Palabras clave
COVID-19
Pediatría
insuficiencia respiratoria aguda
Ventilación mecánica
Oxigenoterapia
Pediatría
insuficiencia respiratoria aguda
Ventilación mecánica
Oxigenoterapia
Cómo citar
1.
Canepari A, Gagioli M, Olguín Ciancio M, Retta A, Sánchez M, Vicente N, et al. Recomendaciones para el manejo del paciente pediátrico con insuficiencia respiratoria aguda en el contexto de sospecha de COVID-19. Rev Arg de Ter Int. [Internet]. 20 de octubre de 2020 [citado 25 de abril de 2024];37(3). Disponible en: https://revista.sati.org.ar/index.php/MI/article/view/710
Resumen
Los niños infectados por SARS-CoV-2 parecen sufrir formas leves de la enfermedad. Aun así, se ha observado que un porcentaje ingresa en las unidades de terapia intensiva y requiere asistencia ventilatoria mecánica y abordajes específicos para su edad. En el marco de esta pandemia, se creó un grupo de profesionales kinesiólogos especializados en la atención de pacientes pediátricos en cuidados críticos, con el objetivo generar recomendaciones para el manejo de niños con insuficiencia respiratoria aguda y sospecha o confirmación de COVID-19, y proporcionar una guía que permita al profesional prever, promover, identificar y generar medidas de tratamiento respiratorio para un seguimiento eficaz, pero a la vez, seguro de los pacientes pediátricos con sospecha o confirmación de SARS-CoV-2, sobre la base de publicaciones científicas nacionales e internacionales en el ámbito de los cuidados intensivos pediátricos, neonatales y de adultos.
Citas
Referencias
1. Ministerio de salud de la república Argentina. Ministerio de salud. [Online].; 2020 [cited 2020 Abril 17. Available from: http://www.msal.gob.ar/images/stories/bes/graficos/0000000840cnt-2018-07_guia-infecciones-respiratorias-agudas-web.pdf.
2. Zheng F, Liao C, Fan QH. Clinical Characteristics of children with coronavirus disease 2019 in Hubei, China. Current Medical Science. 2020; 40(2).
3. World Health Organization regional office for Europe. World Health Organization regional office for Europe. [Online].; 2020 [cited 2020 Marzo 12. Available from: http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic.
4. Yan-Rong G, Quing-Dong C, Zhong-Si H, Yuan-Yang T. The Origin, Transmission and Clinical Therapies on Coronavirus Disease 2019 (COVID-19) Outbreak - An Update on the Status. Milatary Medical Research. 2020 Marzo; 7(11).
5. Cruz AT, Zeichner SL. COVID-19 in Children: Initial Characterization of the Pediatric Disease. Pediatrics. 2020 Junio; 145(6).
6. Singhal T. A review of Coronavirus Disease-2019 (COVID-19). The indian journal of pediatrics. 2020 Abril; 87(4).
7. Pagina Oficial del gobierno de la república Argentina. Pagina Oficial del gobierno de la república Argentina. [Online].; 2020 [cited 2020 Marzo 26. Available from: https://www.argentina.gob.ar/salud/coronavirus-COVID-19.
8. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Medicine. 2020 Abril.
9. Sociedad Argentina de Cardiologia. Sociedad Argentina de cardiología. [Online].; 2020 [cited 2020 Abril 18. Available from: https://www.sac.org.ar/coronavirus.
10. Vaduganathan M, Vardeny O, Michel T, McMurray J, Pfeffer M, Solomon S. Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19. The new england journal o f medicine. 2020 Abril; 182(17).
11. Weiyong L, Qi Z, Junbo C, Rong X, Huijuan S, Sainan S, et al. Detection of Covid-19 in Children in Early January 2020 in Wuhan, China. New England Journal of medicine. 2020 Marzo; 182(14).
