Objectives: Right ventricle (RV) dysfunction has a significant impact on the morbidity and mortality of critically ill patients and is associated with worse outcomes. This study aims to analyze the frequency of echocardiographic alterations of the RV in children undergoing invasive mechanical ventilation (IMV). Methods: Observational study conducted on patients undergoing mechanical ventilation in a pediatric intensive care unit from May 2019 to June 2022. Bedside echocardiograms were performed, and measurements of tricuspid annular plane systolic excursion (TAPSE), tissue Doppler S’ wave, and right ventricle/left ventricle (RV/LV) ratio were evaluated. Results: A total of 146 echocardiograms were analyzed, with a median age of 7 months, 64.4% were infants, and 51.4% were female. It was observed that 24% (35) had TAPSE alterations, 14% (20) had alterations in the S’ wave, and 10.7% (15) had RV/LV ratio altered. Considering RV dysfunction as any of these altered parameters, the frequency was 38.5% (55), with cardiac index weakly correlated with TAPSE (r=0.171; p<0.048) and S’ wave (r=0.281; p<0.001). There was no significant association between echocardiographic alterations and respiratory parameters. Regarding hemodynamic status, the median Vasoactive-inotropic Score was higher in the dysfunction group (7.5 vs. 3; p<0.048), as well as lactate levels (1.74 vs. 1.3; p<0.015). None of the variables were associated with mortality, duration of IMV or length of hospital stay. Conclusions: Echocardiographic alterations of the RV are frequent in children undergoing MV. Echocardiography is a non-invasive tool that aids in identifying this condition, which can impact the management of critically ill patients.
Introduction: Asthma is a disease with important morbidity and that can lead to death in childhood. The use of intravenous magnesium sulfate has been indicated in cases refractory to the initial management with inhaled bronchodilators and corticosteroids. Objective: To evaluate the use of magnesium sulfate in continuous infusion (50mg/kg/hour in 4 hours) in children with severe acute asthma. Location: 10-bed pediatric emergency room, university hospital. Patients: Children over 2 years old who received a continuous infusion of magnesium sulfate at a dose of 50mg/kg/hour in 4 hours. Methods and main findings: Cross-sectional, prospective study. All patients with severe acute asthma were included in a study protocol. A total of 40 patients met the inclusion criteria, 60% male, with a median age of 3.0 years (2.8-4.3). All patients were monitored and followed by an emergency pediatrician during the 4 hours of infusion. There was no description of adverse events related to the magnesium sulfate. The modified Wood-Downes clinical score was applied and compared before and after the infusion and a significant clinical improvement was observed (p<0.001). The serum magnesium levels at the end of the infusion ranged from 3.3-5.8 mg/dL, suitable as therapeutic and without toxicity (median 4.0). The median length of stay in pediatric emergency was 2 days. Only 2 patients (5%) were transferred to the PICU. Conclusions: On this study, the use of continuous magnesium sulfate proved to be well tolerated, leading to improved respiratory status, and can be considered as adjunctive therapy in the management of severe asthma.