Browsing by Author "Ucrós, Santiago"

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    High altitude pulmonary edema in children: A systematic review
    (2022) Ucrós, Santiago; Aparicio, Camila; Castro Rodriguez, José Antonio; Ivy, Dunbar
    Abstract Introduction: High altitude pulmonary edema (HAPE) is a form of acutenoncardiogenic pulmonary edema caused by altitude‐related hypoxia seen inchildren as well as in adults. In this systematic review we focus in HAPE occurringin children and adolescents.Methods:A systematic review was conducted including publications in children0–18 years of age from three databases up to June 2022.Results:Thirty‐five studies representing 210 cases were found. The mean age was9.8 ± 3.6 years with a male/female ratio of 2.6. The peak age incidence was seen inchildren between 6 and 10 years old. Only two children (0.9%) were≤2 years old.The mean altitude in 166 cases was 2861 masl. Only 17 cases (8.1%) occurred ataltitudes below 2500 masl. Regarding the different HAPE subtypes there was apredominance of re‐entry HAPE (R‐HAPE) with 58%, followed by classic HAPE(C‐HAPE) with 37.6%. The mean time between arrival and onset of symptoms was16.5 h. The mortality rate was 1.4%. In 10/28 (36%) of C‐HAPE cases there was astructural cardiac/pulmonary anomaly compared to 1/19 (5%) in R‐HAPE (p< 0.01).HAPE recurrence was found in 46 cases (21.9%). The involvement in the chest X‐rays was seen predominantly in the apices and in the right lung.Conclusions:R‐HAPE was the most common HAPE subtype; HAPE peak age wasfound between 6 and 10 years of age; HAPE was more frequent in males and wasrare in children under 2 years old; associated HAPE structural abnormalities weremore common in C‐HAPE than in R‐HAPE.
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    Normal values for respiratory sleep polygraphy in children aged 4 to 9 years at 2,560 m above sea level
    (2021) Ucrós, Santiago; Granados Claudia; Hill, Catherine; Castro Rodríguez, José Antonio; Ospina, Juan Camilo
    Obstructive sleep apnea syndrome affects 1%–4% of all children worldwide. Currently, diagnosis of obstructive sleep apnea is based on sea-level guidelines, without taking into account the altitude at which the populations live. It has been shown that at 3,200 m of altitude there is an increase in obstructive events in healthy children aged 7 to 16 years; on the other hand, it is known that SpO2 dispersion between individuals becomes wider as altitude increases, a phenomenon that is more marked during sleep. About 17 million Colombians live in regions between 2,500 m and 2,700 m, as do significant populations in other Latin American countries. This research aimed to characterize respiratory polygraphy sleep parameters in healthy, non-snoring children aged 4–9 years living at 2,560 m. We carried out home respiratory polygraphy in 32 children with a mean age of 6.2 years (range 4–9 years). The average recorded sleep time was 7.8 h, the median apnea–hypopnea index was 9.2/h, the obstructive apnea–hypopnea index had a median of 8.8/h (p5 4.2 to p95 17.9) and central apnea a median of 0.4/h. The median SpO2 was 93% (p5 90.5 to p95 94) and transcutaneous CO2 had a median of 39.4 mmHg (p531.7 to p95 42.3). The median oxygen desaturation index ≥ 3% was 11.2 and median oxygen desaturation index ≥ 4% was 3.9. Normal measurements for respiratory polygraphy obtained at sea level do not apply to children at altitude. If such guidelines are used, obstructive sleep apnea will be over-diagnosed, resulting in unnecessary adenotonsillectomies, among other interventions.
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    Oxygen Saturation in Childhood at High Altitude: A Systematic Review
    (2020) Ucrós, Santiago; Granados Claudia M.; Castro Rodríguez, José Antonio; Hill, Catherine M.
    Background: It is well known that oxygen saturation as measured by pulse oximetry (SpO2) decreases as altitude increases. However, how SpO2 changes across childhood, and more specifically during sleep/wake states, at different high altitudes are less well understood. We aimed to perform a systematic review of all studies with direct SpO2 measurement in healthy children living at high altitude (>2500 meters above sea level) to address these questions. Methods: MEDLINE, EMBASE, and SciELO databases were searched up to December 2018. Two independent reviewers screened the literature and extracted relevant data. Results: Of 194 references, 20 studies met the eligibility criteria. Meta-analysis was not possible due to the use of different oximeters and/or protocols for data acquisition and reporting of different SpO2 central tendency and dispersion measures. The most relevant findings from the data were: (1) SpO2 is lower as altitude increases; (2) at high altitude, SpO2 improves with age through childhood; (3) SpO2 is lower during sleep and feeding in comparison to when awake, this SpO2 gap between wake and sleep states is more evident in the first months of life and narrows later in life; (4) SpO2 dispersion (interindividual variation) is higher at younger ages, and more so during sleep; (5) In 6/20 studies, the SpO2 values were nonnormally distributed with a consistent left skew. Conclusions: At high altitude, the mean/median SpO2 increases in children with aging; a significant gap between wake and sleep states is seen in the first months of life, which narrows as the infant gets older; SpO2 dispersion at high altitude is wider at younger ages; at high altitude, SpO2 shows a nonnormal distribution skewed to the left; this bias becomes more evident as altitude increases, at younger ages and during sleep.