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SUMMARY Introduction.There is currently a deficiency of physicians in pediatric intensive care units (PICU). The cause of this deficit is multifactorial, although the burnout phenomenon has been described as relevant. Objective. To analyze the situation of human resource in the pediatric intensive care units in Argentina and measure the level of burnout.Methods. An observational cross-sectional study through surveys administered electronically; the Maslach Burnout Inventory was used. Physicians that work at public o private pediatric intensive care units in Argentina during at least 24 hours per week were invited to participate. Results. A total of 162 surveys were completed (response rate 60%). We observed a high risk of burnout in emotional exhaustion in 40 therapists (25%), in fulfillment in 9 (6%), and depersonalization in 31 (19%). In combination, 66 professionals (41%) had a high risk of burnout to some extent; there were independent protective factors of this risk as to be certified in the specialty (ORA 0.38, 95% CI 0.19 to 0.75) and work in public sector PICU (ORA 0.31, 95% CI 0.15 to 0.65), while working more than 36 hours/week on duty increased the risk (ORA 1.94, 95% CI 1.1 to 3.85). Additionally, 31% said that they did not plan to continue working in intensive care, and 86% did not think to continue with on call duties in the following years. Over 60% of respondents reported that changes in professional practice (salary, staff positions, early retirement, fewer loads on call) could prolong the expectation of continuing activities in PICU. Conclusions. A significant percentage of doctors working in the PICU of Argentina have a high risk of burnout syndrome and a low expectation of continuing in the field.

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Presentación de casos clínicos RESUMENElizabethkingia meningoseptica es un patógeno oportunista, con una elevada mortalidad y una incidencia en aumento en las terapias intensivas. Se presenta a una paciente de 4 años con antecedente de atresia de vías biliares y trasplante hepático a los 11 meses de vida, que se internó por infección respiratoria aguda baja con hipoxemia. Durante la internación, sufrió un empeoramiento clínico con requerimiento de asistencia respiratoria mecánica. Por fiebre e hipoxemia persistente, se realizó un minilavado broncoalveolar, con cultivo positivo para Elizabethkingia meningoseptica. Recibió vancomicina, trimetoprima/sulfametoxazol y ciprofloxacina durante 14 días, con buena respuesta. Una tomografía de tórax evidenció la presencia de hipoperfusión en mosaico, imágenes quísticas y bronquiectasias bilaterales. Durante los siguientes 2 años, presentó una buena evolución clínica, con escasas intercurrencias respiratorias, síntomas intercrisis aislados y buena tolerancia al ejercicio. En las imágenes de control, se evidenció la resolución de la mayoría de las lesiones iniciales a los 20 meses de su seguimiento. ABSTRACTElizabethkingia meningoseptica is an opportunistic pathogen with a high mortality and an increasing incidence in the intensive care units. We present a 4-year-old patient with a history of atresia of the biliary tract and a liver transplant at 11 months of age, who was admitted for acute respiratory infection with hypoxemia. During the hospitalization, she required mechanical ventilation. Neumonía bullosa secundaria a Elizabethkingia meningoseptica, su evolución clínica y radiológicaBullous pneumonia secondary to Elizabethkingia meningoseptica, its clinical and radiological evolution Due to persistent fever and hypoxemia, mini bronchoalveolar lavage was performed with a positive culture for Elizabethkingia meningoseptica. She received vancomycin, trimethoprim/sulfamethoxazole and ciprofloxacin for 14 days with a good response. A chest tomography showed the presence of mosaic hypoperfusion, cystic images, and bilateral bronchiectasis. During the following 2 years, she presented good clinical progress, with scarce respiratory infections, isolated symptoms and good tolerance to exercise. The resolution of the majority of the initial lesions was evidenced at 20 months of follow-up.

T he 2022 Society of Critical Care Medicine clinical practice guidelines (CPG) on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in critically ill patients with consideration of the ICU Environment and Early Mobility (PANDEM) is a tremendous achievement that starts a new era in our field (1). The CPG provides contemporary understanding of complex issues and provides readers with ideas about future clinical investigations.We would, however, like to ask the PANDEM authors three questions that relate to recommendation 12, and the statement that reads "Rationale: Ketamine appears to be a safe … alternative in patients who are not adequately sedated with other agents …" and in consequence "we suggest... ". Until the PANDEM publication (1), we used to recommend avoiding prolonged continuous infusion of ketamine and, if its use is inevitable, limiting the duration of continuous infusion to 48-72 hours with a maximum of 1 week. Our concern was that preclinical and clinical studies suggest that ketamine, unlike opioids, alpha-adrenergics, and benzodiazepines, poses additional risks to patient neurologic and psychiatric outcomes. The bibliographic underpinnings of our concern are summarized in Table 1. Therefore, can the PANDEM authors address for us:1) What is their opinion about the risk of extended use of ketamine in the PICU?2) The recommended dosing of ketamine by continuous infusion is 0.5-2 mg/kg/hr: is this dosing suitable for prolonged use or should it be time-limited? 3) Are there any studies in children that describe long-term behavioral/cognitive outcomes of extended ketamine use?