DANIELA CARLA DE SOUZA
Projetos de Pesquisa
Unidades Organizacionais
PAINT-62, Hospital Universitário
3 resultados
Resultados de Busca
Agora exibindo 1 - 3 de 3
- 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.
- 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.
- The epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): an observational study(2021) SOUZA, Daniela Carla de; MARTIN, Joelma Goncalves; LANZIOTTI, Vanessa Soares; OLIVEIRA, Claudio Flauzino de; TONIAL, Cristian; CARVALHO, Werther Brunow de; FIORETTO, Jose Roberto; PIVA, Jefferson Pedro; TROSTER, Eduardo Juan; BOSSA, Aline Siqueira; GREGORINI, Flavia; FERREIRA, Josiane; LUBARINO, Juliana; CAVALCANTI, Alexandre Biasi; MACHADO, Flavia RibeiroBackground Data on the prevalence and mortality of paediatric sepsis in resource-poor settings are scarce. We aimed to assess the prevalence and in-hospital mortality of severe sepsis and septic shock treated in paediatric intensive care units (PICUs) in Brazil, and risk factors for mortality. Methods We performed a nationwide, 1-day, prospective point prevalence study with follow-up of patients with severe sepsis and septic shock, using a stratified random sample of all PICUs in Brazil. Patients were enrolled at each participating PICU on a single day between March 25 and 29, 2019. All patients occupying a bed at the PICU on the study day (either admitted previously or on that day) were included if they were aged 28 days to 18 years and met the criteria for severe sepsis or septic shock at any time during hospitalisation. Patients were followed up until hospital discharge or death, censored at 60 days. Risk factors for mortality were assessed using a Poisson regression model. We used prevalence to generate national estimates. Findings Of 241 PICUs invited to participate, 144 PICUs (capacity of 1242 beds) included patients in the study. On the day of the study, 1122 children were admitted to the participating PICUs, of whom 280 met the criteria for severe sepsis or septic shock during hospitalisation, resulting in a prevalence of 25.0% (95% CI 21.6-28.8), with a mortality rate of 19.8% (15.4-25.2; 50 of 252 patients with complete clinical data). Increased risk of mortality was associated with higher Pediatric Sequential Organ Failure Assessment score (relative risk per point increase 1.21, 95% CI 1.14-1.29, p<0.0001), unknown vaccination status (2.57, 1.26-5.24; p=0.011), incomplete vaccination status (2.16, 1.19-3.92; p=0.012), health care-associated infection (2.12, 1.23-3.64, p=0.0073), and compliance with antibiotics (2.38, 1.46-3.86, p=0.0007). The estimated incidence of PICU-treated sepsis was 74.6 cases per 100 000 paedi-atric population (95% CI 61.5-90.5), which translates to 42 374 cases per year (34 940-51 443) in Brazil, with an estimated mortality of 8305 (6848-10 083). Interpretation In this representative sample of PICUs in a middle-income country, the prevalences of severe sepsis or septic shock and in-hospital mortality were high. Modifiable factors, such as incomplete vaccination and health care-associated infections, were associated with greater risk of in-hospital mortality.