12. Brodin P. Why is COVID-19 so mild in children? Acta Pediatrica. 20202 Marzo; 109(6).
13. Sociedad Argentina de Pediatría. Sociedad Argentina de pediatría. [Online].; 2020 [cited 2020 Abril 12. Available from: https://www.sap.org.ar/publicaciones/contenidos-extras/23/reuniones-y-documentos-con-actualizacion-permanente-sobre-coronavirus-covid-19.html.
14. Davis A, Carcillo J, Aneja R, Deymann A, Lin J. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Critical Care Medicine. 2017 Junio; 45(6).
15. James A, Yves C, Carmen Lúcia PS, Paul J, Yuguo Liand WHS. Natural Ventilation for Infection Control in Health-Care Settings. World Health Organization. 2009.
16. Wells WF. Sanitary Ventilation. American Journal of Public Health. 1947 Octubre; 38.
17. Nicas M. An integrated model of infection risl in a Health-CARE enviroment. Risk Analysis An international Journal. 2006 Septiembre; 26(4).
18. Hualing Z, Dan L, Ling X, Yimin X. Documentary research of human respiratory droplet characteristics. Procedia Engineering. 2015 Octubre; 121.
19. Pagina oficial del gobierno de la República Argentina. Argentina.gob.ar. [Online].; 2020 [cited 2020 Abril 18. Available from: www.argentina.gob.ar/salud/coronavirus-COVID-19/recomendaciones-uso-epp.
20. Centers for disease control and prevention. Sitio web del Centers for disease control and prevention. [Online].; 2020 [cited 2020 Abril 12. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html.
21. Arabi Y, Phua J, Koh Y, Du B, Faruq MO, Nishimura M, et al. Structure, Organization, and Delivery of Critical Care in Asian ICUs. Critical Care Medicine. 2016 Octubre; 44(10).
22. Gomersall C, Tai D, S L, Derrick J, Goh M, Buckley T, et al. Expanding ICU facilities in an epidemic: recommendations based on experience from the SARS epidemic in Hong Kong and Singapore. Intensive Care Medicine. 2006 Marzo; 32(7).
23. Phua J, Weng L, Ling L, Egi M, Lim CM, al. e. Intensive Care Management of Coronavirus Disease 2019 (COVID-19): Challenges and Recommendations. Lancet Respiratory Medicine. 2020 Mayo; 8(5).
24. Centers for Disease Control and Prevention. Sitio web del Centers for Disease Control and Prevention. [Online].; 2005 [cited 2020 Abril 13. Available from: https://www.cdc.gov/infectioncontrol/guidelines/isolation/glossary.html.
25. Hospital Italiano de Buenos Aires Comité de control de infecciones. Sitio web del Hospital Italiano de Buenos Aires. [Online].; 2010 [cited 2020 Abril 20. Available from: https://www.hospitalitaliano.org.ar/multimedia/archivos/noticias_archivos/74/documentos/74_INSTRUCTIVOPURIFICADORESDEAIRE.pdf.
26. Centers for Disease Control and Prevention. Sitio web de Centers for Disease Control and Prevention. [Online].; 2010 [cited 2020 Abril 12. Available from: https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/air.html#c3bi.
27. Organizacion panamericana de la salud - Oficina de la organizacion mundial de la salud. Sitio web de la Organizacion panamericana de la salud. [Online].; 2020 [cited 2020 Abril 13. Available from: https://www.paho.org/hq/dmdocuments/2011/ventilacion_natual_spa_25mar11.pdf.
28. Anderson TA, Hart GK, Kainer MA, Commitee ADM. Pandemic Influenza-Implications for Critical Care Resources in Australia and New Zealand. Journal of Critical Care. 2003 Septiembre; 18(3).
29. Bezzi M, Fredes S, Tiribelli N, Setten M, Rodrigues La Moglie R, Plotnikow G, et al. Guía de manejo de pacientes adultos críticos para kinesiología intensivista en COVID-19. Revista Argentina de Terapia Intensiva. 2020 Abril.
