Year
1997 (Farias 1999)
1999 (Farias et al. 2004)
2007 (Monteverde et al. 2008)
ARF; n (%)
65 (63)
526 (79)
773 (80)
ARDS; n (%)
6 (9)
16 (3)
32 (4)
Bronchiolitis; n (%)
18 (28)
35 (7)
275 (36)
Pneumonia; n (%)
15 (23)
100 (19)
164 (21)
Septic shock; n (%)
6 (9)
70 (13)
125 (16)
Postoperative; n (%)
11 (17)
161 (31)
32 (4)
Other; n (%)
9 (14)
144 (27)
145 (19)
CRF; n (%)
14 (13)
51 (8)
54 (6)
Altered mental status; n (%)
13 (13)
87 (13)
131 (14)
Neuromuscular; n (%)
12 (1)
6 (1)
10 (1)
70.1.3 PICU General Characteristics
The majority of PICUs in South America are medical-surgical and many of them also provide care to neonatal and pediatric patients. A partial report (Monteverde et al. 2008) from an ongoing study on MV in PICUs in Latin America and Spain shows that, of 39 units analyzed, 39 % are in pediatric hospitals while 61 % are in general institutions; thus, 9 % of all pediatric beds are in PICUs. This result is double that of a study with a similar methodology carried out 8 years ago (Farias et al. 2004), which obtained a rate of approximately 4 %.
Although as noted previously, the rate of utilization of MV varies greatly between units, particularly in small series (from 8 to 64 %) (Duarte Vilariño 2006; Lopes Riccetto 2006; Slater et al. 2003). However, there is no such variation between large and multicenter studies: 44 % (Farias et al. 2004) vs. 45.4 % (Monteverde et al. 2008), which is in accordance with data from the SATI-Q report: 41.6 % (Ratto et al. 2007). Almost all institutions report providing intermediate care.
70.2 Caregiver Coverage and Role (Tables 70.2 and 70.3)
Table 70.2
Caregiver coverage of mechanical ventilation in different countries of South American PICUs. MV: mechanical ventilation
Country | Pediatric intensivist 24 h/day | PIC fellow 24 h/day | Patients/nurse (n) | Respiratory therapist | Physio therapist | ARDS protocol | Weaning protocol | Sedation protocol | Training in MV for fellows | Training in Mechanical ventilation for nurses |
|---|---|---|---|---|---|---|---|---|---|---|
Argentina | Y | Y | 2 | N | Y | Y | Y | Y | Y | Y |
Honduras | Y | Y | 4 | Y | Y | Y | Y | Y | N | N |
Costa Rica | Y | N | 3 | Y | Y | N | N | N | Y | N |
Colombia | Y | N | 2.5 | Y | Y | N | N | N | Y | Y |
Chile | Y | Y | 3 | Y | Y | N | N | N | Y | Y |
Brazil | Y | Y | 1 | Y | Y | N | N | N | Y | Y |
Total | 100 % | 66.6 % | 2.6 | 83.3 % | 100 % | 33.3 % | 33.3 % | 33.3 % | 83.3 % | 66.6 % |
Table 70.3
Respiratory support equipment for mechanical ventilation in South American PICUs
Country | PICUs (n) | Private/public/Both | Beds in each PICU (n) | Intermediate care | Conventional ventilators in each PICU (n) | HFOV ventilators in each PICU (n) | Noninvasive ventilators in each PICU) |
|---|---|---|---|---|---|---|---|
Argentina
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