Natalia Viu Degaspare

Bio: Natalia Viu Degaspare is an academic researcher from University of São Paulo. The author has contributed to research in topics: Peripherally inserted central catheter. The author has an hindex of 3, co-authored 8 publications receiving 165 citations.

Peripherally inserted central catheters are associated with lower risk of bloodstream infection compared with central venous catheters in paediatric intensive care patients: a propensity-adjusted analysis.

Abstract: Central line-associated bloodstream infection (CLABSI) is an important cause of complications in paediatric intensive care units (PICUs). Peripherally inserted central catheters (PICCs) could be an alternative to central venous catheters (CVCs) and the effect of PICCs compared with CVCs on CLABSI prevention is unknown in PICUs. Therefore, we aimed to evaluate whether PICCs were associated with a protective effect for CLABSI when compared to CVCs in critically ill children. We have carried out a retrospective multicentre study in four PICUs in Sao Paulo, Brazil. We included patients aged 0–14 years, who needed a CVC or PICC during a PICU stay from January 2013 to December 2015. Our primary endpoint was CLABSI up to 30 days after catheter placement. We defined CLABSI based on the Center for Disease Control and Prevention’s National Healthcare Safety Networks (NHSN) 2015 surveillance definitions. To account for potential confounders, we used propensity scores with inverse probability weighting. A total of 1660 devices (922 PICCs and 738 CVCs) in 1255 children were included. The overall CLABSI incidence was 2.28 (95% CI 1.70–3.07)/1000 catheter-days. After covariate adjustment using propensity scores, CVCs were associated with higher risk of CLABSI (adjHR 2.20, 95% CI 1.05–4.61; p = 0.037) compared with PICCs. In a sensitivity analysis, CVCs remained associated with higher risk of CLABSI (adjHR 2.18, 95% CI 1.02–4.64; p = 0.044) after adding place of insertion and use of parenteral nutrition to the model as a time-dependent variable. PICC should be an alternative to CVC in the paediatric intensive care setting for CLABSI prevention.

Epidemiology and outcomes of acute respiratory distress syndrome in children according to the Berlin definition: a multicenter prospective study.

Abstract: Objectives:In 2012, a new acute respiratory distress syndrome definition was proposed for adult patients. It was later validated for infants and toddlers. Our objective was to evaluate the prevalence, outcomes, and risk factors associated with acute respiratory distress syndrome in children up to 15

How to monitor and how to decrease protein hypercatabolism in critically ill children

Abstract: To the Editor: It is known that the metabolic response to surgery, injury, and inflammation is characterized by protein catabolism (1). Most of the studies that reported protein intake have been using nitrogen balance as a gold standard of protein metabolism when a negative balance correlates with catabolism (2). Biolo (3) observed that the amino acid efflux from skeletal muscle provided precursors to “de novo” protein synthesis and energy fuel to the liver and to the rapidly dividing cells of the intestinal mucosa and the immune system. Gielen et al (4) hypothesized that higher amino acid concentration profiles could be a sign of hypercatabolism, but no other measurements of protein balance or other nutritional comparison were considered, bar the assessment of body mass index. Despite certain reservations regarding the accuracy of nitrogen balance, it may provide a better estimation of protein loss (2, 4). The measurement of amino acids profile without other nutritional variables might not be the best way to predict and calculate protein catabolism; furthermore, it behaves differently in postsurgical cardiac patients (1). Hsu et al (2) used a more complete nutritional evaluation by performing a study in adults with very similar design, but comparing urinary nitrogen excretion, nitrogen balance, serum albumin/pre albumin concentrations, and clinical outcome among patients receiving moderate and conventional insulin therapy in a medical ICU. They evidenced a lesser negative nitrogen balance and similar benefits, mainly in the first 72 hours of critical illness, in a group with moderate insulin therapy with a lower prevalence of hypoglycemia comparing to Gielen et al (4). It is well documented that patients who undergo cardiopulmonary bypass similar to other critically ill patients have hypercatabolism as a result of complex neuroendocrine responses (1, 3). The hormonal and metabolic responses to cardiopulmonary bypass are greater in neonates compared with older children and adults due to a variety of metabolic and physical changes after birth. With the marked variation in all patients and clinical conditions evaluated by Gielen et al (4) (different surgeries, underlying diseases, and cyanotic and acyanotic cardiac defects), it is rather difficult to compare protein metabolism using a single biomarker (amino acid profile). Higher levels of protein intake are required to reach a lower negative or positive nitrogen balance during the most catabolic phase of illness including the first 72 hours of a postoperative period of time after a cardiac surgery (1). In a systematic review, Bechard et al (5) found that at least 1.5 g/kg/d of protein intake was necessary to achieve positive protein balance in critically ill children receiving mechanical ventilation. It was observed that there is a strong association between malnutrition and poor wound healing, impaired immunity, increased risk of postoperative pneumonia, loss of skeletal muscle, and in patients after cardiac surgery additional loss of myocardial muscle, thus a complete and sequential nutritional evaluation should be performed (1). Should amino acid profiles be used as a biomarker of response to injury or to predict outcome using any kind of treatment in critically ill patients? Despite this question, it is essential to ensure an adequate supply of amino acids and maintain a proper nitrogen balance. The authors have disclosed that they do not have any potential conflicts of interest.