30. Monteverde E, Fernández A, Ferrero F, Barbaro C, De Lillo LM, Golubicki A, et al. High-flow Nasal Cannula Oxygen Therapy in Infants With Acute Lower Respiratory Tract Infection. An Experience in Hospitals of the City of Buenos Aires. Archivos Argentinos de Pediatría. 2019 Octubre; 117(5).
31. Xiaobo Y, Yuan Y, Jiqian X, Huaqing S, Jia´an X, Hong L, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine. 2020 Mayo; 8(5).
32. Kneyber MC, de Luca D, Calderini E, Jarreau PH, Javouhey E, al. e. Recommendations for Mechanical Ventilation of Critically Ill Children From the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Medicine. 2017 Diciembre; 43(12).
33. Franklin D, Babl FE, Schlapbach LJ, Oakley E, al e. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. The New England Journal of Medicine. 2018 Marzo; 378.
34. Wainwright C, France M, O'Rourke P, Anuj T, Kidd J, Nissen M, et al. Cough-generated Aerosols of Pseudomonas Aeruginosa and Other Gram-negative Bacteria From Patients With Cystic Fibrosis. Thorax. 2009 Noviembre; 64(11).
35. Aintablian N, Walpita P, Sawyer M. Detection of Bordetella Pertussis and Respiratory Synctial Virus in Air Samples From Hospital Rooms. Infection Control Hospital Epidemiology. 1998 Diciembre; 19(12).
36. Gattinoni M. Sitio web de la Society for Pediatric Anesthesia. [Online].; 2020 [cited 2020 Marzo 28. Available from: https://www.pedsanesthesia.org/wp-content/uploads/2020/03/Ventilator-Management_Covid-19-ICU-EXPERT-OPINION-Gattinoni.pdf.
37. Medina Villanueva A, Pons Odena M, Martinon-Torres F. Non-invasive ventilation in pediatrics. Tercera ed. Barcelona: Ergón; 2015.
38. Mayordomo-Colunga J, Medina A, Rey C, Díaz JJ, Concha A, Al. e. Predictive Factors of Non Invasive Ventilation Failure in Critically Ill Children: A Prospective Epidemiological Study. Intensive Care Medicine. 2008 Marzo; 35(5).
39. Khemani RG, Rubin S, Belani S, Leung D, Erickson S, al. e. Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definitionof ARDS and mortality risk. Intensive Care Medicine. 2015 Septiembre; 41.
40. Sun Q, Qiu H, Huang M, Yang Y. Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province. Annals of Intensive Care. 2020 Marzo; 10(33).
41. Moreno L, Ferrero F, Abramovich N, Aguerre V, Bruno M, al. e. Sitio web de la Sociedad Argentina de Pediatría. [Online].; 2010 [cited 2020 Abril 13. Available from: https://www.sap.org.ar/docs/profesionales/consensos/Subcom.Abram.pdf.
42. Khemani RG, Patel NR, Bart 3rd RD, Newth CJ. Comparison of the Pulse Oximetric Saturation/Fraction of Inspired Oxygen Ratio and the PaO2/fraction of Inspired Oxygen Ratio in Children. Chest. 2009 Marzo; 135(3).
43. Lee CM, Fan E. ICU-acquired Weakness: What Is Preventing Its Rehabilitation in Critically Ill Patients? BMC Medicine. 2012 Octubre; 3(10).
44. Godoy DA, Mello Vd, Masotti L, Di Napoli M. Intesive Care Unit Acquired Weakness (ICU-AW): a brief and practical review. Reviews in Health Care. 2015; 6(1).
45. McGloughlin S, Fraser M, Nicholls M, Attokaran AG, Avard B, al. e. Sitio web de la Sociedad de terapia intensiva Australiana y Neozelandeza ANZICS. [Online].; 2020 [cited 2020 Abril 26. Available from: https://www.anzics.com.au/wp-content/uploads/2020/04/ANZI_3367_Guidelines_V2.pdf.
46. Hunter A, Johnson L, Coustasse A. Reduction of Intensive Care Unit Length of Stay: The Case of Early Mobilization. The Health Care Manager. 2014; 33(2).
