DANIELA CARLA DE SOUZA
Projetos de Pesquisa
Unidades Organizacionais
PAINT-62, Hospital Universitário
28 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 28
- Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce(2023) CARROL, Enitan D.; RANJIT, Suchitra; MENON, Kusum D.; BENNETT, Tellen D.; SANCHEZ-PINTO, L. Nelson J.; ZIMMERMAN, Jerry J. C.; SOUZA, Daniela C. R.; SORCE, Lauren R. G.; RANDOLPH, Adrienne G.; ISHIMINE, Paul; OLIVEIRA, Claudio Flauzino de; LODHA, Rakesh; HARMON, Lori; WATSON, R. Scott J.; SCHLAPBACH, Luregn J.; KISSOON, Niranjan C.; ARGENT, Andrew C.Sepsis is a leading cause of global mortality in children, yet definitions for pediatric sepsis are outdated and lack global applicability and validity. In adults, the Sepsis-3 Definition Taskforce queried databases from high-income countries to develop and validate the criteria. The merit of this definition has been widely acknowledged; however, important considerations about less-resourced and more diverse settings pose challenges to its use globally. To improve applicability and relevance globally, the Pediatric Sepsis Definition Taskforce sought to develop a conceptual framework and rationale of the critical aspects and context-specific factors that must be considered for the optimal operationalization of future pediatric sepsis definitions. It is important to address challenges in developing a set of pediatric sepsis criteria which capture manifestations of illnesses with vastly different etiologies and underlying mechanisms. Ideal criteria need to be unambiguous, and capable of adapting to the different contexts in which children with suspected infections are present around the globe. Additionally, criteria need to facilitate early recognition and timely escalation of treatment to prevent progression and limit life-threatening organ dysfunction. To address these challenges, locally adaptable solutions are required, which permit individualized care based on available resources and the pretest probability of sepsis. This should facilitate affordable diagnostics which support risk stratification and prediction of likely treatment responses, and solutions for locally relevant outcome measures. For this purpose, global collaborative databases need to be established, using minimum variable datasets from routinely collected data. In summary, a ""Think globally, act locally"" approach is required.
- Knowledge regarding extracorporeal membrane oxygenation management among Brazilian pediatric intensivists: a cross-sectional survey(2023) COLLETI JÚNIOR, José; PRATA-BARBOSA, Arnaldo; ARAUJO, Orlei Ribeiro; TONIAL, Cristian Tedesco; OLIVEIRA, Felipe Rezende Caino de; SOUZA, Daniela Carla de; LIMA-SETTA, Fernanda; OLIVEIRA, Thiago Silveira Jannuzzi de; MELLO, Mary Lucy Ferraz Maia Fiuza de; AMORETTI, Carolina; JOÃO, Paulo Ramos David; NEVES, Cinara Carneiro; OLIVEIRA, Norma Suely; COSTA, Cira Ferreira Antunes; GARROS, DanielABSTRACT Objective: To assess Brazilian pediatric intensivists’ general knowledge of extracorporeal membrane oxygenation, including evidence for its use, the national funding model, indications, and complications. Methods: This was a multicenter cross-sectional survey including 45 Brazilian pediatric intensive care units. A convenience sample of 654 intensivists was surveyed regarding their knowledge on managing patients on extracorporeal membrane oxygenation, its indications, complications, funding, and literature evidence. Results: The survey addressed questions regarding the knowledge and experience of pediatric intensivists with extracorporeal membrane oxygenation, including two clinical cases and 6 optional questions about the management of patients on extracorporeal membrane oxygenation. Of the 45 invited centers, 42 (91%) participated in the study, and 412 of 654 (63%) pediatric intensivists responded to the survey. Most pediatric intensive care units were from the Southeast region of Brazil (59.5%), and private/for-profit hospitals represented 28.6% of the participating centers. The average age of respondents was 41.4 (standard deviation 9.1) years, and the majority (77%) were women. Only 12.4% of respondents had taken an extracorporeal membrane oxygenation course. Only 19% of surveyed hospitals have an extracorporeal membrane oxygenation program, and only 27% of intensivists reported having already managed patients on extracorporeal membrane oxygenation. Specific extracorporeal membrane oxygenation management questions were responded to by only 64 physicians (15.5%), who had a fair/good correct response rate (median 63.4%; range 32.8% to 91.9%). Conclusion: Most Brazilian pediatric intensivists demonstrated limited knowledge regarding extracorporeal membrane oxygenation, including its indications and complications. Extracorporeal membrane oxygenation is not yet widely available in Brazil, with few intensivists prepared to manage patients on extracorporeal membrane oxygenation and even fewer intensivists recognizing when to refer patients to extracorporeal membrane oxygenation centers.
- Avoid re-interpreting fluid bolus recommendations for low-income settings(2023) RANJIT, Suchitra; KISSOON, Niranjan; ARGENT, Andrew; INWALD, David; VENTURA, Andrea Maria Cordeiro; JABORINSKY, Roberto; SANKAR, Jhuma; SOUZA, Daniela Carla de; NATRAJ, Rajeswari; OLIVEIRA, Claudio Flauzino De; SAMRANSAMRUAJKIT, Rujipat; JAYASHREE, Muralidharan; SCHLAPBACH, Luregn J.
