Objective: Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Case description: A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. Comments: Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.

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RESUMO OBJETIVO: Avaliar o desempenho dos escores de mortalidade Pediatric Risk of Mortality (PRISM) e Pediatric Index of Mortality 2 (PIM2) na Unidade de Terapia Intensiva Pediátrica (UTIP) Terciária da Fundação Santa Casa de Misericórdia do Pará (FSCMPA). MATERIAIS E MÉTODOS: Estudo de coorte retrospectivo, incluindo pacientes admitidos na UTIP, entre janeiro de 2017 a abril de 2018, com permanência por mais de 8 h. Os critérios de exclusão foram: permanência superior a 90 dias; parada cardiorrespiratória sem estabilidade em 12 h; cuidados paliativos; e morte encefálica. Para calcular os sistemas de escores e desfecho, utilizou-se as variáveis Standardized Mortality Rate (SMR), calibração e discriminação, que foram comparadas pelos testes goodness-of-fit e curvas Receiver Operating Characteristic (ROC), respectivamente. RESULTADOS: Entre as 458 internações, 429 (93,7%) foram incluídas. A mortalidade geral foi de 17,5%, sendo que 64,0% eram menores de 2 anos de idade e 58,7% dos que evoluíram a óbito foram submetidos à ventilação mecânica por período maior que sete dias. A média de probabilidade de morte estimada do PRISM foi 9,85%, enquanto a média do PIM2 foi de 14,2%. O SMR foi de 1,35 (1,26-1,72) para o PRISM e de 1,23 (1,13-1,58) para o PIM2. A área sob a curva ROC foi de 0,89 (IC 95% 0,81-0,91) para o PRISM e 0,87 (IC 95% 0,83-0,91) para o PIM2. CONCLUSÃO: Na UTIP da FSCMPA, o PRISM e o PIM2 tiveram boa calibração e bom poder discriminatório. O SMR foi superior a um.ABSTRACT OBJECTIVE: To evaluate the performance of the Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality 2 (PIM2) scores in the Tertiary Pediatric Intensive Care Unit (PICU) of the Fundação Santa Casa de Misericórdia do Pará (FSCMPA). MATERIALS AND METHODS: A retrospective cohort study was conducted with patients hospitalized in PICU for more than 8 h, from January 2017 to April 2018. Exclusion criteria were: stay longer than 90 days; cardiorespiratory arrest without stability in 12 h; palliative care; and brain death. To calculate score and outcome systems, Standardized Mortality Rate (SMR), calibration, and discrimination variables were used and compared by goodness-of-fit and Receiver Operating Characteristic (ROC) curves, respectively. RESULTS: Among the 458 hospitalizations, 429 (93.7%) were included. Overall mortality was 17.5%, with 64.0% under 2 years of age; and 58.7% of those who evolved to death were submitted to mechanical ventilation for more than seven days. The estimated mean probability of death from PRISM was 9.85%, while the mean PIM2 was 14.2%. The SMR was 1.35 (1.26-1.72) for PRISM and 1.23 (1.13-1.58) for PIM2. The area under the ROC curve was 0.89 (95% CI 0.81-0.91) for PRISM and 0.87 (95% CI 0.83-0.91) for PIM2. CONCLUSION: In the FSCMPA PICU, PRISM and PIM2 had good calibration and good discriminatory power. The SMR was greater than one.

Objectives: To determine blood glucose distribution values; to assess the association of admission serum glucose levels with 28-day mortality to the frequency of invasive mechanical ventilation-free days. Design: Retrospective cohort studySetting: Brazilian Amazon Region. Patients: Population (n = 400) composed of patients admitted to the pediatric intensive care unit, from January 2016 to December 2017. Exclusion criteria were patients with length of stay of <24 hours; diabetes mellitus; suspicion or evidence of inborn errors of metabolism; insulin use; palliative care and brain death. Main outcome measures: The patients were divided into 4 groups: 1) serum glucose <60mg/dL; 2) control group if serum glucose between 60-126 mg/dL; 3) between 127-150mg/dL; or 4) if > 150mg/dL. Results: Serum glucose levels frequency were: <60: 43 (11%); 60-126: 235 (58.7%); 127-150: 51 (13%) and > 150: 71 (18%). Groups 3 and 4 had the highest frequency of external origin, with respectively 24 (47.1%) and 40 (56.3%); the main diagnosis was infection, with 26 (51%) and 50 (70.4%), respectively. Sepsis occurred in 24 (47.1%) and 47 (66.2%) individuals in the groups 3 and 4, respectively, while septic shock was more frequent in the group 4 (46 [4.8%]). Group 2 had predominance of ventilator-associated pneumonia with 11 (36.7%). The estimate of ventilation-free days in group 4 was 2.84 (SD +/- 0.69; 95% CI: 1.5-4.2). Conclusion: Hyperglycemia group had a lower frequency of ventilation-free days and higher 28-day mortality.

Background: Electrical impedance tomography (EIT) is widely used in the practice of patients with respiratory distress syndrome (ARDS), but little is known about the determination of adequate positive end-expiratory pressure (PEEP) in the pediatric intensive care unit. Aim: Evaluating the effects of titration of PEEP with EIT after alveolar recruitment in children with ARDS on ventilatory variables and blood gas analysis. Methods: This is a longitudinal analytical study carried out in the pediatric intensive care unit. The study included 5 patients diagnosed with ARDS, aged between 6 and 11 years and had an indication for alveolar recruitment maneuver (RM). The EIT belt was posicionated around the sternum and the ventilatory variables were collected (compliance, regional ventilation, driving pressure, alveolar overdistension, alveolar collapse and PEEP titration) and blood gas analysis. The RM was performed in steps, then PEEP titration was performed with the help of the EIT. Results: There was a significant improvement in the ventilatory variables and blood gas analysis of the participants after PEEP titration. The parameters that most changed the pre-and posttitration values were pulmonary compliance (p<0.05), alveolar overdistension (p<0.05), partial pressure of carbon dioxide (p<0.01), blood pressure of oxygen and arterial oxygen saturation (p<0.05). Conclusion: Titration of PEEP with the aid of EIT is safety, improving ventilation and basic acid balance in children with ARDS.

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