The goals of management of pediatric patients with intracranial hypertension include: normalizing the intracranial pressure, optimizing cerebral blood flow and cerebral perfusion pressure, preventing second insults that exacerbate secondary injury, and avoiding complications associated with the various treatment modalities employed.

ResumoA obtenção e manutenção de via aérea artificial é atualmente um procedimento rotineiro nas UTIs pediátricas. Entretanto existe um risco não desprezível de ocorrência de extubação acidental (EA) que varia, nos diversos serviços, entre 0,9 e 3,3 EA para cada 100 dias de entubação. A ocorrência de EA está relacionada a fatores de risco como grau de sedação, faixa etária, via de intubação, entre outros. Os autores se propuseram a verificar a incidência de EA em seu serviço e comparar, através do risco relativo, a taxa de EA entre os pacientes entubados via oro e naso traqueal. Foi realizado um estudo prospectivo por um período de 6 meses, sendo acompanhados todos os pacientes entubados internados na UTI do Hospital da Criança Santo Antônio, de Porto Alegre (Brasil), exceto aqueles com traqueostomia, totalizando 673 pacientes-dias com via aérea artificial, com uma média de 3,7 pacientes entubados por dia. Ocorreram 18 extubações acidentais, com uma taxa de 2,7 EA/100dias. A incidência de EA na via orotraqueal foi de 3,1% contra 1,6% na via nasotraqueal (p=0,6), não havendo diferença estatisticamente significativa. Os autores concluem que a via de entubação não consiste em risco adicional para a ocorrência de extubação acidental. J. pediatr. (Rio J.). 1995; 71(2):72-76:Extubação, intubação, via aérea artificial, tubo traqueal, tubo nasotraqueal, tubo orotraqueal. AbstractIt is an on-going practice in the pediatric ICUs to obtain and to maintain a working artificial airway. Nevertheless this procedure bears not infrequent risks of accidental extubation (AE) which ranges in several services from 0,9 to 3,3 for each 100 days of intubation. The risk factors that are involved in AE are related to: sedation level, age-group, intubation path, and others. The purpose of the authors in this article was to observe the incidence of AE in their service and to compare the relative risk in the rate of AE among orotracheal and nasotracheal intubation population. A prospective study was taken during six months, in which every patients with artificial airway admitted at the PICU of the Santo Antonio Hospital in Porto Alegre (Brazil) was included except those with tracheostomy. The total number of cases were 673 patients-day with artificial airway, with an average of 3.7 patients with tracheal tube per day. In the period there were 18 AE, with a rate of 2.7 AE/ 100 days. The incidence rate of AE in the orotracheal group was 3.1% and 1.6% in the nasotracheal group with no statistically significant difference (p=0.6). The authors concluded that the pathway of intubation in their study does not carry any additional risk in the incidence of accidental extubation. J. pediatr. (Rio J.). 1995; 71(2):72-76:Extubation, intubation, artificial airway, tracheal tube, nasotracheal tube, orotracheal tube. IntroduçãoCom o desenvolvimento e aperfeiçoamento de novas técnicas de atendimento e suporte à criança criticamente enferma, a entubação endotraqueal e a ventilação mecânica tornaram-se procedimentos rotineiros nas unidades de terapia intensi...

Three patients with hemolytic uremic syndrome (HUS) developed peripheral gangrene. Bilateral carotid artery thromboses occurred in one of these patients after recovery from HUS. One patient had a long history of juvenile rheumatoid arthritis. In the second patient, a flu-like illness preceded the onset of HUS. The third was one of two sisters, with the HUS appearing more than 1 year apart. None had evidence of disseminated intravascular coagulation or infection with Streptococcus pneumoniae. The patient with rheumatoid arthritis had renal cortical necrosis but recovered moderate renal function after treatment with dialysis and plasmapheresis for 6 months. The child with a genetic form of HUS died of renal failure and had massive cortical necrosis and vascular thrombosis at autopsy. This is the first report of peripheral gangrene in children with idiopathic HUS and autosomal recessive HUS.

