Rationale: Limited data exist about the international burden of severe sepsis in critically ill children.Objectives: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials.Methods: A point prevalence study was conducted on 5 days throughout 2013-2014 at 128 sites in 26 countries. Patients younger than 18 years of age with severe sepsis as defined by consensus criteria were included. Outcomes were severe sepsis point prevalence, therapies used, new or progressive multiorgan dysfunction, ventilator-and vasoactive-free days at Day 28, functional status, and mortality.Measurements and Main Results: Of 6,925 patients screened, 569 had severe sepsis (prevalence, 8.2%; 95% confidence interval, 7.6-8.9%). The patients' median age was 3.0 (interquartile range [IQR], 0.7-11.0) years. The most frequent sites of infection were respiratory (40%) and bloodstream (19%). Common therapies included mechanical ventilation (74% of patients), vasoactive infusions (55%), and corticosteroids (45%). Hospital mortality was 25% and did not differ by age or between developed and resourcelimited countries. Median ventilator-free days were 16 (IQR, 0-25), and vasoactive-free days were 23 (IQR,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Sixty-seven percent of patients had multiorgan dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multiorgan dysfunction. Among survivors, 17% developed at least moderate disability. Sample sizes needed to detect a 5-10% absolute risk reduction in outcomes within interventional trials are estimated between 165 and 1,437 patients per group.Conclusions: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted.

High-flow humidified oxygen (HFHO) is a respiratory therapy which allows the administration of an oxygen/air admixture via a nasal cannula at flows greater than 2 L/min. [1] The precise amount of oxygen delivered can be independently titrated to the oxygen flow with delivery of up to 100% oxygen attainable. In addition, the oxygen/air admixture is heated to a temperature of 34 °C and humidified to 'optimal humidity' with a water content of 44 mg/L. The benefits of HFHO therapy on the respiratory system appear to be numerous. [2,3] The high inspiratory flows result in reduced work of breathing, as well as washout of nasopharyngeal dead space. By warming and humidifying inspired gas, it firstly reduces the metabolic work of the patient, and secondly, it minimises the pulmonary broncho-constrictor response which is mediated by nasal muscarinic receptors. [4] In this way, both conductance as well as compliance in the lungs is improved. [5] Additionally, flows above 2 L/kg/min appear to provide some positive end-expiratory pressure (PEEP), estimated to be ~4 cmH 2 O. The amount of PEEP generated appears to be related to both the flow rate and size of the nasal cannula used. [6,7] At the time of embarking on our study, the use of HFHO therapy in infants with a diagnosis of bronchiolitis appeared to be a promising therapy, but its place in the routine management of these infants was not clear in the absence of data from high-quality RCT's. One RCT in infants with moderate bronchiolitis had shown that among infants given HFHO at 1 L/kg/min compared with those given 2 L nasal cannula oxygen, there was no difference between groups in terms of the time spent requiring oxygen. [8] This research aimed to test the hypothesis that there would be no difference in respiratory distress (as measured by the Modified TAL (M-TAL) score) in infants with bronchiolitis who have more severe disease (M-TAL score >6 and hypoxaemia in room air), when comparing standard oxygen therapy to HFHO therapy. The primary outcome assessed was the severity of respiratory distress (measured by the M-TAL score), and the secondary outcome

No abstract

IntroductionHerpes simplex virus has been reported in the literature to commonly complicate burn wounds. However, there is paucity of such data in the South African setting.Case presentationEight paediatric burns patients with ages ranging between 10 months and 5 years presented with a febrile maculopapular rash illness in a paediatric ward of a large South African tertiary hospital. The rash became vesicular in three cases, involving the limbs and face. Varicella was suspected.Management and outcomeMedical records of suspected cases were reviewed. Blood, vesicular fluid and scab samples were collected. Electron microscopy of vesicular fluid revealed herpes virus particles. Laboratory testing confirmed herpes simplex virus type 1.ConclusionHerpes simplex virus type 1 infection can present atypically in burns patients.