Introduction:Ventilator-associated pneumonia (VAP) increases the risk of mortality by 2 to 3 times. Objectives: To know characteristics of VAP, determining VAP infection rates, analyze related factors, isolatedgerms, antibiotic sensitivity and mortality. Methods:Descriptive, retrospective study in patients with VAP2015-2018. The data was obtained from the Rikchary program of a pediatric intensive care unit, analyzed withSPSS 24.00. Results:There were 60 cases of VAP, with average annual rates of 9.8 per 1000 days of mechanicalventilation (MV). 65% of the VAPs were late diagnosed after 5 days of MV, the average MV days were 15, 25%of the patients were re-admitted to MV. The average hospitalization was 31 days. The most frequent germswere Stenotrophomona maltophilia sensitive 81% to Cotrimoxazol and Pseudomona aureginosa sensitive80% to cefepime, 90% to Amikacin and between 50% t...

Objetive. Nutritional intake in a reference pediatric intensive care unit is described and factors associated with inadequate achievement of the caloric goal are identified. Methods. Retrospective study that reviews the medical records of children under 14 years of age to identify clinical data, anthropometric nutritional assessment and energy expenditure according to the Schofield equation. Results. 65 patients were included, 54% male, age range from one month to 13 years, 60% admitted to the emergency department, most frequent diagnoses were shock and respiratory failure and and 49.2% presented normal nutritional status. In 28% of patients an adequate caloric goal was reached, 34% was excessive and 38% deficient. Nutritional support was started in the first 72 hours in 95% of patients, 84.6% by enteral route, 80% had nutrition interruptions. The inadequate achievement of the goal was m...

Introduction:Ventilator-associated pneumonia (VAP) increases the risk of mortality by 2 to 3 times. Objectives: To know characteristics of VAP, determining VAP infection rates, analyze related factors, isolatedgerms, antibiotic sensitivity and mortality. Methods:Descriptive, retrospective study in patients with VAP2015-2018. The data was obtained from the Rikchary program of a pediatric intensive care unit, analyzed withSPSS 24.00. Results:There were 60 cases of VAP, with average annual rates of 9.8 per 1000 days of mechanicalventilation (MV). 65% of the VAPs were late diagnosed after 5 days of MV, the average MV days were 15, 25%of the patients were re-admitted to MV. The average hospitalization was 31 days. The most frequent germswere Stenotrophomona maltophilia sensitive 81% to Cotrimoxazol and Pseudomona aureginosa sensitive80% to cefepime, 90% to Amikacin and between 50% t...

INTRODUCCIÓN: El Sindrome Inflamatorio Multisistémico Pediatrico (SIMP) asociado a SARS CoV2 afecta gravemente a niños. Objetivo: Describir clínica, tratamiento y evolución del SIMP en pacientes de una Unidad de Cuidados Intensivos Pediátricos (UCIP) de referencia. Hallazgos: Se identificaron 18 niños con edad promedio de 8,76 años, 50% masculino, todos con prueba serológica positiva. Las manifestaciones más frecuentes fueron: Fiebre (100%), dificultad respiratoria (94%), dolor abdominal (89%), Proteina C reactiva elevada (promedio 21,8), plaquetopenia (50%), Radiografía de tórax patológica (89%) y contractilidad miocárdica deprimida (61%). El 72% requirió ventilación mecánica invasiva (promedio 3 días) y catecolaminas; 89% usó corticoides más inmunoglobulinas. La estancia promedio en UCIP fue 5.5 días. Un paciente falleció por hemorragia intracerebral. CONCLUSIONES...

Introducción: El Sindrome Inflamatorio Multisistémico Pediatrico (SIMP) asociado a SARS CoV2 afecta gravemente a niños. Objetivo: Describir clínica, tratamiento y evolución del SIMP en pacientes de una Unidad de Cuidados Intensivos Pediátricos (UCIP) de referencia. Hallazgos: Se identificaron 18 niños con edad promedio de 8,76 años, 50% masculino, todos con prueba serológica positiva. Las manifestaciones más frecuentes fueron: Fiebre (100%), dificultad respiratoria (94%), dolor abdominal (89%), Proteina C reactiva elevada (promedio 21,8), plaquetopenia (50%), Radiografía de tórax patológica (89%) y contractilidad miocárdica deprimida (61%). El 72% requirió ventilación mecánica invasiva (promedio 3 días) y catecolaminas; 89% usó corticoides más inmunoglobulinas. La estancia promedio en UCIP fue 5.5 días. Un paciente falleció por hemorragia intracerebral. Conclusiones...

Background: Pediatric Multisystemic Inflammatory Syndrome (SIMP) associated with SARS CoV2 seriously affects children. Objective: To describe the symptoms, treatment and evolution of SIMP in patients of a reference Pediatric Intensive Care Unit (PICU). Findings: 18 children were identified with a mean age of 8.76 years, 50% male, all with a positive serological test. The most frequent manifestations were: fever (100%), respiratory distress (94%), abdominal pain (89%), elevated C-reactive protein (average 21.8), thrombocytopenia (50%), pathological chest X-ray (89%) and depressed myocardial contractility (61%). 72% required invasive mechanical ventilation (average 3 days) and catecholamines; 89% used corticosteroids plus immunoglobulins. The average stay in the PICU was 5.5 days. One patient died of intracerebral hemorrhage. Conclusions: SIMP in PICU is characterized by fever, respiratory...

