Impacto de una modificación de la guía de práctica clínica de la Academia Americana de Pediatría en el manejo de la bronquiolitis aguda grave en una unidad de cuidados intensivos pediátricos

Guitart, Carmina; Alejandre, Carme; Torrús, Isabel; Balaguer, Mònica; Esteban, Elisabeth; Cambra, F.J.; Jordán, Iolanda

doi:10.1016/j.medin.2019.10.006

Cited by 4 publications

(2 citation statements)

References 35 publications

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“…При этом введение ГКС может играть положительную роль в течении постэкстубационного стридора [51], может улучшить исходы при развитии острого респираторного дистресс-синдрома у де тей, однако для подтверждения данных необходимы дальнейшие исследования [52]. На сегодняшний день распространенность применения ГКС у де тей с ОБ в ОРИТ составляет в среднем 23-37 % [4,6,12,53]. Возможным показанием для ингаляционных ГКС при ОБ может быть БЛД [2].…”

Section: глюкокортикостероидыunclassified

A modern view on the treatment of acute bronchiolitis in pediatric intensive care units: a review

Tsygankov¹,

Ovsyannikov

Афуков

et al. 2022

Annals of Critical Care

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INTRODUCTION. The literature has accumulated enough data on the treatment of children with acute bronchiolitis (OB). However, this information is formed mainly on the general population of patients with OB and is often not applicable to patients with a severe course of the disease. From the standpoint of evidence-based medicine, routine use of medications is not recommended in modern consent documents, and there are also no clear recommendations on respiratory support and certain aspects of intensive care in children with OB. OBJECTIVES. To analyze approaches to therapy in children with severe acute course in need of intensive care, and to assess the validity, effectiveness and safety of the use of the analyzed groups of drugs and respiratory strategies. MATERIALS AND METHODS. The analysis of publications in the electronic databases PubMed and the Russian Scientific Citation Index on the keywords “bronchiolitis”, “intensive care units”, “critical care”, “fluid therapy”, “respiratory therapy”, “ventilation”, “co-morbidity”; “respiratory syncytial virus”; “hypertonic saline” was carried out, “corticosteroids”; “epinephrine”; “high-flow oxygen therapy”, “inhalation”, “infant”, “bronchiolitis in children”. The date of the last search is January 15, 2022. RESULTS. This systematic review provides information on the etiology and risk factors of severe acute respiratory syndrome in children, from the standpoint of evidence-based medicine, studies on the treatment of severe acute respiratory syndrome are characterized, including in the intensive care unit with glucocorticosteroids, inhalations of bronchodilators, epinephrine, 3 % hypertonic sodium chloride solution, respiratory support, high-flow oxygenation, noninvasive ventilation, artificial ventilation, antibiotics, air-helium mixture. CONCLUSIONS. Currently, there is more information that infants with OB show a high degree of heterogeneity, while the main uncertainty lies in a misunderstanding of the processes, which patients will benefit most from a particular treatment method. Further research is needed to fill the research deficit in children with a severe course of OB.

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Section: глюкокортикостероидыunclassified

A modern view on the treatment of acute bronchiolitis in pediatric intensive care units: a review

Tsygankov¹,

Ovsyannikov

Афуков

et al. 2022

Annals of Critical Care

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“…La concurrencia a cunas puede ser la causante de 33% a 50% de capítulos de bronquiolitis. 31 Alternamente al momento de disponer el día a día de que un infante fuera cuidado o no en una cuna tiene que meditar si la familia tiene otros métodos de cuidados, tanto como aportes en conducta social y estímulo a la educación anticipada. Estos datos son relevantes alcances para el estudio, la aplicación clínica, los encargados de la salud y comunidad.…”

Section:  Guarderías Y Cunasunclassified

Factores de riesgo asociados a bronquiolitis en niños menores de 2 años del hospital San Juan de Dios de Pisco 2019