COVID-19 and Cardiovascular Disease: From Bench to Bedside.

Abstract: A pandemic of historic impact, coronavirus disease 2019 (COVID-19) has potential consequences on the cardiovascular health of millions of people who survive infection worldwide. Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), the etiologic agent of COVID-19, can infect the heart, vascular tissues, and circulating cells through ACE2 (angiotensin-converting enzyme 2), the host cell receptor for the viral spike protein. Acute cardiac injury is a common extrapulmonary manifestation of COVID-19 with potential chronic consequences. This update provides a review of the clinical manifestations of cardiovascular involvement, potential direct SARS-CoV-2 and indirect immune response mechanisms impacting the cardiovascular system, and implications for the management of patients after recovery from acute COVID-19 infection.

Coronavirus Disease 2019 and the Athletic Heart: Emerging Perspectives on Pathology, Risks, and Return to Play.

Abstract: Importance Cardiac injury with attendant negative prognostic implications is common among patients hospitalized with coronavirus disease 2019 (COVID-19) infection. Whether cardiac injury, including myocarditis, also occurs with asymptomatic or mild-severity COVID-19 infection is uncertain. There is an ongoing concern about COVID-19–associated cardiac pathology among athletes because myocarditis is an important cause of sudden cardiac death during exercise. Observations Prior to relaxation of stay-at-home orders in the US, the American College of Cardiology’s Sports and Exercise Cardiology Section endorsed empirical consensus recommendations advising a conservative return-to-play approach, including cardiac risk stratification, for athletes in competitive sports who have recovered from COVID-19. Emerging observational data coupled with widely publicized reports of athletes in competitive sports with reported COVID-19–associated cardiac pathology suggest that myocardial injury may occur in cases of COVID-19 that are asymptomatic and of mild severity. In the absence of definitive data, there is ongoing uncertainty about the optimal approach to cardiovascular risk stratification of athletes in competitive sports following COVID-19 infection. Conclusions and Relevance This report was designed to address the most common questions regarding COVID-19 and cardiac pathology in athletes in competitive sports, including the extension of return-to-play considerations to discrete populations of athletes not addressed in prior recommendations. Multicenter registry data documenting cardiovascular outcomes among athletes in competitive sports who have recovered from COVID-19 are currently being collected to determine the prevalence, severity, and clinical relevance of COVID-19–associated cardiac pathology and efficacy of targeted cardiovascular risk stratification. While we await these critical data, early experiences in the clinical oversight of athletes following COVID-19 infection provide an opportunity to address key areas of uncertainty relevant to cardiology and sports medicine practitioners.

Systemic and organ-specific immune-related manifestations of COVID-19.

Abstract: Immune-related manifestations are increasingly recognized conditions in patients with COVID-19, with around 3,000 cases reported worldwide comprising more than 70 different systemic and organ-specific disorders. Although the inflammation caused by SARS-CoV-2 infection is predominantly centred on the respiratory system, some patients can develop an abnormal inflammatory reaction involving extrapulmonary tissues. The signs and symptoms associated with this excessive immune response are very diverse and can resemble some autoimmune or inflammatory diseases, with the clinical phenotype that is seemingly influenced by epidemiological factors such as age, sex or ethnicity. The severity of the manifestations is also very varied, ranging from benign and self-limiting features to life-threatening systemic syndromes. Little is known about the pathogenesis of these manifestations, and some tend to emerge within the first 2 weeks of SARS-CoV-2 infection, whereas others tend to appear in a late post-infectious stage or even in asymptomatic patients. As the body of evidence comprises predominantly case series and uncontrolled studies, diagnostic and therapeutic decision-making is unsurprisingly often based on the scarcely reported experience and expert opinion. Additional studies are required to learn about the mechanisms involved in the development of these manifestations and apply that knowledge to achieve early diagnosis and the most suitable therapy.