An experienced cardiac anesthesiologist and critical care physician, Dr. Jose Diaz-Gomez serves as chief for cardiothoracic, circulatory support, and transplantation critical care for the Baylor College of Medicine in Houston. One of Dr. Jose Diaz-Gomez’s areas of expertise is transesophageal echocardiography.
Transesophageal echocardiography (TEE) is a form of ultrasound medical imaging that uses high-frequency sound waves to produce pictures of the heart and the various arteries and veins that connect to it. Providing significantly more detail than a traditional echocardiogram, these pictures (called transesophageal echocardiograms) are powerful tools when it comes to examining and evaluating the structural integrity and functional processes of the heart.
The TEE procedure involves inserting a sound wave-producing echo transducer through the throat and into the esophagus of the patient. This places the transducer close to the upper chambers of the heart, enabling the TEE equipment to produce extremely clear video images transmitted in real time to a monitor for immediate analysis.
TEE overcomes some of the difficulties of performing surface or transthoracic echocardiography. And it assist the clinician recognizing treatable causes of cardiac arrest. Also, TEE provides a higher quality cardiac imaging given its position after insertion in the esophagus (directly, behind the heart). Thus, TEE images can be extremely valuable during cardiac arrest without requiring to cease external cardiac compressions.
The Society of Critical Care Medicine (SCCM) focuses on promoting excellent practices in critical care. Among its many activities, it hosts the Critical Care Congress. In February 2021, the 50th anniversary of this event, researchers presented interesting findings related to pediatric care, including one presentation focusing on the incidence of sepsis in children.
The presentation was based on a study that made the connection among children who developed sepsis, their stay in critical care units, and their socio-economic background. Critical care is typically located in the intensive care unit (ICU) and is for patients who have incurred serious, life-threatening injuries or illnesses. One condition treated in the ICU is sepsis, which refers to the body’s extreme response to an infection, one that typically starts in the lung, urinary tract, skin, or gastrointestinal tract. Left untreated, sepsis can lead to organ damage.
Other studies have already proven that improving conditions in a hospital can result in better outcomes for patients, including children. A 2020 study conducted at the Muhimbili National Hospital (MNH) in Tanzania found that when the quality of care for children achieved the minimum standard, education and training for staff was provided, and equipment was updated, the result was reduced pediatric sepsis mortality.
Improving conditions does have positive a impact, but what if the child comes from a low-income neighborhood? The study presented at the SCCM conference answered the above question by looking at children living in zip codes that were low-income in comparison to zip codes in more affluent neighborhoods. Researchers found that, of the 10,000 children hospitalized with sepsis, the ones who came from homes located in low-income neighborhoods stayed in the hospital one day longer.
Data gleaned from the Nationwide Readmissions Database was used in the study. Researchers focused on more than 1 million children who were hospitalized from 2016 to 2017 with sepsis. They separated the children into quartiles based on the average household income to make comparisons.
The data revealed that 3,140 (30.1 percent) children lived in the lowest-income quartile while 1,736 (17.1 percent) were in the highest-income quartile. The study found that while 8.4 percent of all of the children succumbed to sepsis, they could not find a connection between family income and susceptibility to contracting the condition.
However, researchers did discover that those children living in the lowest income zip codes stayed in the hospital a median of nine days, as opposed to eight days for children living in the wealthiest zip codes. They also determined that children living in the lowest-income zip codes were younger (age 11) compared to the wealthiest children (age 13). The lowest-income group also received more financial support from Medicaid.
While this is a start, researchers need to know more before drawing additional conclusions. For example, some of the gaps that need to be filled include understanding disparities in healthcare centers, the type of care delivered, or outside factors related to this group of children not being able to go home after recovery.
These results are important because they highlight the income disparities that exist in healthcare at the early stages of life for many children. According to the Surviving Sepsis Campaign, 1.2 million children worldwide develop this condition, and this study illustrates the need to provide accessible and culturally appropriate interventions that make receiving care affordable for all children.
Some of the policy interventions that might make a difference in reducing the incidence of sepsis for children from families on the lower end of the socioeconomic ladder include access to clean water, safe spaces to play, and healthy food. For more information on this topic and others on critical care, please visit http://www.sccm.org/About-SCCM.
Jose Diaz Gomez 