RESUMO
OBJECTIVES: We hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries. DESIGN: Cross-sectional survey. SETTING: PICUs in Canada, the United States, France, Italy, Saudi Arabia, Japan, Thailand, and Brazil. SUBJECTS: Pediatric intensivists. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used literature review and focus groups to develop the survey and its clinical scenarios (pneumonia, septic shock, meningitis, and intra-abdominal infections) in which cultures were unreliable due to antibiotic pretreatment. Data analyses included descriptive statistics and linear regression with bootstrapped SEs. Overall response rate was 39% (482/1,251), with individual country response rates ranging from 25% to 76%. Respondents in all countries prolonged antibiotic duration based on patient characteristics, disease severity, pathogens, and radiologic findings (from a median increase of 1.8 d [95% CI, 0.5-4.0 d] to 9.5 d [95% CI, 8.5-10.5 d]). Younger age, severe disease, and ventilator-associated pneumonia prolonged antibiotic treatment duration despite a lack of evidence for such practices. No variables were reported to shorten treatment duration for all countries. Importantly, more than 39% of respondents would use greater than or equal to 7 days of antibiotics for patients with a positive viral polymerase chain reaction test in all scenarios, except in France for pneumonia (29%), septic shock (13%), and meningitis (6%). The use of elevated levels of inflammatory markers to prolong antibiotic treatment duration varied among different countries. CONCLUSIONS: Antibiotic-related decisions are complex and may be influenced by cultural and contextual factors. Evidence-based criteria are necessary to guide antibiotic duration and ensure the rational use of antibiotics in PICUs.
Assuntos
Antibacterianos , Estado Terminal , Antibacterianos/uso terapêutico , Brasil , Canadá , Criança , Estado Terminal/terapia , Estudos Transversais , França , Humanos , Itália , Japão , Inquéritos e Questionários , Estados UnidosRESUMO
OBJETIVO: Avaliar a razão entre espaço morto e volume corrente fisiológicos (V D/V T) como preditor do fracasso na extubação em 42 crianças ventiladas (idade média: 4,75 anos). MÉTODO: Prontidão para extubação foi determinada usando os critérios propostos pela 6ª Conferência Internacional de Consenso em Medicina Intensiva adaptados a crianças. RESULTADOS: A ventilação não invasiva (VNI) foi usada em quatro pacientes que desenvolveram insuficiência respiratória após a extubação; nenhum foi reintubado. Crianças que precisaram de VNI para evitar a reintubação tiveram razão V D/V T significativamente maior do que as que foram extubadas sem VNI (p < 0,001). O valor de corte da razão V D/V T foi 0,55, e a área sob a curva ROC foi 0,86. CONCLUSÃO: Nossos achados confirmam o bom valor preditivo do sucesso/fracasso do desmame pela razão V D/V T e sugere seu papel como preditor da necessidade de VNI após extubação.
OBJECTIVE: To evaluate the physiological deadspace/tidal volume ratio (V D/V T) as a predictor of extubation failure in 42 ventilated children (median age: 4.75 years). METHOD: Extubation readiness was determined using the criteria proposed by the 6th International Consensus Conference on Intensive Care Medicine adapted to children. RESULTS: Non-invasive ventilation (NIV) was used in four patients who developed respiratory failure after extubation; none was reintubated. Children who needed NIV to avoid reintubation had a significantly higher V D/V T ratio than those who were extubated without NIV (p < 0.001). The cut-off value of V D/V T ratio was 0.55 and the area under the receiver operating characteristic curve was 0.86. CONCLUSION: Our findings confirm the good predictive value of weaning success/failure of the V D/V T ratio and suggest its role for predicting the need for NIV after extubation.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Extubação , Cuidados Críticos , Insuficiência Respiratória/terapia , Desmame do Respirador , Ventilação não Invasiva , Valor Preditivo dos Testes , Curva ROC , Espaço Morto Respiratório/fisiologia , Volume de Ventilação Pulmonar/fisiologiaRESUMO
OBJECTIVE: To evaluate the physiological deadspace/tidal volume ratio (VD/VT) as a predictor of extubation failure in 42 ventilated children (median age: 4.75 years). METHOD: Extubation readiness was determined using the criteria proposed by the 6th International Consensus Conference on Intensive Care Medicine adapted to children. RESULTS: Non-invasive ventilation (NIV) was used in four patients who developed respiratory failure after extubation; none was reintubated. Children who needed NIV to avoid reintubation had a significantly higher VD/VT ratio than those who were extubated without NIV (p < 0.001). The cut-off value of VD/VT ratio was 0.55 and the area under the receiver operating characteristic curve was 0.86. CONCLUSION: Our findings confirm the good predictive value of weaning success/failure of the VD/VT ratio and suggest its role for predicting the need for NIV after extubation.