adolescent Archives - Critical Care Science (CCS)

  • Original Article

    Analysis of factors associated with admission to the intensive care unit of children and adolescents with COVID-19: application of a multilevel model

    Crit Care Sci. 2024;36:e20240068en

    Abstract

    Original Article

    Analysis of factors associated with admission to the intensive care unit of children and adolescents with COVID-19: application of a multilevel model

    Crit Care Sci. 2024;36:e20240068en

    DOI 10.62675/2965-2774.20240068-en

    Views56

    ABSTRACT

    Objective

    To identify factors associated with hospitalization in the intensive care unit in children and adolescents with COVID-19.

    Methods

    This was a retrospective cohort study using secondary data of hospitalized children and adolescents (zero to 18 years old) with COVID-19 reported in Paraíba from April 2020 to July 2021, totaling 486 records. Descriptive analysis, logistic regression and multilevel regression were performed, utilizing a significance level of 5%.

    Results

    According to logistic regression without hierarchical levels, there was an increased chance of admission to the intensive care unit for male patients (OR = 1.98; 95%CI 1.18 - 3.32), patients with respiratory distress (OR = 2.43; 95%CI 1.29 - 4.56), patients with dyspnea (OR = 3.57; 95%CI 1.77 - 7.18) and patients living in large cities (OR = 2.70; 95%CI 1.07 - 6.77). The likelihood of requiring intensive care was observed to decrease with increasing age (OR = 0.94; 95%CI = 0.90 - 0.97), the presence of cough (OR = 0.32; 95%CI 0.18 - 0.59) or fever (OR = 0.42; 95%CI 0.23 - 0.74) and increasing Gini index (OR = 0.003; 95%CI 0.000 - 0.243). According to the multilevel analysis, the odds of admission to the intensive care unit increased in male patients (OR = 1.70; 95%CI = 1.68-1.71) and with increasing population size of the municipality per 100,000 inhabitants (OR = 1.01; 95%CI 1.01-1.03); additionally, the odds of admission to the intensive care unit decreased for mixed-race versus non-brown-skinned patients (OR = 0.981; 95%CI 0.97 - 0.99) and increasing Gini index (OR = 0.02; 95%CI 0.02 - 0.02).

    Conclusion

    The effects of patient characteristics and social context on the need for intensive care in children and adolescents with SARS-CoV-2 infection were better estimated with the inclusion of a multilevel regression model.

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    Analysis of factors associated with admission to the intensive care unit of children and adolescents with COVID-19: application of a multilevel model
  • Case Report

    Influenza B infection and Kawasaki disease in an adolescent during the COVID-19 pandemic: a case report

    Rev Bras Ter Intensiva. 2021;33(2):320-324

    Abstract

    Case Report

    Influenza B infection and Kawasaki disease in an adolescent during the COVID-19 pandemic: a case report

    Rev Bras Ter Intensiva. 2021;33(2):320-324

    DOI 10.5935/0103-507X.20210041

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    ABSTRACT

    We report a case of Influenza B infection and Kawasaki disease in an adolescent, diagnosed during the COVID-19 pandemic. An asthmatic female adolescent presented with fever and flu-like symptoms for 7 days and was admitted with acute respiratory failure requiring mechanical ventilation. She progressed with hemodynamic instability responsive to vasoactive drugs. Antibiotic therapy and support measures were introduced, showing progressive hemodynamics and respiratory improvement, however with persistent fever and increased inflammatory markers. During the hospitalization, she developed bilateral non-purulent conjunctivitis, hand and feet desquamation, strawberry tongue, and cervical adenopathy, and was diagnosed with Kawasaki disease. She was prescribed intravenous immunoglobulin and, due to the refractory clinical conditions, corticosteroid therapy was added; 24 hours later, the patient was afebrile. No coronary changes were found. A full viral panel including COVID-19 C-reactive protein and serology could only isolate the Influenza B virus. During the hospitalization, she was diagnosed with pulmonary thromboembolism; coagulopathies were investigated, and she was diagnosed with heterozygous factor V Leiden mutation. There is a potential association between Kawasaki disease and infection with Influenza B or with other viruses such as coronavirus. Therefore, this association should be considered in pediatric patients, adolescents included, with prolonged febrile conditions.

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    Influenza B infection and Kawasaki disease in an adolescent during the COVID-19 pandemic: a case report
  • Original Articles

    Etiology and prognostic factors of sepsis among children and adolescents admitted to the intensive care unit

    Rev Bras Ter Intensiva. 2015;27(3):240-246

    Abstract

    Original Articles

    Etiology and prognostic factors of sepsis among children and adolescents admitted to the intensive care unit

    Rev Bras Ter Intensiva. 2015;27(3):240-246

    DOI 10.5935/0103-507X.20150044

    Views1

    ABSTRACT

    Objective:

    To determine the etiology and clinical disease progression variables of sepsis associated with the prognosis of patients admitted to a pediatric intensive care unit.

    Methods:

    Prospective and retrospective case series. Data were collected from the medical records of patients diagnosed with sepsis who were admitted to the pediatric intensive care unit of a general hospital from January 2011 to December 2013. Bacteria were identified in blood and fluid cultures. Age, sex, vaccination schedule, comorbidities, prior antibiotic use, clinical data on admission, and complications during disease progression were compared in the survival and death groups at a 5% significance level.

    Results:

    A total of 115 patients, with a mean age of 30.5 months, were included in the study. Bacterial etiology was identified in 40 patients. Altered peripheral perfusion on admission and diagnosis of severe sepsis were associated with complications. A greater number of complications occurred in the group of patients older than 36 months (p = 0.003; odds ratio = 4.94). The presence of complications during hospitalization was associated with death (odds ratio = 27.7). The main etiological agents were Gram-negative bacteria (15/40), Staphylococcus aureus (11/40) and Neisseria meningitidis (5/40).

    Conclusion:

    Gram-negative bacteria and Staphylococcus aureus predominated in the etiology of sepsis among children and adolescents admitted to an intensive care unit. The severity of sepsis and the presence of altered peripheral perfusion on admission were associated with complications. Moreover, the presence of complications was a factor associated with death.

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  • Artigos de Revisão

    Severe traumatic braininjury in children and adolescents

    Rev Bras Ter Intensiva. 2007;19(1):98-106

    Abstract

    Artigos de Revisão

    Severe traumatic braininjury in children and adolescents

    Rev Bras Ter Intensiva. 2007;19(1):98-106

    DOI 10.1590/S0103-507X2007000100013

    Views2

    BACKGROUND AND OBJECTIVES: Present a critical review of traumatic brain injury (TBI) in children and adolescents, focusing on severe TBI, the mortality and the factors related with poor outcome. CONTENTS: It was made a systematic review in MEDLINE, SciElo e Lilacs, with the key words: traumatic brain injury, craniocerebral trauma, children and mortality. The most important articles related in the Guidelines of Brain Trauma Foundation (2000 e 2003) were selected too. TBI is one of the most important causes of mortality and morbidity in children and adolescents, and morbidity in children and adolescents. The mortality variation was between 10% and 55%, depending of the patients select criteria, trauma severity and units where the studies were made. The children mortality was, in general, lower than that found in adults and the most important factors related with an increased mortality were: Glasgow Coma Score, hypotension, cerebral swelling and lower cerebral perfusion press. Severe TBI endpoint treatment is to correct the secondary brain lesions related factors. CONCLUSIONS: The factors related with better outcomes in children with severe TBI are still obscures, despite the large number of studies, large numbers of studies. Many of these factors can be avoided or correct by aggressive fluid resuscitation, surgery treatment, monitoration and adequate intensive care.

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