Pablo Vasquez Hoyos

National University of Colombia | UNAL · Departamento de Pediatría

Objective: To describe lung mechanics in Pediatric Acute Respiratory Distress Syndrome (PARDS)associated with acute COVID-19 and MIS-C with respiratory failure. Methods: A concurrent multicenter observational study was performed, analyzing clinical variables and pulmonary mechanics of PARDS associated with COVID-19 in 4 Pediatric intensive care uni...

La adquisición de una nueva morbilidad (NM) se ha convertido en una medida de resultado clínico fundamental después de la enfermedad crítica pediátrica. Los datos en niños latinoamericanos son aún escasos. Objetivo: analizar el desarrollo de nuevas morbilidades adquiridas tras hospitalización por Infección del Tracto Respiratorio Inferior (ITRI) en...

Background: Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator...

Spontaneous pneumomediastinum is a rare disorder, secondary to lung over-inflation. Patients with this disorder have dysp-nea, chest pain, and subcutaneous emphysema. Treatment consists of analgesia, rest, oxygen therapy, and management of the underlying condition. Being a rare disorder, we present two cases of exacerbated asthma complicated with s...

Introduction: Intraventricular Hemorrhage (IVH) is a devastating condition mostly in preterm infants at < 30 weeks GA with large morbidities and mortality usually in the first 72 hours after birth. Prevention seems to be the only way to completely deal with this problem. The IVH prevention in this age group has been studied and includes some strate...

Introduction Antibiotic self-medication is a common practice in pediatric caregivers in low-income countries with limited resources and represents a public health problem. Our study sought to determine what factors are associated with this practice, including differences in knowledge or attitudes of caregivers who attend a pediatric emergency servi...

Background Acute appendicitis is an infrequent pathology in children under 4 years of age, and its diagnosis is a clinical challenge that can lead to late detection. The intention of this study is to describe the clinical and surgical findings and to explore factors and outcomes associated with appendiceal perforation in patients under 4 years of a...

Introduction: Some of the practices in medicine are carried out of habit without proven benefits. This is the case of premature babies from 30 to 34 weeks of gestation who are always given parenteral fluids, even though this practice has been associated with an increase incidence of infection. At the end of 2017, we started a protocol of rationaliz...

Background Strong social distancing measures were quickly implemented in Chile during the SARS-CoV-2 outbreak. One of the aims of non-pharmaceutical interventions (NPI) mandates was to decrease overcrowding, thus is usually measured as mobility changes. Methods we gather data from national health statistics for pediatric emergency (PED) visits for...

Background To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries. Methods Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe betw...

Background To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries.

Resumen Antecedentes: Comprender la enfermedad crítica pediátrica por coronavirus 2019 (COVID-19) y evaluar los factores asociados con la mortalidad en niños de países de ingresos altos y medios-bajos. Métodos: Estudio observacional prospectivo de niños gravemente enfermos hospitalizados por COVID-19 en 18 países de América del Norte, América Lati...

Supplemental Data Tables and Figures Supplemental Table 1: Number of patients and study sites per country Supplemental Table 2: Comparison of symptoms at presentation Supplemental Table 3: Association of Comorbidities and Clinical Presentation with Mortality Supplemental Table 4: Laboratory abnormalities identified on hospital Supplementa...

New diagnoses of leukaemia and other malignancies are recently being made in paediatric patients with COVID- 19. The rates of mortality and morbidity in some of these children are expected to be higher. In new cases, concurrent diagnosis can be difficult because multisystemic inflammatory syndrome (MIS- C) and malignancies have similar clinical pre...

Background: Children with cancer are at risk of critical disease and mortality from COVID-19 infection. In this study, we describe the clinical characteristics of pediatric patients with cancer and COVID-19 from multiple Latin American centers and risk factors associated with mortality in this population. Methods: This study is a multicenter, pr...

Introducción: Los defectos congénitos cardíacos se presentan entre 4 a 10 por cada 1000 nacidos vivos y representan cerca del 10 % de las muertes. En la actualidad son pocos los hallazgos clínicos que sugieren un ecocardiograma anormal poco lo que se recurre a pruebas de tamizaje como la pulsioximetría, pero existen dudas sobre su precisión en ciud...