Fernández Buleje

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En nuestro país la bronquiolitis es una de las infecciones respiratorias con mayor incidencia en niños y la cual ha tenido una tendencia creciente en los últimos cinco años. Por esto el MINSA en 2019 presento la “Guía de práctica clínica para diagnóstico y tratamiento de bronquiolitis en niños menores de dos años” , dentro de este contexto el presente trabajo de investigación tiene como Objetivo: conocer los factores de riesgo asociados a bronquiolitis en niños menores de 2 años del hospital San Juan de Dios – Pisco, 2019. Material y método: con una población que consta de 64 pacientes con historial clínico que presentó bronquiolitis y 64 casos de control; con método analítico de casos y controles, corte transversal, retrospectivo y observacional, teniendo como instrumento una ficha de recolección de datos, donde se contemplan todos los factores mencionados por el MINSA. Resultados: los factores de riesgo medio ambientales; el tipo de vivienda (OR= 1,23) y los servicios básicos (OR=1,58). Entre los factores de riesgo de estilo de vida; la ausencia de lactancia (OR=1) es un factor nulo. Entre los factores de riesgo de riesgos individuales; la edad (OR= 1,13), el bajo peso al nacer (OR= 1,13), la desnutrición (OR= 1,28) y las comorbilidades (OR= 1,87) son factores de riesgo para desarrollar bronquiolitis en niños de 2 años. Conclusiones: De los factores de riesgo especificados en la “Guía de práctica clínica para diagnóstico y tratamiento de bronquialitos en niños menores de 2 años”, los de mayor asociación en los pacientes del Hospital San Juan de Dios de Pisco durante el 2019 fueron el tipo de vivienda, servicios básicos, ausencia de lactancia materna exclusiva, edad, bajo peso al nacer, desnutrición y las comorbilidades. No encontrándose tanta repercusión el tabaquismo pasivo, la asistencia a guarderías, la condición económica y prematuridad; esto se manifiesta por el concepto social propio de la ciudad en estudio; considerando que la guía del MINSA es generalizada para todos los contextos y características de todo el país.

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3% nebulized hypertonic saline versus normal saline for infants with acute bronchiolitis: A systematic review and meta-analysis of randomized controlled trials

Zhang

Liu

et al. 2022

Medicine

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Background: This study evaluated the efficacy and safety of 3% nebulized hypertonic saline (NHS) in infants with acute bronchiolitis (AB).Methods: We systematically searched the PUBMED, EMBASE, Cochrane Library, China National Knowledge Infrastructure Database, WANFANG, and VIP databases from inception to June 1, 2022. We included randomized controlled trials comparing NHS with 0.9% saline. Outcomes included the length of hospital stay (LOS), rate of hospitalization (ROH), clinical severity score (CSS), rate of readmission, respiratory distress assessment instrument, and adverse events. RevMan V5.4 software was used for statistical analysis.Results: A total of 27 trials involving 3495 infants were included in this study. Compared to normal saline, infants received 3% NHS showed better outcomes in LOS reduction (MD = −0.60, 95% CI [−1.04, −0.17], I 2 = 92%, P = .007), ROH decrease (OR = 0.74, 95% CI [0.59, 0.91], I 2 = 0%, P = .005), CSS improvement at day 1 (MD = −0.79, 95% CI [−1.23, −0.34], I 2 = 74%, P < .001), day 2 (MD = −1.26, 95% CI [−2.02, −0.49], I 2 = 91%, P = .001), and day 3 and over (MD = −1.27, 95% CI [−1.92, −0.61], I 2 = 79%, P < .001), and respiratory distress assessment instrument enhancement (MD = −0.60, 95% CI [−0.95, −0.26], I 2 = 0%, P < .001). No significant adverse events related to 3% NHS were observed. Conclusion:This study showed that 3% NHS was better than 0.9% normal saline in reducing LOS, decreasing ROH, improving CSS, and in enhancing the severity of respiratory distress. Further studies are needed to validate these findings.Abbreviations: AB = acute bronchiolitis, AEs = adverse events, CI = confidence interval, CSS = clinical severity score, LOS = length of hospital stay, MD = mean difference, NHS = nebulized hypertonic saline, NS = normal saline, RCTs = randomized controlled trials, RDAI = respiratory distress assessment instrument, ROH = rate of hospitalization, ROR = rate of readmission, RR = risk ratio.

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Impacto de una modificación de la guía de práctica clínica de la Academia Americana de Pediatría en el manejo de la bronquiolitis aguda grave en una unidad de cuidados intensivos pediátricos

Cited by 4 publications

References 35 publications

A modern view on the treatment of acute bronchiolitis in pediatric intensive care units: a review

A modern view on the treatment of acute bronchiolitis in pediatric intensive care units: a review

Factores de riesgo asociados a bronquiolitis en niños menores de 2 años del hospital San Juan de Dios de Pisco 2019

3% nebulized hypertonic saline versus normal saline for infants with acute bronchiolitis: A systematic review and meta-analysis of randomized controlled trials

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