ALBERT BOUSSO
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- 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.
- 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
conferenceObject 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.- 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.