Objective: During the last decades, cardiac surgery has revolutionized, there is a growing interest in minimizing the physical aggression of surgical procedures, seeking a quick recovery, minimally invasive approaches have been a trend in recent years, with safety and efficacy equivalent to traditional techniques sternotomy. The objective of this s...

Introducción: La desnutrición es un estado patológico generado por un déficit de energía, proteínas y micronutrientes debido a un desequilibrio entre el requerimiento y la ingesta de nutrientes. Para su manejo, el Ministerio de Salud de Bolivia en conjunto con la Organización Mundial de la Salud (OMS) desarrolló el “Manual de Manejo Integral del De...

Introduction: Intraventricular Hemorrhage (IVH) is a devastating condition mostly in preterm infants at < 30 weeks GA with large morbidities and mortality usually in the first 72 hours after birth. Prevention seems to be the only way to completely deal with this problem. The IVH prevention in this age group has been studied and includes some strate...

Background The epidemiology of methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus in pediatrics has changed in recent years. MRSA infections have been reported to be more severe than MSSA. Methods Multicenter retrospective cohort, in 6 pediatric hospitals in Bogotá, Colombia, between January 1, 2014, and December 31, 2018, 1...

Introduction: The use of high-flow nasal cannulas (HFNC) in patients with hypoxemic ventilatory failure reduces the need for mechanical ventilation and does not increase mortality when intubation is promptly applied. The aim of the study is to describe the behavior of HFNC in patients who live at high altitudes, and the performance of predictors of...

Importance: Multisystem Inflammatory Syndrome in Children (MIS-C) associated with SARS-CoV-2 infection is thought to be driven by a post-viral dysregulated immune response, where interleukin 6 (IL-6) might have a central role. In this setting, IL-6 inhibitors are prescribed as immunomodulation in cases refractory to standard therapy. Objective: To...

Background: The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) has changed in recent years. The present article is intended to establish differences between clinical, laboratory and imaging findings and outcomes of MSSA and MRSA infections, as well as among subgroups of infection such...

Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Onlin...

SARS-CoV-2 infection in children with primary immunodeficiency disease (PID) and its complications have not yet been well described, the course of COVID-19 can range from mild illness to death. We aim to report the case of a child with a PID who develop a severe and persistent pulmonary COVID-19 infection. We present chronologically his clinical co...

Objectives: To understand the international epidemiology of critical pediatric COVID-19 and compare presentation, treatments, and outcomes of younger (<2 years) and older (>2 years) children. Design: Prospective, observational study from April 1 to December 31, 2020 Setting: International multicenter study from 55 sites from North America, Latin Am...

ntroduction Red blood cell transfusions in infants born at ≤30 weeks gestation are frequent. Erythropoietin therapy reduces transfusions. An increase in hematocrit is an adaptive response at high altitudes but a guaranteed source of iron is necessary for adequate erythropoiesis. Methods A retrospective cohort study was done to compare red blood ce...

Several challenges exist for referral and transport of critically ill children in resource-limited regions such as Latin America; however, little is known about factors associated with clinical outcomes. Thus, we aimed to describe the characteristics of critically ill children in Latin America transferred to pediatric intensive care units for acute...

Objetivos: describir las características clínicas y epidemiológicas de niños admitidos por bronquiolitis en 13 unidades de cuidados intensivos pediátricos (UCIP) del Uruguay y comparar los resultados asistenciales finales entre UCIP de Montevideo (UM) y del interior del país (UI). Material y método: estudio observacional retrospectivo multicéntrico...

Introduction Most scales for acute respiratory infection (ARI) are limited to healthcare worker (HCW) use for clinical decision-making. The Respiratory Syncytial Virus network (ReSVinet) Scale offers a version for parents that could potentially help as an early warning system. Objective To determine whether or not the ReSVinet Scale for ARI in infa...

