ALI in children is uncommon but has a high mortality rate. Risk factors for mortality are easily identified. Ventilatory variables and indexes of lung severity were significantly associated with mortality.

The 2009 H1N1 virus had a substantial effect on ICUs during the winter in Australia and New Zealand. Our data can assist planning for the treatment of patients during the winter in the Northern Hemisphere.

Aim: Traditional paediatric intravenous maintenance fluids are prescribed using hypotonic fluids and the weight-based 4:2:1 formula for administration rate. However, this may cause hyponatraemia in sick and post-operative children. We studied the effect of two types of intravenous maintenance fluid and two administration rates on plasma sodium concentration in intensive care patients. Methods: A Factorial-design, double-blind, randomised controlled trial was used. We randomised 50 children with normal electrolytes without hypoglycaemia who needed intravenous maintenance fluids for >12 h to 0.9% saline (normal saline) or 4% dextrose and 0.18% saline (dextrose saline), at either the traditional maintenance fluid rate or 2/3 of that rate. The main outcome measure was change in plasma sodium from admission to 12-24 h later. Results: Fifty patients (37 surgical) were enrolled. Plasma sodium fell in all groups: mean fall 2.3 (standard deviation 4.0) mmol/L. Fluid type (P = 0.0063) but not rate (P = 0.12) was significantly associated with fall in plasma sodium. Dextrose saline produced a greater fall in plasma sodium than normal saline: difference 3.0, 95% confidence interval 0.8-5.1 mmol/L. Full maintenance rate produced a greater fall in plasma sodium than restricted rate, but the difference was small and non-significant: 1.6 (-0.7, 3.9) mmol/L. Fluid type, but not rate, remained significant after adjustment for surgical status. One patient, receiving normal saline at restricted rate, developed asymptomatic hypoglycaemia. Conclusion: Sick and post-operative children given dextrose saline at traditional maintenance rates are at risk of hyponatraemia.Key words: child; fluid therapy; infusion; intravenous.Intravenous (IV) fluids have been used in paediatrics for over 50 years. The most commonly used maintenance fluid, used to replace normal expected fluid losses in situations such as fasting, is hypotonic saline with dextrose. Volumes are typically calculated using a weight-based infusion rate: for the first 10 kg, 4 mL/kg/h, for the next 10 kg, 2 mL/kg/h and 1 mL/kg/h for each kilogram thereafter.1-6 However, it may be inappropriate for those children who have non-osmotic production of antidiuretic hormone (ADH). The syndrome of inappropriate ADH 7 occurs in meningitis, 8,9 encephalitis, 10 pneumonia, 11 bronchiolitis 12 and after surgery. [13][14][15][16] Any consequent hyponatraemia may be exacerbated by hypotonic IV fluids. 14,17 Natriuresis (urinary salt loss) may cause hyponatraemia. Sodium loss and hypovolaemia occur in cerebral salt wasting (CSW), 18,19 probably caused by a hormone such as atrial natriuretic hormone.19 Hyponatraemia in neurosurgical patients may be from CSW, not the syndrome of inappropriate ADH.20 CSW occurs in children with neurological illness, neurosurgery and craniofacial surgery. 21-23Symptomatic hyponatraemia is uncommon if the plasma sodium ([Na]) is >120-125 mmol/L, 24,25 but depends on the rate of fall, 26 and can occur at higher values. 17 It can cause death or serious neurological mo...

Hyperglycemia is common in PICUs, occurs early, and is independently associated with organ failure and death. However, early hyperglycemia is not associated with later or worsening organ failure. Australasian PICUs seldom use insulin.

Objectives Although critically ill children are at increased risk for developing deep venous thrombosis, there are few pediatric studies establishing the prevalence of thrombosis or the efficacy of thromboprophylaxis. We tested the hypothesis that thromboprophylaxis is infrequently used in critically ill children even for those in whom it is indicated. Design Prospective multinational cross-sectional study over four study dates in 2012. Setting Fifty-nine PICUs in Australia, Canada, New Zealand, Portugal, Singapore, Spain, and the United States. Patients All patients less than 18 years old in the PICU during the study dates and times were included in the study, unless the patients were 1) boarding in the unit waiting for a bed outside the PICU or 2) receiving therapeutic anticoagulation. Interventions None. Measurements and Main Results Of 2,484 children in the study, 2,159 (86.9%) had greater than or equal to 1 risk factor for thrombosis. Only 308 children (12.4%) were receiving pharmacologic thromboprophylaxis (e.g., aspirin, low-molecular-weight heparin, or unfractionated heparin). Of 430 children indicated to receive pharmacologic thromboprophylaxis based on consensus recommendations, only 149 (34.7%) were receiving it. Mechanical thromboprophylaxis was used in 156 of 655 children (23.8%) 8 years old or older, the youngest age for that device. Using nonlinear mixed effects model, presence of cyanotic congenital heart disease (odds ratio, 7.35; p < 0.001) and spinal cord injury (odds ratio, 8.85; p = 0.008) strongly predicted the use of pharmacologic and mechanical thromboprophylaxis, respectively. Conclusions Thromboprophylaxis is infrequently used in critically ill children. This is true even for children at high risk of thrombosis where consensus guidelines recommend pharmacologic thromboprophylaxis.

Objectives-To determine whether children with severe acute asthma treated with large doses of inhaled salbutamol, inhaled ipratropium, and intravenous steroids are conferred any further benefits by the addition of aminophylline given intravenously. Study design-Randomised, double blind, placebo controlled trial of 163 children admitted to hospital with asthma who were unresponsive to nebulised salbutamol. Results-The placebo and treatment groups of children were similar at baseline. The 48 children in the aminophylline group had a greater improvement in spirometry at six hours and a higher oxygen saturation in the first 30 hours. Five subjects in the placebo group were intubated and ventilated after enrolment compared with none in the aminophylline group. Conclusions-Aminophylline continues to have a place in the management of severe acute asthma in children unresponsive to initial treatment. (Arch Dis Child 1998;79:405-410)

HS is an acceptable alternative to NS in DKA and may benefit those with severe DKA.

Repeat head imaging is more likely to alter management of children with moderate to severe TBI. There is no role for routine repeat CT scan on mild TBI. Results of repeat cranial imaging should be correlated with the clinical status of the patient.