SHIEH HUEI HSIN
Projetos de Pesquisa
Unidades Organizacionais
PAINT-62, Hospital Universitário
3 resultados
Resultados de Busca
Agora exibindo 1 - 3 de 3
- Epidemiology of Sepsis in Children Admitted to PICUs in South America(2016) SOUZA, Daniela Carla de; SHIEH, Huei Hsin; BARREIRA, Eliane Roseli; VENTURA, Andrea Maria Cordeiro; BOUSSO, Albert; TROSTER, Eduardo JuanObjectives: To report the prevalence of sepsis within the first 24 hours at admission and the PICU sepsis-related mortality among critically ill children admitted to PICU in South America. Design: A prospective multicenter cohort study. Setting: Twenty-one PICU, located in five South America countries. Patients: All children from 29 days to 17 years old admitted to the participating PICU between June 2011 and September 2011. Clinical, demographic, and laboratory data were registered within the first 24 hours at admission. Outcomes were registered upon PICU discharge or death. Interventions: None. Measurements and Main Results: Of the 1,090 patients included in this study, 464 had sepsis. The prevalence of sepsis, severe sepsis, and septic shock were 42.6%, 25.9%, and 19.8%, respectively. The median age of sepsis patients was 11.6 months (interquartile range, 3.2-48.7) and 43% had one or more prior chronic condition. The prevalence of sepsis was higher in infants (50.4%) and lower in adolescents (1.9%). Sepsis-related mortality was 14.2% and was consistently higher with increased disease severity: 4.4% for sepsis, 12.3% for severe sepsis, and 23.1% for septic shock. Twenty-five percent of deaths occurred within the first 24 hours at PICU admission. Multivariate analysis showed that higher Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores, the presence of two or more chronic conditions, and admission from pediatric wards were independently associated with death. Conclusions: We observed high prevalence of sepsis and sepsis-related mortality among this sample of children admitted to PICU in South America. Mortality was associated with greater severity of illness at admission and potentially associated with late PICU referral.
- Sepsis Is SEPSIS! It's High Time to Globalize Pediatric Sepsis(2015) SOUZA, Daniela C.; BARREIRA, Eliane R.; SHIEH, Huei H.; BOUSSO, Albert
- Double-Blind Prospective Randomized Controlled Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs in Pediatric Septic Shock(2015) VENTURA, Andrea M. C.; SHIEH, Huei Hsin; BOUSSO, Albert; GOES, Patricia F.; FERNANDES, Iracema de Cassia F. O.; SOUZA, Daniela C. de; PAULO, Rodrigo Locatelli Pedro; CHAGAS, Fabiana; GILIO, Alfredo E.Objectives: The primary outcome was to compare the effects of dopamine or epinephrine in severe sepsis on 28-day mortality; secondary outcomes were the rate of healthcare-associated infection, the need for other vasoactive drugs, and the multiple organ dysfunction score. Design: Double-blind, prospective, randomized controlled trial from February 1, 2009, to July 31, 2013. Setting: PICU, Hospital Universitario da Universidade de SAo Paulo, Brazil. Patients: Consecutive children who are 1 month to 15 years old and met the clinical criteria for fluid-refractory septic shock. Exclusions were receiving vasoactive drug(s) prior to hospital admission, having known cardiac disease, having already participated in the trial during the same hospital stay, refusing to participate, or having do-not-resuscitate orders. Interventions: Patients were randomly assigned to receive either dopamine (5-10 g/kg/min) or epinephrine (0.1-0.3 g/kg/min) through a peripheral or intraosseous line. Patients not reaching predefined stabilization criteria after the maximum dose were classified as treatment failure, at which point the attending physician gradually stopped the study drug and started another catecholamine. Measurements and Main Results: Physiologic and laboratory data were recorded. Baseline characteristics were described as proportions and mean ( sd) and compared using appropriate statistical tests. Multiple regression analysis was performed, and statistical significance was defined as a p value of less than 0.05. Baseline characteristics and therapeutic interventions for the 120 children enrolled (63, dopamine; 57, epinephrine) were similar. There were 17 deaths (14.2%): 13 (20.6%) in the dopamine group and four (7%) in the epinephrine group (p = 0.033). Dopamine was associated with death (odds ratio, 6.5; 95% CI, 1.1-37.8; p = 0.037) and healthcare-associated infection (odds ratio, 67.7; 95% CI, 5.0-910.8; p = 0.001). The use of epinephrine was associated with a survival odds ratio of 6.49. Conclusions: Dopamine was associated with an increased risk of death and healthcare-associated infection. Early administration of peripheral or intraosseous epinephrine was associated with increased survival in this population. Limitations should be observed while interpreting these results.