SECCION VI. Población pediátrica

Introduction: High-altitude pulmonary edema (HAPE) occurs when a person without adequate pulmonary adap tation ascends above 2500 meters above sea level. Usually, it is more frequent among those living at low altitudes, however, it can occur in people who live at high altitudes and descend to lower ones for a short time, which is called re-entry H...

Aims & Objectives: To describe the epidemiology, therapeutic management and outcomes of children admitted to pediatric ICU (PICU) for acute respiratory failure (ARF) in a contemporary multinational PICU cohort. Methods: Retrospective analysis using prospectively collected clinical data within the LARed Network ARF clinical registry (35 hospitals,...

Aims & Objectives: to describe contemporary invasive mechanical ventilation (IMV) practices in children admitted to Latin American PICUs with acute respiratory failure (ARF). Methods: Retrospective analysis within LARed Network ARF Registry. We analyzed all children who were prescribed IMV between May 2017 and October 2019. Data described as median...

Aims & Objectives: To determine risk factors of non-invasive ventilation techniques (NIV) failure in children admitted with acute respiratory failure (ARF) and to compare their outcomes with children treated successfully or with invasive ventilation alone (IMV). Methods: Retrospective analysis within LARed Network ARF multicenter registry. We inclu...

Aims & Objectives: To determine risk factors and outcomes for prolonged invasive mechanical ventilation (pIMV) in infants admitted to pediatric ICU (PICU) due to acute respiratory failure (ARF). Methods: Retrospective analysis using prospectively collected data within LARed Network ARF registry (33 hospitals, 8 countries). All PICU encounters in ch...

Aims & Objectives: To compare the epidemiology, therapeutic management and clinical outcomes of infants with bronchiolitis admitted to 13 PICUs from Uruguay (UY) using a multinational Latin-American (LATAM) PICU cohort. Methods: Retrospective analysis using prospectively collected clinical data within LARed Network Acute Respiratory Failure registr...

Aims & Objectives: To compare Bedside Physician Diagnosis (BPD) for pediatric sepsis with the new infection associated organ failure Consensus Criteria (CC) on a large Latin American registry To describe the clinical outcomes of ventilated patients with a respiratory infection. Methods:Design: Retrospective analysis within LARed Network’s Pediatric...

Aims & Objectives: To systematically summarize all pediatric cases in the literature with acute liver failure and severe dengue infection, compare their findings, including our own case. Methods: We searched in EMBASE, LILACS, PUBMED and EBSCO using: liver failure and dengue, limited to less than 18 years old, up to December 2017. Reports were incl...

Aims & Objectives: Acute respiratory distress syndrome (ARDS) is an important cause of mortality. In pediatrics, its diagnosis is based on the Berlin consensus definition (BERLIN) and more recently on the Pediatric Acute Lung Injury Consensus Conference (PALICC). We measure the concordance of ARDS by BERLIN and PALICC definitions with autopsy findi...

AIMS & OBJECTIVES: AIM: In pediatric critical care, is necessary to use tools for prediction of mortality and compare to own outcomes. Paediatric index of mortality 3 (PIM 3) is one of the scores used for this. It is necessary to assess its performance in predicting mortality, according to the population in study. OBJECTIVE: To validate PIM 3 score...

Aims & Objectives: To develop a comprehensive description of multisystem inflammatory syndrome temporally associated with SARS -Cov-2 (PIMS-TS) by conducting a case series quantitative systematic review. Methods: PIMS-TS studies were identified by searching Pub Med and Embase from May 1st to July 1st 2020.We extracted data on demographics, clinica...

Introducción: El edema pulmonar de las alturas (EPA) ocurre cuando una persona sin adecuada adaptación pulmo nar asciende a más de 2500 metros sobre el nivel del mar. Suele ser más frecuente entre quienes viven en bajas alturas, sin embargo, puede ocurrir en personas que viven a gran altura y descienden a alti tudes menores por un período corto de...

Objective: During the last decades, cardiac surgery has revolutionized, there is a growing interest in minimizing the physical aggression of surgical procedures, seeking a quick recovery, minimally invasive approaches have been a trend in recent years, with safety and efficacy equivalent to traditional techniques sternotomy. The objective of this...

