ALBERT BOUSSO
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- Pulmonary Surfactant in Respiratory Syncytial Virus Bronchiolitis: The Role in Pathogenesis and Clinical Implications(2011) BARREIRA, Eliane Roseli; PRECIOSO, Alexander Roberto; BOUSSO, AlbertRespiratory syncytial virus (RSV) bronchiolitis is the leading cause of lower respiratory tract infection, and the most frequent reason for hospitalization among infants throughout the world. In addition to the acute consequences of the disease, RSV bronchiolitis in early childhood is related to further development of recurrent wheezing and asthma. Despite the medical and economic burden of the disease, therapeutic options are limited to supportive measures, and mechanical ventilation in severe cases. Growing evidence suggests an important role of changes in pulmonary surfactant content and composition in the pathogenesis of severe RSV bronchiolitis. Besides the well-known importance of pulmonary surfactant in maintenance of pulmonary homeostasis and lung mechanics, the surfactant proteins SP-A and SP-D are essential components of the pulmonary innate immune system. Deficiencies of such proteins, which develop in severe RSV bronchiolitis, may be related to impairment in viral clearance, and exacerbated inflammatory response. A comprehensive understanding of the role of the pulmonary surfactant in the pathogenesis of the disease may help the development of new treatment strategies. We conducted a review of the literature to analyze the evidences of pulmonary surfactant changes in the pathogenesis of severe RSV bronchiolitis, its relation to the inflammatory and immune response, and the possible role of pulmonary surfactant replacement in the treatment of the disease. Pediatr Pulmonol. 2011; 46:415-420. (c) 2010 Wiley-Liss, Inc.
bookPart Hipertensão intracraniana(2022) FEITOZA, Cassiana Duarte Barcellos; BOUSSO, Albert- The impact of daily evaluation and spontaneous breathing test on the duration of pediatric mechanical ventilation: A randomized controlled trial(2011) FORONDA, Flavia K.; TROSTER, Eduardo J.; FARIAS, Julio A.; BARBAS, Carmen S.; FERRARO, Alexandre A.; FARIA, Lucilia S.; BOUSSO, Albert; PANICO, Flavia F.; DELGADO, Artur F.Objectives: To assess whether the combination of daily evaluation and use of a spontaneous breathing test could shorten the duration of mechanical ventilation as compared with weaning based on our standard of care. Secondary outcome measures included extubation failure rate and the need for noninvasive ventilation. Design: A prospective, randomized controlled trial. Setting: Two pediatric intensive care units at university hospitals in Brazil. Patients: The trial involved children between 28 days and 15 yrs of age who were receiving mechanical ventilation for at least 24 hrs. Interventions: Patients were randomly assigned to one of two weaning protocols. In the test group, the children underwent a daily evaluation to check readiness for weaning with a spontaneous breathing test with 10 cm H(2)O pressure support and a positive end-expiratory pressure of 5 cm H(2)O for 2 hrs. The spontaneous breathing test was repeated the next day for children who failed it. In the control group, weaning was performed according to standard care procedures. Measurements and Main Results: A total of 294 eligible children were randomized, with 155 to the test group and 139 to the control group. The time to extubation was shorter in the test group, where the median mechanical ventilation duration was 3.5 days (95% confidence interval, 3.0 to 4.0) as compared to 4.7 days (95% confidence interval, 4.1 to 5.3) in the control group (p = .0127). This significant reduction in the mechanical ventilation duration for the intervention group was not associated with increased rates of extubation failure or noninvasive ventilation. It represents a 30% reduction in the risk of remaining on mechanical ventilation (hazard ratio: 0.70). Conclusions: A daily evaluation to check readiness for weaning combined with a spontaneous breathing test reduced the mechanical ventilation duration for children on mechanical ventilation for > 24 hrs, without increasing the extubation failure rate or the need for noninvasive ventilation. (Crit Care Med 2011; 39: 2526-2533)
- 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.
bookPart Coagulação intravascular disseminada(2022) VICTORINO, Paula Ferreira; DANTAS, Gustavo Coelho; GOLDSTEIN, Silvia; Sá, Flávio Roberto Nogueira de; BOUSSO, Albert- Mortality associated with restrictive threshold for red blood cell transfusion in pediatric patients with sepsis(2012) SHIEH, Huei Hsin; BARREIRA, Eliane Roseli; GOES, Patricia Freitas; SOUZA, Daniela Carla; VENTURA, Andrea Maria Cordeiro; BOUSSO, Albert
bookPart Crise asmática e estado de mal asmático(2022) VICTORINO, Paula Ferreira; BOUSSO, AlbertconferenceObject PEDIATRIC HYPOTENSION: QUANTIFICATION OF THE DIFFERENCES BETWEEN THE TWO CURRENT DEFINITIONS(2012) SHIEH, H. H.; GILIO, A. E.; BARREIRA, E. R.; TROSTER, E. J.; VENTURA, A. M. Cordeiro; GOES, P. F.; SOUZA, D. C.; SINIMBU FILHO, J. M.; BOUSSO, A.bookPart Pneumonia complicada(2022) YOSHIOKA, Cristina Ryoka Miyao; GILIO, Alfredo Elias; BOUSSO, Albert; CIRINO, Luis Marcelo Inacio; LOTUFO, João Paulo BeckerbookPart Pneumonia necrosante(2019) GILIO, Alfredo Elias; BOUSSO, Albert