Catálogo de publicaciones - revistas

<jats:title>Abstract</jats:title><jats:sec><jats:title>Rationale</jats:title><jats:p>Infant pulmonary function testing has a great value in the diagnosis of post‐infectious bronchiolitis obliterans (BOs), because of characteristic patterns of severe and fixed airway obstruction. Unfortunately, infant pulmonary function testing is not available in most pediatric pulmonary centers.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To develop and validate a clinical prediction rule (BO‐Score) to diagnose children under 2 years of age with BOs, using multiple objectively measured parameters readily available in most medical centers.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Study subjects, children under 2 years old with a chronic pulmonary disease assisted at R. Gutierrez Children's Hospital of Buenos Aires. Patients were randomly divided into a derivation (66%) and a validation (34%) set. ROC analyses and multivariable logistic regression included significant clinical, radiological, and laboratory predictors. The main outcome measure was a diagnosis of BOs. The performance of the BO‐Score was tested on the validation set.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Hundred twenty‐five patients were included, 83 in the derivation set and 42 in the validation set. The BO‐Score (area under ROC curve = 0.96; 95% CI, 0.9–1.0%) was developed by assigning points to the following variables: typical clinical history (four points), adenovirus infection (three points), and high‐resolution computed tomography with mosaic perfusion (four points). A Score ≥7 predicted the diagnosis of BOs with a specificity of 100% (95% CI, 79–100%) and a sensitivity of 67% (95% CI, 47–80%).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The BO‐Score is a simple‐to‐use clinical prediction rule, based on variables that are readily available. A BO‐Score of 7 or more predicts a diagnosis of post‐infectious BOs with high accuracy. Pediatr Pulmonol. 2009; 44:1065–1069. ©2009 Wiley‐Liss, Inc.</jats:p></jats:sec>

<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>Evidence‐based ventilation strategies for infants with severe bronchopulmonary dysplasia (BPD) remain unknown. Determining whether contemporary ventilation approaches cluster as specific BPD strategies may better characterize care and enhance the design of clinical trials. The objective of this study was to test the hypothesis that unsupervised, multifactorial clustering analysis of point prevalence ventilator setting data would classify a discrete number of physiology‐based approaches to mechanical ventilation in a multicenter cohort of infants with severe BPD.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We performed a secondary analysis of a multicenter point prevalence study of infants with severe BPD treated with invasive mechanical ventilation. We clustered the cohort by mean airway pressure (MAP), positive end expiratory pressure (PEEP), set respiratory rate, and inspiratory time (Ti) using Ward's hierarchical clustering analysis (HCA).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Seventy‐eight patients with severe BPD were included from 14 centers. HCA classified three discrete clusters as determined by an agglomerative coefficient of 0.97. Cluster stability was relatively strong as determined by Jaccard coefficient means of 0.79, 0.85, and 0.77 for clusters 1, 2, and 3, respectively. The median PEEP, MAP, rate, Ti, and PIP differed significantly between clusters for each comparison by Kruskall–Wallis testing (<jats:italic>p</jats:italic> &lt; 0.0001).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In this study, unsupervised clustering analysis of ventilator setting data identified three discrete approaches to mechanical ventilation in a multicenter cohort of infants with severe BPD. Prospective trials are needed to determine whether these approaches to mechanical ventilation are associated with specific severe BPD clinical phenotypes and differentially modify respiratory outcomes.</jats:p></jats:sec>

<jats:title>Abstract</jats:title><jats:p>Children on long‐term home mechanical ventilation are a growing population due to clinical and technological advances and the benefit for the child's quality of life. Invasive home ventilation is one of the most complex therapies offered in the home setting, requiring adequate home environment and appropriate equipment and supplies before discharge. The transition from hospital to home represents a vulnerable period that can be facilitated with an established transition plan with multidisciplinary team involvement. Readiness for home care is achieved when the patient is stable and has been transitioned from a critical care ventilator to a home mechanical ventilator. In parallel, comprehensive competency‐based training regarding the knowledge and skills needed to help families use the equipment confidently and safely. Before discharge, families should be counseled on an adequate home environment to ensure a safe transition. The residence arrangement may include physical space modifications, verifying electrical installation, or moving to another home. Durable medical equipment and supplies must be ordered, and community healthcare support arranged. Parents should receive practical advice on setting up the equipment at home and on preventive measures to minimize complications related to tracheostomy and ventilator dependence, including regular maintenance and replacement of necessary equipment. Given the overall impact of invasive ventilation on home life, a structured home care action package is essential to alleviate the burdens involved.</jats:p>