47. Field-Ridley A, Dharmar M, Steinhorn D, McDonald C, Marcin JP. ICU-Acquired Weakness Is Associated With Differences in Clinical Outcomes in Critically Ill Children. Pediatric Critical Care Medicine. 2016 Enero; 17(1).
48. Wieczorek B, Ascenzi J, Kim Y, Lenker H, Potter C, al. e. PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill Children. Pediatric Critical Care Medicine. 2016 Diciembre; 17(12).
49. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, al. e. Journal of phisiotherapy. [Online].; 2020 [cited 2020 Abril 12. Available from: https://www.journals.elsevier.com/journal-of-physiotherapy.
1. Ministerio de salud de la república Argentina. Ministerio de salud. [Online].; 2020 [cited 2020 Abril 17. Available from: http://www.msal.gob.ar/images/stories/bes/graficos/0000000840cnt-2018-07_guia-infecciones-respiratorias-agudas-web.pdf.
2. Zheng F, Liao C, Fan QH. Clinical Characteristics of children with coronavirus disease 2019 in Hubei, China. Current Medical Science. 2020; 40(2).
3. World Health Organization regional office for Europe. World Health Organization regional office for Europe. [Online].; 2020 [cited 2020 Marzo 12. Available from: http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic.
4. Yan-Rong G, Quing-Dong C, Zhong-Si H, Yuan-Yang T. The Origin, Transmission and Clinical Therapies on Coronavirus Disease 2019 (COVID-19) Outbreak - An Update on the Status. Milatary Medical Research. 2020 Marzo; 7(11).
5. Cruz AT, Zeichner SL. COVID-19 in Children: Initial Characterization of the Pediatric Disease. Pediatrics. 2020 Junio; 145(6).
6. Singhal T. A review of Coronavirus Disease-2019 (COVID-19). The indian journal of pediatrics. 2020 Abril; 87(4).
7. Pagina Oficial del gobierno de la república Argentina. Pagina Oficial del gobierno de la república Argentina. [Online].; 2020 [cited 2020 Marzo 26. Available from: https://www.argentina.gob.ar/salud/coronavirus-COVID-19.
8. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Medicine. 2020 Abril.
9. Sociedad Argentina de Cardiologia. Sociedad Argentina de cardiología. [Online].; 2020 [cited 2020 Abril 18. Available from: https://www.sac.org.ar/coronavirus.
10. Vaduganathan M, Vardeny O, Michel T, McMurray J, Pfeffer M, Solomon S. Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19. The new england journal o f medicine. 2020 Abril; 182(17).
11. Weiyong L, Qi Z, Junbo C, Rong X, Huijuan S, Sainan S, et al. Detection of Covid-19 in Children in Early January 2020 in Wuhan, China. New England Journal of medicine. 2020 Marzo; 182(14).
12. Brodin P. Why is COVID-19 so mild in children? Acta Pediatrica. 20202 Marzo; 109(6).
13. Sociedad Argentina de Pediatría. Sociedad Argentina de pediatría. [Online].; 2020 [cited 2020 Abril 12. Available from: https://www.sap.org.ar/publicaciones/contenidos-extras/23/reuniones-y-documentos-con-actualizacion-permanente-sobre-coronavirus-covid-19.html.
14. Davis A, Carcillo J, Aneja R, Deymann A, Lin J. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Critical Care Medicine. 2017 Junio; 45(6).
15. James A, Yves C, Carmen Lúcia PS, Paul J, Yuguo Liand WHS. Natural Ventilation for Infection Control in Health-Care Settings. World Health Organization. 2009.
16. Wells WF. Sanitary Ventilation. American Journal of Public Health. 1947 Octubre; 38.
17. Nicas M. An integrated model of infection risl in a Health-CARE enviroment. Risk Analysis An international Journal. 2006 Septiembre; 26(4).
18. Hualing Z, Dan L, Ling X, Yimin X. Documentary research of human respiratory droplet characteristics. Procedia Engineering. 2015 Octubre; 121.
