Background and Aims:Studies carried out in different countries have shown that source of patient admission in Intensive Care Units (ICUs) is associated to death. Patients admitted from wards show a greater ICU mortality. The aim of the present study was to investigate the association between admission source and outcome in a Pediatric Intensive Care Unit (PICU).Materials and Methods:We studied all PICU admissions that took place between January 2002 and December 2005 in a tertiary hospital in Brazil. The major outcome studied was death while in the PICU. The independent variable analyzed was admission source, defined either as pediatric emergency room (PER), wards, operating room (OR) of the same hospital or other sources.Results:A total of 1823 admissions were studied. The overall expected mortality based on the Pediatric Index of Mortality 2 was 6.5% and the observed mortality was 10.3%. In adjusted analysis, the mortality was doubled in patients admitted from wards when compared with the PER patients.Conclusions:Observed mortality rates were higher in patients admitted from wards within the same hospital, even after adjustment.

The high prevalence of prescription of drugs not appropriate for children confirms, in the Brazilian context, the inadequate and inadvertent use of drugs either not approved or off-label for PICU use. This demonstrates the need to encourage further studies on the quality, efficacy and safety of drugs for pediatric use.

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Objective: To present a critical and updated review about sepsis, focusing especially on diagnosis and treatment. Sources of data:Literature review of Medline, including review articles, clinical trials and original research. Summary of the findings:The International Sepsis Definitions Conference amplified the list of possible clinical and laboratory signs of sepsis, which may allow for more efficacious suspicion and management. In terms of laboratory evaluation, in addition to the research for infectious agents, many inflammatory response markers, such as inflammatory cytokines and procalcitonin, have been identified. However, they lack sensitivity and specificity for safe diagnosis. In terms of treatment, early intervention to prevent hemodynamic disturbances is still essential for a positive outcome, together with the appropriate use of antimicrobials. The value of treatments to remove toxins and to increase the innate immune response has not yet been established. The use of isolated inflammatory response blockers, at any stage of sepsis, does not decrease mortality. The use of corticosteroid makes a comeback with encouraging results, even in patients without sepsis-related adrenal insufficiency. A large study on activated protein C (drotrecogin-α) reports a 6% decrease in mortality in a selected sample, suggesting the possibility of a better prognosis for sepsis patients. Conclusions:In comparison to the advances of the past few years, little has been achieved in terms of decreasing sepsis-related mortality due to the complexity of the pathogen-host relationships. The individual regulation of host reactions did not have the expected effects. The benefits of some known strategies were confirmed. Other types of treatment, such as corticosteroids and activated protein C therapies, are emerging as promising alternatives. Research indicates that the combination of immune modulator therapies is probably the best choice to improve outcomes in sepsis.J Pediatr (Rio J) 2003;79(Suppl 2):S195-S204: Sepsis, systemic inflammatory response syndrome, critical care. Advances in sepsis diagnosis and treatment

Validation of sedation scores in mechanically ventilated children admitted to a tertiary pediatric intensive care unit Validação de escalas de sedação em crianças submetidas à ventilação mecânica internadas em uma unidade de terapia intensiva pediátrica terciária Artigo originAl introDUCtion Most patients admitted to the pediatric intensive care unit (ICU) need sedation and analgesia to optimize treatment. Sedation lessens agitation and permits better synchronization with mechanical ventilation, reduces oxygen demand and controls anxiety or pain caused by disease or by the unit environment. (1) For an adequate assessment of the patient's sedation level, a practical, objective and easy to use tool is required. Although the clinical opinion of physicians and nurses is important, a scale application is required to estimate the neurophysiologic effects of sedatives and other interventions as well as to permit a comparison between samples of