- Da Conferência Internacional de Sepse em Pediatria 2005 ao Consenso Sepsis-3(2018) SOUZA, Daniela Carla de; BRANDÃO, Marcelo Barciela; PIVA, Jefferson Pedro
bookPart Cateterização arterial(2022) SOUZA, Daniela Carla de- Latin American Consensus on the Management of Sepsis in Children: Sociedad Latinoamericana de Cuidados Intensivos Pediatricos [Latin American Pediatric Intensive Care Society] (SLACIP) Task Force: Executive Summary(2022) FERNANDEZ-SARMIENTO, Jaime; SOUZA, Daniela Carla De; MARTINEZ, Anacaona; NIETO, Victor; LOPEZ-HERCE, Jesus; LANZIOTTI, Vanessa Soares; LOPEZ, Maria del Pilar Arias; CARVALHO, Werther Brunow De; OLIVEIRA, Claudio F.; JARAMILLO-BUSTAMANTE, Juan Camilo; DIAZ, Franco; YOCK-CORRALES, Adriana; RUVINSKY, Silvina; MUNAICO, Manuel; PAVLICICH, Viviana; IRAMAIN, Ricardo; MARQUEZ, Marta Patricia; GONZALEZ, Gustavo; YUNGE, Mauricio; TONIAL, Cristian; CRUCES, Pablo; PALACIO, Gladys; GRELA, Carolina; SLOCKER-BARRIO, Maria; CAMPOS-MINO, Santiago; GONZALEZ-DAMBRAUSKAS, Sebastian; SANCHEZ-PINTO, Nelson L.; GARCIA, Pedro Celiny; JABORNISKY, Roberto
- Beta-Lactams Therapeutic Monitoring in Septic Children-What Target Are We Aiming for? A Scoping Review(2022) MORALES JUNIOR, Ronaldo; PEREIRA, Gabriela Otofuji; TIGUMAN, Gustavo Magno Baldin; JUODINIS, Vanessa D'Amaro; TELLES, Joao Paulo; SOUZA, Daniela Carla de; SANTOS, Silvia Regina Cavani JorgeThe antimicrobial therapy of sepsis and septic shock should be individualized based on pharmacokinetic/pharmacodynamic (PK/PD) parameters to deliver effective and timely treatment of life-threatening infections. We conducted a literature scoping review to identify therapeutic targets of beta-lactam antibiotics in septic pediatric patients and the strategies that have been applied to overcome sepsis-related altered pharmacokinetics and increase target attainment against susceptible pathogens. A systematic search was conducted in the MEDLINE, EMBASE and Web of Science databases to select studies conducted since 2010 with therapeutic monitoring data of beta-lactams in septic children. Last searches were performed on 02 September 2021. Two independent authors selected the studies and extracted the data. A narrative and qualitative approach was used to summarize the findings. Out of the 118 identified articles, 21 met the eligibility criteria. Population pharmacokinetic modeling was performed in 12 studies, while nine studies reported data from bedside monitoring of beta-lactams. Most studies were conducted in the United States of America (n = 9) and France (n = 5) and reported PK/PD data of amoxicillin, ampicillin, azlocillin, aztreonam, cefazolin, cefepime, cefotaxime, ceftaroline, ceftazidime, doripenem, meropenem and piperacillin/tazobactam. Therapeutic targets ranged from to 40% fT> MIC to 100% fT> 6 x MIC. Prolonging the infusion time and frequency were most described strategies to increase target attainment. Monitoring beta-lactam serum concentrations in clinical practice may potentially maximize therapeutic target attainment. Further studies are required to define the therapeutic target associated with the best clinical outcomes.
- Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): a narrative review and the viewpoint of the Latin American Society of Pediatric Intensive Care (SLACIP) Sepsis Committee(2021) FERNANDEZ-SARMIENTO, Jaime; SOUZA, Daniela De; JABORNISKY, Roberto; GONZALEZ, Gustavo Ariel; LOPEZ, Maria Del Pilar Arias; PALACIO, GladysBackground In this review, we discuss some important aspects of paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), a new syndrome that is temporally related to previous exposure to SARS-CoV-2 infection. This virus has a broad spectrum of presentation that may overlap with Kawasaki disease in terms of presenting symptoms and laboratory and cardiac findings. Our objective was to review and summarise published evidence regarding the most important aspects of PIMS-TS, with special emphasis on the treatment strategies suggested for middle-income and low-income countries. Methods A systematic review of the literature was performed in the principal medical databases including PubMed, Embase (OVID) and Google Scholar between December 2019 and August 2020. Results A total of 69 articles were identified in the described databases. Altogether, 13 articles met the inclusion criteria and were eligible. The most frequently described symptoms of PIMS-TS include fever (82%), shock (67%) and gastrointestinal (87%), skin (71%) and cardiac disorders (75%). In most series, it has been observed between 4 and 6 weeks after the pandemic appears in the general population. Multisystem inflammatory syndrome in children is presented as a great systemic inflammatory response syndrome, which sometimes presents as shock requiring fluid resuscitation and vasoactive drug support (26%). Several treatment strategies have been used, including immunoglobulin, steroids, aspirin, anakinra and anticoagulation among others. These general and specific interventions should be guided by an interdisciplinary and multidisciplinary team, especially in settings with limited resources. Conclusions PIMS-TS COVID-19 is a new type of presentation of SARS-CoV-2 infection, with an exaggerated inflammatory response and frequent-but not exclusive-digestive and myocardial involvement. It is important to describe the clinical course and outcomes in countries with limited resources as well as establish the role of biomarkers for early diagnosis, effective therapeutic strategies and outpatient follow-up schemes.