19. Pagina oficial del gobierno de la República Argentina. Argentina.gob.ar. [Online].; 2020 [cited 2020 Abril 18. Available from: www.argentina.gob.ar/salud/coronavirus-COVID-19/recomendaciones-uso-epp.
20. Centers for disease control and prevention. Sitio web del Centers for disease control and prevention. [Online].; 2020 [cited 2020 Abril 12. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html.
21. Arabi Y, Phua J, Koh Y, Du B, Faruq MO, Nishimura M, et al. Structure, Organization, and Delivery of Critical Care in Asian ICUs. Critical Care Medicine. 2016 Octubre; 44(10).
22. Gomersall C, Tai D, S L, Derrick J, Goh M, Buckley T, et al. Expanding ICU facilities in an epidemic: recommendations based on experience from the SARS epidemic in Hong Kong and Singapore. Intensive Care Medicine. 2006 Marzo; 32(7).
23. Phua J, Weng L, Ling L, Egi M, Lim CM, al. e. Intensive Care Management of Coronavirus Disease 2019 (COVID-19): Challenges and Recommendations. Lancet Respiratory Medicine. 2020 Mayo; 8(5).
24. Centers for Disease Control and Prevention. Sitio web del Centers for Disease Control and Prevention. [Online].; 2005 [cited 2020 Abril 13. Available from: https://www.cdc.gov/infectioncontrol/guidelines/isolation/glossary.html.
25. Hospital Italiano de Buenos Aires Comité de control de infecciones. Sitio web del Hospital Italiano de Buenos Aires. [Online].; 2010 [cited 2020 Abril 20. Available from: https://www.hospitalitaliano.org.ar/multimedia/archivos/noticias_archivos/74/documentos/74_INSTRUCTIVOPURIFICADORESDEAIRE.pdf.
26. Centers for Disease Control and Prevention. Sitio web de Centers for Disease Control and Prevention. [Online].; 2010 [cited 2020 Abril 12. Available from: https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/air.html#c3bi.
27. Organizacion panamericana de la salud - Oficina de la organizacion mundial de la salud. Sitio web de la Organizacion panamericana de la salud. [Online].; 2020 [cited 2020 Abril 13. Available from: https://www.paho.org/hq/dmdocuments/2011/ventilacion_natual_spa_25mar11.pdf.
28. Anderson TA, Hart GK, Kainer MA, Commitee ADM. Pandemic Influenza-Implications for Critical Care Resources in Australia and New Zealand. Journal of Critical Care. 2003 Septiembre; 18(3).
29. Bezzi M, Fredes S, Tiribelli N, Setten M, Rodrigues La Moglie R, Plotnikow G, et al. Guía de manejo de pacientes adultos críticos para kinesiología intensivista en COVID-19. Revista Argentina de Terapia Intensiva. 2020 Abril.
30. Monteverde E, Fernández A, Ferrero F, Barbaro C, De Lillo LM, Golubicki A, et al. High-flow Nasal Cannula Oxygen Therapy in Infants With Acute Lower Respiratory Tract Infection. An Experience in Hospitals of the City of Buenos Aires. Archivos Argentinos de Pediatría. 2019 Octubre; 117(5).
31. Xiaobo Y, Yuan Y, Jiqian X, Huaqing S, Jia´an X, Hong L, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine. 2020 Mayo; 8(5).
32. Kneyber MC, de Luca D, Calderini E, Jarreau PH, Javouhey E, al. e. Recommendations for Mechanical Ventilation of Critically Ill Children From the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC). Intensive Care Medicine. 2017 Diciembre; 43(12).
33. Franklin D, Babl FE, Schlapbach LJ, Oakley E, al e. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. The New England Journal of Medicine. 2018 Marzo; 378.
34. Wainwright C, France M, O'Rourke P, Anuj T, Kidd J, Nissen M, et al. Cough-generated Aerosols of Pseudomonas Aeruginosa and Other Gram-negative Bacteria From Patients With Cystic Fibrosis. Thorax. 2009 Noviembre; 64(11).