Introduction Red blood cell transfusions in infants born at ≤30 weeks gestation are frequent. Erythropoietin therapy reduces transfusions. An increase in hematocrit is an adaptive response at high altitudes but a guaranteed source of iron is necessary for adequate erythropoiesis. Methods A retrospective cohort study was done to compare red blood ce...

Introduction Acute respiratory failure is the leading cause of hospitalization in pediatrics. High-flow nasal cannulas (HFNCs) offer a new alternative, but the evidence and indications are still debated. The performance of HFNCs at high altitude has not been described to date. Objective To describe the use of HFNCs in pediatric patients admitted w...

School closures (SC) were adopted globally as a COVID-19 disease pandemic containment strategy. This extreme measure provoked a disruption of the educational system involving hundreds of million children worldwide. The return of children to school has been variable and is still an unresolved and contentious issue. Importantly the process has not be...

With the arrival of SARS-CoV-2 vaccines, a new stage of the pandemic commenced, with new challenges ahead. During the coming months, countries will be implementing their COVID-19 vaccination programs depending on their implementation of vaccine availability and its prescription on risk stratification. Although children will not benefit from active...

Background: Care variability for children with severe acute asthma has been well documented in high‐income countries, yet data from low‐ and middle‐income regions are lacking. We sought to characterize the magnitude of practice variability in the care of Latin American children to identify opportunities for standardization of care. Methods: A cross...

School closures (SC) were adopted globally as a COVID-19 disease pandemic containment strategy. This extreme measure provoked a disruption of the educational system involving hundreds of million children worldwide. The return of children to school has been variable and is still an unresolved and contentious issue. Importantly the process has not be...

School closures (SC) were adopted globally as a COVID-19 disease pandemic containment strategy. This extreme measure provoked a disruption of the educational system involving hundreds of million children worldwide. The return of children to school has been variable and is still an unresolved and contentious issue. Importantly the process has not be...

Pediatric inflammatory multisystem syndrome associated with SARS-CoV-2 (PIMS-TS) is infrequent, but children might present as a life-threatening disease. In a systematic quantitative review, we analyzed 11 studies PIMS-TS, including 468 children reported before Jul 1st. We found a myriad of clinical features, but we were able to describe common cha...

The study aimed to measure the agreement between the clinical and anatomopathological results of children who died with pneumonia from two pediatric intensive care units. Pediatric patients chosen were those who died between January 2008 and December 2015. The agreement was tested with Kappa. A total of 111 autopsies were included. Upon autopsy, 58...

Una nueva pandemia fue declarada por la Organización Mundial de la Salud por elvirus SARS-CoV-2 recientemente. Este virus se caracteriza por ser altamente transmisible, letaly afectar a todos los grupos etarios. Esta declaración permitió la activación en todos los paí-ses de mecanismos de urgencia para atender esta crisis de salud pública que ha ex...

Presentación para estudiantes de posgrado de SDRA con énfasis en definiciones y manejo.

Multisystem inflammatory syndrome temporally related to COVID-19 in children and adolescents is a clinical presentation of SARS-CoV-2 infection. It shares some features with Kawasaki disease, toxic shock, sepsis, macrophage activation syndrome, and myocarditis. Few publications have addressed its initial management, which is similar to that propose...

Background: The COVID-19 pandemic reached the Southern Hemisphere in the autumn of 2020, thus coinciding with its expected annual viral respiratory season. The potential impact of national strategies aimed at mitigating COVID-19 during the pandemic on the incidence of other critical viral lower respiratory tract infections (LRTIs) in children is un...

Over the last two decades, there has been a worldwide cultural shift toward family-centered intensive care. We conducted a survey of 47 pediatric intensive care units (PICUs) across 11 Latin American countries to assess visitation practices and bedside family presence (with a 97.9% response rate). All PICUs had at least some form of parental visita...

Una revisión de las definiciones y las recomendaciones de consenso. Mi visión. Si desean ver la presentación acá: http://youtu.be/xwB8q0eCLTM