- Reporting of Social Determinants of Health in Pediatric Sepsis Studies*(2023) MENON, Kusum R.; SORCE, Lauren; ARGENT, Andrew D.; BENNETT, Tellen D.; CARROL, Enitan; KISSOON, Niranjan; SANCHEZ-PINTO, L. Nelson J.; SCHLAPBACH, Luregn C.; SOUZA, Daniela de; WATSON, R. Scott L.; WYNN, James J.; ZIMMERMAN, Jerry; RANJIT, Suchitra; Pediat Sepsis Definition TaskforceOBJECTIVE:Standardized, consistent reporting of social determinants of health (SDOH) in studies on children with sepsis would allow for: 1) understanding the association of SDOH with illness severity and outcomes, 2) comparing populations and extrapolating study results, and 3) identification of potentially modifiable socioeconomic factors for policy makers. We, therefore, sought to determine how frequently data on SDOH were reported, which factors were collected and how these factors were defined in studies of sepsis in children. DATA SOURCES AND SELECTION:We reviewed 106 articles (published between 2005 and 2020) utilized in a recent systematic review on physiologic criteria for pediatric sepsis. DATA EXTRACTION:Data were extracted by two reviewers on variables that fell within the World Health Organization's SDOH categories. DATA SYNTHESIS:SDOH were not the primary outcome in any of the included studies. Seventeen percent of articles (18/106) did not report on any SDOH, and a further 36.8% (39/106) only reported on gender/sex. Of the remaining 46.2% of articles, the most reported SDOH categories were preadmission nutritional status (35.8%, 38/106) and race/ethnicity (18.9%, 20/106). However, no two studies used the same definition of the variables reported within each of these categories. Six studies reported on socioeconomic status (3.8%, 6/106), including two from upper-middle-income and four from lower middle-income countries. Only three studies reported on parental education levels (2.8%, 3/106). No study reported on parental job security or structural conflict. CONCLUSIONS:We found overall low reporting of SDOH and marked variability in categorizations and definitions of SDOH variables. Consistent and standardized reporting of SDOH in pediatric sepsis studies is needed to understand the role these factors play in the development and severity of sepsis, to compare and extrapolate study results between settings and to implement policies aimed at improving socioeconomic conditions related to sepsis.
- Haemodynamic support for paediatric septic shock: a global perspective(2023) RANJIT, Suchitra; KISSOON, Niranjan; ARGENT, Andrew; INWALD, David; VENTURA, Andrea Maria Cordeiro; JABORINSKY, Roberto; SANKAR, Jhuma; SOUZA, Daniela Carla de; NATRAJ, Rajeswari; OLIVEIRA, Claudio Flauzino De; SAMRANSAMRUAJKIT, Rujipat; JAYASHREE, Muralidharan; SCHLAPBACH, Luregn J.Septic shock is a leading cause of hospitalisation, morbidity, and mortality for children worldwide. In 2020, the paediatric Surviving Sepsis Campaign (SSC) issued evidence-based recommendations for clinicians caring for children with septic shock and sepsis-associated organ dysfunction based on the evidence available at the time. There are now more trials from multiple settings, including low-income and middle-income countries (LMICs), addressing optimal fluid choice and amount, selection and timing of vasoactive infusions, and optimal monitoring and therapeutic endpoints. In response to developments in adult critical care to trial personalised haemodynamic management algorithms, it is timely to critically reassess the current state of applying SSC guidelines in LMIC settings. In this Viewpoint, we briefly outline the challenges to improve sepsis care in LMICs and then discuss three key concepts that are relevant to management of children with septic shock around the world, especially in LMICs. These concepts include uncertainties surrounding the early recognition of paediatric septic shock, choices for initial haemodynamic support, and titration of ongoing resuscitation to therapeutic endpoints. Specifically, given the evolving understanding of clinical phenotypes, we focus on the controversies surrounding the concepts of early fluid resuscitation and vasoactive agent use, including insights gained from experience in LMICs and high-income countries. We outline the key components of sepsis management that are both globally relevant and translatable to low-resource settings, with a view to open the conversation to the large variety of treatment pathways, especially in LMICs. We emphasise the role of simple and easily available monitoring tools to apply the SSC guidelines and to tailor individualised support to the patient's cardiovascular physiology.
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