Medicina pulmonar y respiratoria

Background: Necrotizing pneumonia is an uncommon, but serious complication of pneumonia in children. The indications and timing of surgical procedures are not outlined and are controversial.

Case report: In this report, we presented two pediatric cases, which be diagnosed with necrotizing pneumonia and have recognized indications for aggressive surgical operation. Nevertheless, the two patients were not treated with surgery due to their parents' concerns about complications of thoracotomy and damage to lung function and still achieved complete recovery in manifestations and radiology by conservative modalities including a lengthy course of antibiotics, bronchoscopy lavaging, thoracocentesis, and symptomatic treatment.

Conclusion: Necrotizing pneumonia can be successfully treated with a conservative treatment regimen even in patients with a recognized indication for surgery.

Introduction: During the COVID-19 pandemic, the risk of collapse of the health system generated great difficulties. UCRIs allow adequate management of patients with non-invasive respiratory support, which is evident in patients with SARS-VOC-2 pneumonia.

Methods: A prospective observational study of patients with COVID 19 admitted to an ICU of a tertiary hospital from February 25 to April 28, 2020 with a staff of 11 beds. Sociodemographic, comorbidities, pharmacological, respiratory support, laboratory and blood gas variables were collected. The overall cost of the unit was analyzed.

Results: 991 patients were admitted, 56 to the ICU (of the 81 who needed admission to the critical care unit). Mean age of 65 years (SD 12.8), Barthel index 75 (SD 8.3), Charlson 3.1 (SD 2.2), HTN 27%, COPD 89% and obesity 24%. Significant relationship (p <0.05) with higher mortality regarding: fever greater than or equal to 39ºC [OR 5.6; 95% CI (1.2-2.7); p=0.020], protocolized pharmacological treatment [OR 0.3; 95% CI (0.1-0.9); p=0.023] and the IOT [OR 3.7; 95% CI (1.1-12.3); p=0.025]. NIMV showed less negative impact [OR 1.8; 95% CI (0.4-8.4); p=0.423] than IOT. The total cost of UCRI amounted to 66,233 Eur. The cost per day of stay in UCRI was 164 Eur. The cost avoided was 214,865 Eur.

Conclusion: The pandemic has highlighted the importance of UCRI allowing the management of a high patient volume. The treatment carried out in them is effective and efficient, reducing both admissions and stays in the ICU.