Objective: to review the current therapeutic approach of intracranial hypertension in pediatric patients admitted to intensive care unit. Sources of data: bibliographic review of the subject based on Medline.Summary of the findings: the authors noticed that some measures to control intracranial hypertension are consensual, and others remain controversial.Conclusions: the goals of management of pediatric patients with intracranial hypertension include: normalizing the intracranial pressure, optimizing cerebral blood flow and cerebral perfusion pressure, preventing second insults that exacerbate secondary injury, and avoiding complications associated with the various treatment modalities employed.J Pediatr (Rio J) 2003;79(4):287-96: intracranial hypertension in children, intracranial trauma. ResumoObjetivo: revisar a abordagem terapêutica atual nos pacientes pediátricos com hipertensão intracraniana, internados em unidade de terapia intensiva. Fonte de dados: revisão bibliográfica sobre o tema, utilizando como base de dados o Medline.Síntese dos dados: a partir da literatura levantada pode-se observar a existência de medidas de monitorização e tratamento da hipertensão intracraniana aceitas como consenso pelos diferentes autores, assim como abordagens que ainda motivam controvérsias.Conclusões: os objetivos no manejo do paciente pediátrico com hipertensão intracraniana incluem a normalização da pressão intracraniana, a otimização do fluxo sangüíneo cerebral e pressão de perfusão cerebral, prevenindo o segundo insulto que exacerba a lesão secundária, evitando as complicações associadas com as várias modalidades de tratamento empregadas. J Pediatr (Rio J) 2003;79(4):287-96: hipertensão intracraniana em crianças, trauma craniencefálico. Tratamento da hipertensão intracraniana IntroduçãoA hipertensão intracraniana (HIC) é uma condição clínica que acomete muitos pacientes em unidades de tratamento intensivo (UTI), tendo como origem diferentes anormalidades, tanto do sistema nervoso central como sistêmi-cas. A HIC é uma das causas mais comuns de lesão cerebral secundária em crianças 1 . A correlação da HIC com a morbimortalidade nos pacientes pediátricos justifica a busca de uma melhor compreensão da fisiopatologia, levando, conseqüentemente, à maior adequação no tratamento 2 .

The interleukin-2 levels showed a heterogeneous behavior. We found no association between interleukin-2 levels in nasopharyngeal secretion and respiratory syncytial virus bronchiolitis.

The interleukin-2 levels showed a heterogeneous behavior. We found no association between interleukin-2 levels in nasopharyngeal secretion and respiratory syncytial virus bronchiolitis.

Objective: To assess interleukin-2 concentrations in nasopharyngeal secretion of children (0-24 months) with acute respiratory syncytial virus bronchiolitis, within the first 12 hours of hospital admission, and compare the levels of IL-2 with the severity of the illness.Methods: Prospective study performed between June and August 1999. The study included 62 patients, previously healthy, hospitalized with acute viral bronchiolitis characterized by recent prodromes of coryza and/or nasal obstruction, which evolved to at least two of the following signs: respiratory dysfunction, tachypnea, wheezing or rales, and detection of respiratory syncytial virus in nasopharyngeal aspirate. The nasopharyngeal specimens were collected within 12 hours of hospital admission. The interleukin-2 levels were obtained by enzyme immunoassay. Severity of illness was assessed through oxygen saturation by pulse oximetry, Modified Clinical Score System, time of supplemental oxygen required, length of hospital stay, and mechanical ventilation. Spearman s correlation and Kruskal-Wallis test were used to compared these variables in relation to the median of interleukin-2. The chi-square test was used for categorical analysis of interleukin-2.Results: The mean age of patients was 2.2 (1.3-4) months. Males comprised 54% of cases. Hemoglobin oxygen saturation by pulse oximetry at hospital admission was below 95% in 66.1% of patients. The mean time of supplemental oxygen use was 4.7 days (±3.54). The mean length of hospital stay was 4.25 days (±1.76). Mechanical ventilation was used in 4.8% of patients. The values of interleukin-2 in nasopharyngeal aspirates varied from 0 to 40,256 ng/ml with median of 86 ng/ml (4.4 457.3). The study showed no statistical difference between levels of IL-2 and severity of illness. Conclusions:The interleukin-2 levels showed a heterogeneous behavior. We found no association between interleukin-2 levels in nasopharyngeal secretion and respiratory syncytial virus bronchiolitis.J Pediatr (Rio J). 2004;80(4):315-20: Interleukin-2, acute viral bronchiolitis, respiratory syncytial virus, nasopharyngeal aspirates.

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