Vanessa Soares Lanziotti

Objective: To evaluate the association between invasive mechanical ventilation use, functional capacity, and 12-month mortality in critically ill children with cancer after a pediatric intensive care unit stay. Methods: We conducted a single-center, retrospective cohort study of critically ill children with cancer admitted to the pediatric intensive care unit from January 2018 to December […] Abstract Objective: To evaluate the association between invasive mechanical ventilation use, functional capacity, and 12-month mortality in critically ill children with cancer after a pediatric intensive care unit stay. Methods: We conducted a single-center, retrospective cohort study of critically ill children with cancer admitted to the pediatric intensive care unit from January 2018 to December […]

É indiscutível que a ventilação mecânica invasiva (VMI) é uma das intervenções mais praticadas em pacientes graves em unidades de terapia intensiva pediátrica (UTIP), sobretudo naqueles com insuficiência respiratória aguda (IRA). Nas últimas décadas, o conhecimento técnico a respeito dos aparelhos de ventilação mecânica avançou de forma significativa, mas, junto com ele, também aprendeu-se sobre seus efeitos adversos, principalmente quando utilizada de forma inadequada, ignorando a individualidade da mecânica respiratória de cada paciente. O presente artigo aborda a falta de conhecimento do pediatra a respeito da mecânica ventilatória, que pode levar a malefícios da VMI em detrimento de seus benefícios.

INTRODUCTION The medical field has historically been male-dominated, particularly in specialties like surgery, anesthesia, and critical care medicine. Although women now enroll in medical school at rates equal to or even higher than men, gender equity in the medical profession remains elusive. Women are still significantly underrepresented in leadership positions, especially in academic medicine and […] INTRODUCTION The medical field has historically been male-dominated, particularly in specialties like surgery, anesthesia, and critical care medicine. Although women now enroll in medical school at rates equal to or even higher than men, gender equity in the medical profession remains elusive. Women are still significantly underrepresented in leadership positions, especially in academic medicine and […]

O artigo em questão aborda a utilização cada vez mais ampla do ultrassom à beira do leito (POCUS: Point-of-care ultrasound), uma ferramenta válida e importante no diagnóstico e manejo clínicos. No entanto, por estar se tornando cada vez mais acessível, há o risco de uma tendência ao sobrediagnóstico e subtratamento, mostrando-se necessário um direcionamento para a utilização criteriosa dessa ferramenta.

“Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease.” (Sir William Osler) The COVID-19 pandemic is amplifying historic inequities worldwide. These inequities include not only gender disparities, but also systemic racism and an overall lack of diversity and representation in all areas of professional life.[1] At a time when the media has spotlighted science and medicine, women have been barely visible, with conspicuous underrepresentation in pandemic leadership and public policy.[2] With challenges of social isolation and closure of schools and childcare, women in health care and academia face inequalities in professional, childcare, and household responsibilities. These deep-rooted inequities are pervasive in medicine and unacceptable in every arena. As female pediatric intensivists, we observed many examples in our own field that have not improved with time. A recent publication[3] examined gender distribution in Program in Cellular and Molecular Medicine (PCCM) randomized clinical trials, and found that the proportion of women authors increased from 28% in 1985 to 1989 to only 39% in 2015 to 2018. The authorship inequity in pediatric critical care[4] reflects other stark realities of underrepresentation in our field in leadership and senior positions[5] and as speakers at medical conferences.[6] As an example, in the Pediatric Sepsis Guidelines group, women comprised only 11 of 42 authors, and the presentation at the 2020 Society of Critical Care Medicine (SCCM) Congress Plenary included six men and no women. We cannot ignore disparities in the workforce data worldwide, both in high- and low-middle income countries. The American Board of Pediatrics reported that in 2017 to 2018 women comprised >60% of first-year PCCM fellows in the United States and 40% of all PCCM board-certified physicians.[5] [7] We need to support and champion these rising intensivists by ensuring that they have advantages that have historically been denied to them and level the playing field for the next generation of leaders. Some recent examples include recent panel sessions at major conferences devoted to highlighting achievements in Women in Medicine and development of a list of interprofessional PCCM women speakers (bit.ly/picuwomenspeakers). This public list is open to any PCCM women worldwide that would like to join it with a goal to disseminate as widely as possible. We believe that this list in combination with increased remote conferences and grand rounds can give opportunities to women from different backgrounds and nationalities to speak and be heard in their areas of expertise. The number of women entering medical schools annually now equals or surpasses that of men.[6] We need to break the cycle of the enduring systemic and organizational implicit bias reflected by fewer promotion and leadership opportunities and unequal pay that have long-term repercussions on women's academic career trajectories.[8] A recent study showed that even among specialties with higher numbers of women, such as pediatrics, women are disproportionally represented in leadership roles.[9] Gender inequity is clear among speakers at critical care conferences worldwide, with proportions of female physician speakers as low as 1%.[10] A lack of representation in the leadership and planning process may contribute to implicit bias in both conference planning and speaker invitations. Higher burden of childcare and home responsibilities for women translate to fewer opportunities and publications, increased time to promotion, and lower pay.[11] On a broader level, studies have shown a negative impact during the pandemic on women's academic productivity and decreased rates of publication, especially as first author.[12] However, we must also acknowledge the role of discrimination in the underrepresentation of women. One in three physician moms have experienced discrimination because of pregnancy or breastfeeding.[13] Harassment, discrimination, and abuse have been described more frequently for women in subspecialty training.[14] In addition to strategies described above to reduce gender disparities in our field, there is emerging literature in critical care medicine as a whole[11] including guidelines, practical initiatives, and education on gender bias and diversity benefits. These strategies must be widely promoted in PCCM, with broad support from medical and academic institutions, conference committees, journal editorial boards, and professional societies, where mentorship, women's group, leadership training sessions may not only support women but also identify potential leaders. Because the gender gap starts early and widens as women reach mid- or late-career, timing is especially important. If women experience burnout and feel undervalued in their roles, it further increases gaps in leadership opportunities and salary. Thus, mentorship/sponsorship relationships and leadership programs for women in training and in academic positions are also important.[15] Other strategies and innovations to reduce the gender disparities include reform in grant funding agencies, increased human resources to support women in negotiations and arbitrations, and creative approaches to pediatric critical care staffing schedules to facilitate work-life integration. To encourage progress, transparency is crucial, including publicly available information on diversity metrics in pediatric critical care medicine departments/divisions. We cannot begin to fix what everyone cannot see. Studies on gender disparities in medicine bring forth an urgent call for strategies to ensure greater diversity and inclusion. Medicine is overdue for an overhaul in the way we recognize and support providers. Diversity and inclusion in medicine, including gender, nationality, race, religion, and sexual...