Objectives: Spain has been one of the countries most severely affected by the coronavirus disease 2019. This study aims to describe a series of children admitted to a PICU due to coronavirus disease 2019 infection. Design: Prospective observational study. Setting: Tertiary hospital in Madrid, Spain. Patients: Children admitted to the PICU with severe acute respiratory syndrome coronavirus 2 (severe acute respiratory syndrome coronavirus 2) infection, from March 1, 2020, to April 15, 2020. Interventions: Observational study. Measurements and Main Results: Epidemiologic data, previous clinical characteristics, support therapy needed, imaging tests, laboratory observations on admission, and pharmacologic therapy. Eleven children were admitted to the PICU, with suspected coronavirus disease 2019; the polymerase chain reaction test was positive in seven. The median age was 100.7 months (range, 0.5-162). Five were admitted from the emergency department and two from the ward. The Pediatric Sequential Organ Failure Assessment score was 3 (range, 0-9), and Pediatric Risk of Mortality II score was 4 (range, 0-16). All children were previously healthy except one (allogeneic hematopoietic stem cell transplantation). Respiratory symptoms and fever were prevalent. A chest radiograph led to a pneumonia diagnosis. Not all patients presented with lymphopenia on admission. d-Dimer and ferritin were elevated. All patients needed oxygen therapy through a nasal cannula; five patients received high-flow nasal cannula therapy, which was later substituted with noninvasive ventilation in four. Mechanical ventilation was necessary in two patients on the first day of PICU admission. Two children required mechanical ventilation and inotropic support. Tocilizumab was applied in two intubated children. Also, four children received heparin. No patients died.Conclusions: On the whole, the children were previously healthy and are more than 1 year old. Respiratory symptoms were the leading cause of PICU admission, making respiratory support the principal therapy. Patients requiring mechanical ventilation showed deterioration on the first day of admission. These children seemed to require close monitoring, and multicenter studies are necessary.
Background: in recent years, High Flow Nasal Cannula (HFNC) has been
considered an alternative to non-invasive mechanical ventilation (NIMV)
in severe asthma respiratory management in children. Objective: to
describe the use of HFNC in children with severe asthma admitted to
pediatric critical care unit (PICU). To compare its clinical
characteristic and evolution with those receiving NIMV or other
respiratory support. Methods: prospective observational study done in
children admitted to PICU with severe asthma (October 2017 to October
2019). Data collected: epidemiological, clinical, respiratory support,
thorax x-ray, pharmacological treatments and days of admission. Patients
were divided into groups: 1) Only HFNC 2) HFNC and NIMV, and 3) Only
NIMV. Results: Seventy-six patients included, 39 girls. The median age
was two years and one month (range 160). The median pulmonary score was
5 (range 7). PICU admission lengths a median of 3 days (range 9),
hospital 6 days (range 23). There were no epidemiological or clinical
differences between groups. Children with only HNFC showed a shorter
time of PICU days (p 0,025) and none of them required NIMV. In the group
receiving both modalities, NIMV was used first and then HFNC in all
cases. Children with HFNC showed higher SaO2/FiO2 ratio (p=0,025) and
lower PCO2 level (p=0,032). There were no deaths. Conclusions: in our
study the HFNC did not require escalation to NIMV and did not increase
the length of PICU or hospital days. Normal initial blood gases and
absence of high oxygen requirements were useful to select responders to
HNFC.
A new clinical syndrome named as Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) has been described. This new disease is a main cause of hospital and pediatric intensive care unit (PICU). We made a prospective-retrospective observational study to describe the innate cell signature and immunophenotype of children admitted to PICU because of PIMS-TS (from March 2020 to September 2020). They were compared with previous cohorts of healthy controls and children admitted to PICU because bacterial infection, viral infection and Kawasaki disease (KD). Two hundred and forty seven children were studied: 183 healthy controls, 25 viral infections, 20 bacterial infections, 6 KD and 13 PIMS-TS. PIMT-TS showed the lowest percentage of lymphocytes and monocytes with higher relative numbers of CD4+ (p =0,000). Monocytes and neutrophils in PIMS-TS showed higher levels of CD64 expression (p = 0,000). Also, CD11a and CD11b were highly expressed compare to other severe viral or bacterial infections (p = 0,000). In conclusion, we describe and compare for the first time the innate cellular response of children with PIMS-TS with other severe forms of viral or bacterial infection and KD. These data should be further studied and may facilitate the diagnosis and management of these patients.
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