The nutritional support of the critical pediatric patient directly influences their morbimotality. Various conditions make the child particularly vulnerable to malnutrition when he has serious illnesses. The metabolic response to stress is mainly protein hypercatabolism that causes a negative nitrogen balance. It is important to adopt strategies to provide adequate and timely nutrition, making a good nutritional assessment, calculating the expenditure of energy requirements, prioritizing the contribution of proteins as the most relevant macronutrient, initiating early nutritional support, through the correct route and performing the monitoring and timely follow-up. In conclusion, nutritional support should be an important part of the therapeutic strategy in every critical child.     DOI 10.25176/RFMH.v18.n4.1737

El soporte nutricional del paciente pediátrico crítico influencia directamente en su morbimotalidad. Diversas condiciones hacen al niño particularmente vulnerable a la desnutrición cuando tiene enfermedades graves. La respuesta metabólica al estrés es principalmente hipercatabolismo de proteínas que ocasiona un balance nitrogenado negativo. Es importante adoptar estrategias que permitan proporcionar una adecuada y oportuna nutrición, realizando una buena valoración nutricional, calculando el gasto de los requerimientos energéticos, priorizando el aporte de proteínas como el macronutriente de mayor relevancia, iniciando el soporte nutricional temprano, mediante la vía correcta y realizando el monitoreo y seguimiento oportuno. En conclusión, el soporte nutricional debe formar parte importante de la estrategia terapéutica en todo niño crítico.     DOI 10.25176/RFMH...

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Determina los factores asociados a la adecuación del aporte nutricional con la meta calórica en la unidad de cuidados intensivos pediátricos del Hospital Nacional Edgardo Rebagliati Martins 2016. El estudio es observacional retrospectivo. En cuanto a la recolección de datos de historias clínicas, se realizó valoración nutricional antropométrica, se calculó gasto energético requerido empleando la ecuación de Schofield (considerando logro adecuado de la meta calórica entre 70% y 110% del calculado a los 7 días del ingreso). Además, se realizó análisis estadístico con el programa SPSS y se obtuvo autorización institucional. Sobre los resultados obtenido, se incluyeron 65 pacientes, 46% sexo femenino, la mediana de edad fue 17 meses; 60% ingresó directamente del servicio de emergencia y 49.2% tuvo estado de nutrición normal. Los diagnósticos más frecuentes fueron shock,...

The coronavirus disease 2019 (COVID-19) affects more adults than children. Later, the Pediatric Multisystemic Inflammatory Syndrome (SIMS) associated with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) was described, whose peak incidence was 4 weeks after the maximum peak of infections, so it is postulated that it is a post-infectious entity, and is characterized by affecting several organs and systems. In response to this new need, the Pediatric Intensive Care Unit (PICU) of the Edgardo Rebagliati Martins National Hospital set up a differentiated environment with two beds for the care of children with SARS-CoV-2 infection, to reduce the risk of in-hospital infections.

The coronavirus disease 2019 (COVID-19) affects more adults than children. Later, the Pediatric Multisystemic Inflammatory Syndrome (SIMS) associated with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) was described, whose peak incidence was 4 weeks after the maximum peak of infections, so it is postulated that it is a post-infectious entity, and is characterized by affecting several organs and systems. In response to this new need, the Pediatric Intensive Care Unit (PICU) of the Edgardo Rebagliati Martins National Hospital set up a differentiated environment with two beds for the care of children with SARS-CoV-2 infection, to reduce the risk of in-hospital infections.

Se deben maximizar las medidas preventivas dentro de los hospitales (también en áreas que no tienen relación directa con los pacientes), evaluar la necesidad de realizar PCR-TR en hisopado nasofaríngeo como pruebas de tamizaje y no solamente las pruebas serológicas (para detectar (6) inmunoglobulina M y G) . Así como implementar medidas inmediatas de control de brotes ante la presencia de más de dos casos relacionados para minimizar el impacto de esta enfermedad en el personal de salud, hecho que revierte negativamente en la atención del paciente.

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We carried out an observational, retrospective and descriptive study in order to identify the clinical and epidemiological characteristics of children with SARS-CoV-2 infection admitted to a Peruvian national referral hospital. We included patients from one month old to fourteen years old hospitalized between March and August 2020. A total of 125 patients with SARS-CoV-2 infection were admitted, 18.4% (n = 23) had critical illness and 16.8% (n = 21) had multisystem inflammatory syndrome (MIS-C). The absence of comorbidities and previous history of epidemiological contact were more frequent in patients with MIS-C. Patients in critical condition and patients with MIS-C had lower lymphocyte and platelet counts, and higher C-reactive protein, ferritin and D-dimer values than patients who did not have said conditions. Six (4.8%) out of 125 children died, as well as 3 (13%) children from the g...