Validation of sedation scores in mechanically ventilated children admitted to a tertiary pediatric intensive care unit Validação de escalas de sedação em crianças submetidas à ventilação mecânica internadas em uma unidade de terapia intensiva pediátrica terciária Artigo originAl introDUCtion Most patients admitted to the pediatric intensive care unit (ICU) need sedation and analgesia to optimize treatment. Sedation lessens agitation and permits better synchronization with mechanical ventilation, reduces oxygen demand and controls anxiety or pain caused by disease or by the unit environment. (1) For an adequate assessment of the patient's sedation level, a practical, objective and easy to use tool is required. Although the clinical opinion of physicians and nurses is important, a scale application is required to estimate the neurophysiologic effects of sedatives and other interventions as well as to permit a comparison between samples of
OBJECTIVES: To assess the prevalence of burnout, anxiety and depression symptoms, and posttraumatic stress disorder (PTSD) in PICU workers in Brazil during the first peak of the COVID-19 pandemic. To compare the results of subgroups stratified by age, gender, professional category, health system, and previous mental health disorders. DESIGN: Multicenter, cross-sectional study using an electronic survey. SETTING: Twenty-nine public and private Brazilian PICUs. SUBJECTS: Multidisciplinary PICU workers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Self-reported questionnaires were used to measure burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), and PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]) in 1,084 respondents. Subjects were mainly young (37.1 ± 8.4 yr old) and females (85%), with a median workload of 50 hours per week. The prevalence of anxiety and depression was 33% and 19%, respectively, whereas PTSD was 13%. The overall median burnout scores were high in the emotional exhaustion and personal accomplishment dimensions (16 [interquartile range (IQR), 8–24] and 40 [IQR, 33–44], respectively) whereas low in the depersonalization one (2 [IQR, 0–5]), suggesting a profile of overextended professionals, with a burnout prevalence of 24%. Professionals reporting prior mental health disorders had higher prevalence of burnout (30% vs 22%; p = 0.02), anxiety (51% vs 29%; p < 0.001), and depression symptoms (32.5% vs 15%; p < 0.001), with superior PCL-5 scores for PTSD ( p < 0.001). Public hospital workers presented more burnout (29% vs 18.6%, p < 0.001) and more PTSD levels (14.8% vs 10%, p = 0.03). Younger professionals were also more burned out ( p < 0.05 in all three dimensions). CONCLUSIONS: The prevalence of mental health disorders in Brazilian PICU workers during the first 2020 peak of COVID-19 was as high as those described in adult ICU workers. Some subgroups, particularly those reporting previous mental disorders and younger professionals, should receive special attention to prevent future crises.
As doenças respiratórias são associadas a grande morbidade e mortalidade na faixa etária pediátrica e, assim, responsáveis por hospitalizações em Unidades de Terapia Intensiva Pediátricas (UTIPs). O objetivo deste estudo foi descrever as principais causas de admissão por doenças respiratórias e a evolução desses pacientes em duas UTIPs. Tratou-se de estudo descritivo e retrospectivo. Foram coletados dados de todos os pacientes admitidos por doença do trato respiratório, durante o ano de 2011, em duas UTIPs terciárias, da cidade de Salvador, Bahia. Nesse período, foram admitidos 625 pacientes, dos quais 355 (56,8%) tinham doença do trato respiratório. Destes, a maioria foi do sexo masculino (55,2%) e houve predominância de lactentes (55,8%). O tempo de permanência em UTIP esteve entre um e sete dias (75,8%). Pneumonia foi a principal causa de admissão (37,7%), seguida de bronquiolite (18,9%) e asma (12,4%). O uso de ventilação não invasiva foi verificado em 178 pacientes (50,1%) e 86 pacientes (24,2%) necessitaram de ventilação invasiva. Houve 23 óbitos (6,47%). Concluiu--se que as doenças respiratórias constituem ainda causas importantes de morbimortalidade na infância. Palavras-chave: Doença respiratória. Unidade de terapia intensiva pediátrica. Mortalidade.
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