Diaphragm atrophy is present in children on mechanical ventilation for acute respiratory failure. Diaphragm contractility, measured as thickening fraction, is strongly correlated with spontaneous breathing fraction. The combination of exposure to neuromuscular blockade infusion with low overall spontaneous breathing fraction is associated with a greater degree of atrophy.

[a] have been described in humans, ranging in size from Ͻ 300 kDa to Ͼ 800 kDa (2).Plasma levels of Lp[a] vary greatly between individuals, from Ͻ 1 mg/dl to Ͼ 100 mg/dl (2). The source of most of this variability in plasma concentrations is variability in the production rate of Lp[a] (3, 4), which, in turn, is controlled largely by the apo[a] gene locus (5). Apo[a] is synthesized by hepatocytes and rapidly associates with LDL after secretion to form Lp[a] in the sinusoids of the liver (2, 6). Although the steps involved in Lp[a] production are known, the major mechanisms involved in Lp [a] clearance from plasma are not currently known. It has been suggested that the kidney might play a major role in Lp[a] clearance, after several clinical studies reported increased plasma Lp[a] levels in patients with renal failure (7,8). In addition, Kronenberg et al. (9) Several receptors that mediate the binding and uptake of lipoproteins containing apoB-100 have been proposed as receptors for Lp [a] catabolism. These include the LDL receptor (LDLR) (10-15), megalin/gp330 (16), the LDL receptor-related protein (LRP) (17), and the VLDL receptor (18). The latter two receptors can mediate binding to lipoproteins through apoE. According to the secretioncapture model, apoE that is secreted by the liver rapidly

Implementation of a critical care bedside ultrasound program for critical care providers in a large academic PICU is feasible. Bedside ultrasound evaluation and interpretation by intensivists affected the management of critically ill children.