPNIC joanajones.rev2MV 20.06.2019 01:14
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ESPNIC joanajones.revMV 20.06.2019 00:49
Video on Demand
CRITICAL INCIDENTS: THE REALITY OF A PEDIATRIC INTENSIVE CARE UNIT IN
THE LAST TEN YEARS
Abstract
Background
A critical incident (CI) is an event or circumstance that caused or could have caused (such as a near miss) unplanned harm, suffering or loss to a patient. The study of CIs in intensive care units (ICU) is crucial to improve healthcare quality.
Objectives
To determine the incidence, type and outcomes of CI in a level III Pediatric ICU over a ten-year period (2008-2018).
Methods
Descriptive and quantitative study. Retrospective review of all CI notification forms (filled voluntarily and anonymously). Statistical analysis using SPSS® (v21, p<0,05).
Results
A total of 968 CIs were reported (34-147 per year). The main categories were: 41,7% medication (50,7% in prescription; 27,7% in administration); 17,5% airway/ventilation (64,3% in security - 88,9% of these related to accidental extubation); 12,7% procedures/techniques. The majority (64%) of CIs affected the patient and 16% of these resulted in harm. In 80% of cases, the occupation rate of ICU was equal to or above 50% and 25% occurred during the night shift. The CIs concerning ventilation were associated with greater severity, recurrence and harm to the patient (p<0,05). A higher occupation rate was also associated with greater severity (p<0,05). A total of 132 clinical recommendations were written and implemented in order to minimize the occurrence of CI.
Conclusion
CI related to medication and ventilation were the most prevalent, in line with the published literature. Notification, analysis and periodic discussion of CI are very important in order to prevent recurrence of these events.
OLA STRATEGY LOWERS MORTALITY OF VENTILATED ARDS PATIENTS, ALTHOUGH THE EFFECT DEPENDS ON LUNG RECRUITMENT (PAO2/FIO2) AND MECHANICAL POWER: SYSTEMATIC REVIEW AND META-ANALYSIS
Abstract
Background
Mechanical ventilation (MV) can produce VILI. “Open Lung Approach” (OLA) strategies could improve survival, but evidence is conflictive.
Objectives
Compare the clinical effectof a MV strategy aimed at maximising lung recruitmentin ARDS patients. And to see if this effect depends on the mechanical power (MP) transmitted to the lungs.
Methods
Systematic review and meta-analysis. We included RCTs of ARDS patients which included MV strategies aimed at maximising the lung recruited volume using high PEEP (OLA-group), versus standard strategies (CONTROL-group). RCTs of prone position or HFV were excluded. We used GRADE methodology. Random effects model was used to evaluate OLA strategy effect on 28 day Relative Risk of mortality (RR). A meta-regression was also performed with 3 candidate variables: PEEP level in OLA-group, recruitment (PaO2/FiO2) achieved in CONTROL-group, and relative MP/kg. The “best fit” model was the one with the minimum Akaike Information Criteria.
Results
Twelve RCTs (4,761 patients) were included. Mortality was significantly lower in OLA-group: RR = 0.86 (95% CI = 0.74 to 0.99; RE model). Quality of evidence was downgraded and there was no evidence of publication bias. The best model included PaO2/FiO2 of CONTROL-group and relative MP/kg. It shows that the effect of OLA disappears when the CONTROL-group has a PaO2/FiO2 > 170, and when relative MP/kg >= 1.
Conclusion
MV with OLA strategy improves mortality in ARDS patients. The effect vanishes when patients are already well recruited or when OLA strategy produces a higher energy transmission to the lungs.