35. Aintablian N, Walpita P, Sawyer M. Detection of Bordetella Pertussis and Respiratory Synctial Virus in Air Samples From Hospital Rooms. Infection Control Hospital Epidemiology. 1998 Diciembre; 19(12).
36. Gattinoni M. Sitio web de la Society for Pediatric Anesthesia. [Online].; 2020 [cited 2020 Marzo 28. Available from: https://www.pedsanesthesia.org/wp-content/uploads/2020/03/Ventilator-Management_Covid-19-ICU-EXPERT-OPINION-Gattinoni.pdf.
37. Medina Villanueva A, Pons Odena M, Martinon-Torres F. Non-invasive ventilation in pediatrics. Tercera ed. Barcelona: Ergón; 2015.
38. Mayordomo-Colunga J, Medina A, Rey C, Díaz JJ, Concha A, Al. e. Predictive Factors of Non Invasive Ventilation Failure in Critically Ill Children: A Prospective Epidemiological Study. Intensive Care Medicine. 2008 Marzo; 35(5).
39. Khemani RG, Rubin S, Belani S, Leung D, Erickson S, al. e. Pulse oximetry vs. PaO2 metrics in mechanically ventilated children: Berlin definitionof ARDS and mortality risk. Intensive Care Medicine. 2015 Septiembre; 41.
40. Sun Q, Qiu H, Huang M, Yang Y. Lower mortality of COVID-19 by early recognition and intervention: experience from Jiangsu Province. Annals of Intensive Care. 2020 Marzo; 10(33).
41. Moreno L, Ferrero F, Abramovich N, Aguerre V, Bruno M, al. e. Sitio web de la Sociedad Argentina de Pediatría. [Online].; 2010 [cited 2020 Abril 13. Available from: https://www.sap.org.ar/docs/profesionales/consensos/Subcom.Abram.pdf.
42. Khemani RG, Patel NR, Bart 3rd RD, Newth CJ. Comparison of the Pulse Oximetric Saturation/Fraction of Inspired Oxygen Ratio and the PaO2/fraction of Inspired Oxygen Ratio in Children. Chest. 2009 Marzo; 135(3).
43. Lee CM, Fan E. ICU-acquired Weakness: What Is Preventing Its Rehabilitation in Critically Ill Patients? BMC Medicine. 2012 Octubre; 3(10).
44. Godoy DA, Mello Vd, Masotti L, Di Napoli M. Intesive Care Unit Acquired Weakness (ICU-AW): a brief and practical review. Reviews in Health Care. 2015; 6(1).
45. McGloughlin S, Fraser M, Nicholls M, Attokaran AG, Avard B, al. e. Sitio web de la Sociedad de terapia intensiva Australiana y Neozelandeza ANZICS. [Online].; 2020 [cited 2020 Abril 26. Available from: https://www.anzics.com.au/wp-content/uploads/2020/04/ANZI_3367_Guidelines_V2.pdf.
46. Hunter A, Johnson L, Coustasse A. Reduction of Intensive Care Unit Length of Stay: The Case of Early Mobilization. The Health Care Manager. 2014; 33(2).
47. Field-Ridley A, Dharmar M, Steinhorn D, McDonald C, Marcin JP. ICU-Acquired Weakness Is Associated With Differences in Clinical Outcomes in Critically Ill Children. Pediatric Critical Care Medicine. 2016 Enero; 17(1).
48. Wieczorek B, Ascenzi J, Kim Y, Lenker H, Potter C, al. e. PICU Up!: Impact of a Quality Improvement Intervention to Promote Early Mobilization in Critically Ill Children. Pediatric Critical Care Medicine. 2016 Diciembre; 17(12).
49. Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, al. e. Journal of phisiotherapy. [Online].; 2020 [cited 2020 Abril 12. Available from: https://www.journals.elsevier.com/journal-of-physiotherapy.
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