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Objective: To assess the prevalence of systemic inflammatory syndromes on admission to a tertiary-care university pediatric intensive care unit (ICU), and relate this to length of hospital stay, risk of death and mortality rate.Methods: Cross-sectional, prospective, observational study, including all patients admitted to the Hospital de Clínicas de Porto Alegre (HCPA) ICU between August 1 st 1999 and July 31 st 2000. Patient demographic variables were considered together with the risk of mortality on admission, co-morbidities, length of hospital stay and ICU outcome, in addition to variables that characterize the systemic inflammatory syndromes (systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock).Results: We studied 447 admissions of 388 patients; 54% were male, with a median age of 20 months. The prevalence of systemic inflammatory response syndrome (SIRS) was 68%: 2/3 infectious (sepsis, severe sepsis or septic shock) and 1/3 non-infectious. Risk of mortality scores for patients with infectious SIRS were higher than for those with non-infectious SIRS (6.75% [P25=2.25 -P75=21.3] vs. 2.35% [P25=1.1 -P75=6.7]; p=0) and increased according to SIRS severity (2.9; 10.85, 43.9%; p<0.05). The observed mortality was 12% for patients with SIRS and 5.8% for those without SIRS (p=0.057); the observed mortality for infectious SIRS was 14.9% and for non-infectious 6.3% (p=0.041). The period spent in ICU for infectious SIRS was longer than for non-infectious cases: 3 days (P25=2 -P75=7) vs. 2 days (P25=1.5 -P75=4); p=0.006. Conclusions:The prevalence rate of patients with systemic inflammatory response syndrome upon admission to HCPA pediatric intensive care unit was elevated, with a predominance of infectious syndromes, responsible for longer stays, increased risk of mortality and increased mortality of patients during the period evaluated.J Pediatr (Rio J). 2005;81(2):143-8: Systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, prevalence, mortality, intensive care, children.

Background: Exogenous surfactant should be used as early as possible in the presence of respiratory distress syndrome (RDS), but diagnosis may only become clear late in the course of the disease. The stable microbubble test (SMT) in the tracheal aspirates could help in the decision to give early surfactant to preterm babies with respiratory distress. Objectives: The objective of this study was to evaluate the accuracy of the SMT on tracheal aspirate for the diagnosis of RDS in newborns requiring mechanical ventilation. Methods: The test was performed on specimens obtained from 74 infants requiring mechanical ventilation, through routine suctioning. Results: Patients with RDS and meconium aspiration syndrome (MAS) had a significantly lower stable microbubble count than non-RDS and non-MAS patients. Preterm infants without RDS had a significantly higher microbubble count than preterm babies with RDS and a similar count to that of term babies. Considering a cutoff point of 120 microbubbles/mm² for the diagnosis of RDS, the sensitivity of the microbubble test was 96.3% (95% CI: 79.1–99.8) and the specificity 97.6% (95% CI: 85.9–99.9). Conclusions: The SMT on tracheal aspirates is accurate for RDS diagnosis and may be useful to support the decision to give surfactant to newborns on mechanical ventilation.