There is an unacceptably poor agreement between UD and PRAM. We do not recommend the use of PRAM for measuring CO in critically ill children with the current algorithm.

Edi monitoring using NAVA technology is a valuable, minimally invasive, diagnostic adjunct in children with neuromuscular and respiratory control disorders who are ventilator-dependent.

A six-week-old infant presented in extremis and was diagnosed with dextro-transposition of the great arteries, intact ventricular septum, features of left ventricular deconditioning, and abnormal coronary arteries. Treatment with prostaglandin E1 and balloon atrial septostomy was insufficient, necessitating extracorporeal membrane oxygenation (ECMO). Severe acute respiratory syndrome coronavirus-2 was detected. The arterial switch operation was delayed by eight days because of COVID-19. Although stable on ECMO, the infant was treated with remdesivir. Extracorporeal membrane oxygenation was not required postoperatively with chest closure on day 2 and extubation on day 5.

Background and aims: Penetrating neck injuries are infrequent in children. Their management are a challenge for the clinician. Aims: Reflect about a case of penetrating neck injury in a child, with extensive brain lesion. Methods: Retrospective study of one case and review of the literature. The institutional Review Board waived the need for informed consent. Results: A previously healthy 4-year-old boy was brought to emergency room with a severe active bleeding on the right side of his neck following an accidental fall against a glass. Despite first line treatment, he presented hemodynamically unstable. He was submitted to emergency surgery with ligation of the internal carotid artery and internal jugular vein. After the surgery, he was found to have anisocoria. The CT scan showed an extensive infarction of the right cerebral hemisphere with initial right uncal herniation. Urgent craniectomy was performed, with immediate effect and subsequent control of intracranial hypertension. Noradrenaline, thiopental and hypertonic saline infusions were needed until the seventh day of admission and ventilatory support was maintained till the eleventh. After extubation, the patient was interacting, obeying orders, presenting right facial paresis and left hemiparesis. He was then discharged to an intensive ambulatory rehabilitation program. On reevaluation, after eight months, he was autonomous, and had resumed his previous daily activities with minor sequelae. Conclusions: The presentation of this patient entailed a high probability of death and morbidity, however prompt diagnosis and management by a multidisciplinary team experienced in pediatric trauma allowed him to survive with no significant psychomotor disabilities. No sources of support.

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