PCT was better than CRP for diagnosing sepsis and septic shock, mainly at admission, and is related to disease severity.

The study indicates that a larger randomized trial comparing noninvasive positive-pressure ventilation and standard oxygen therapy in children with respiratory failure is feasible, providing a basis for a future trial in this setting. No differences were seen between groups. The number of excluded patients was high.

No abstract

Mechanical ventilation (MV) can induce lung oxidative stress, which plays an important role in pulmonary injury. This study compared protective conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation (HFOV) for oxygenation, oxidative stress, inflammatory and histopathological lung injury in a rabbit model of acute lung injury (ALI). Rabbits (n = 30) were ventilated at FiO(2) 1.0. Lung injury was induced by tracheal saline infusion (30 mL/kg, 38°C). Animals were randomly assigned to: (a) sham control (CG: tidal volume [V(T)] 6 mL/kg, positive end expiratory pressure [PEEP] 5 cmH(2)O, respiratory rate [RR] 40 ipm); (b) ALI + CMV (CMVG: V(T) 6 mL/kg, PEEP 10 cmH(2)O, RR 40 ipm); or (c) ALI + HFOV (HFG: mean airway pressure [Paw] 14 cmH(2)O, RR 10 Hz) groups. Lung oxidative stress was assessed by total antioxidant performance assay, inflammatory response by the number of polymorphonuclear leukocytes/bronchoalveolar lavage fluid/lung and pulmonary histological damage was quantified by a score. Ventilatory and hemodynamic parameters were recorded every 30 min. Both ALI groups showed worse oxygenation after lung injury induction. After four hours of ventilation, HFG showed better oxygenation (partial pressure of oxygen [PaO(2)] - CG: 465.9 ± 30.5 = HFG: 399.1 ± 98.2 > CMVG: 232.7 ± 104 mmHg, P < 0.05) and inflammatory responses (CMVG: 4.27 ± 1.50 > HFG: 0.33 ± 0.20 = CG: 0.16 ± 0.15; polymorphonuclear cells/bronchoalveolar lavage fluid/lung, P < 0.05), less histopathological injury score (CMVG: 5 [1-16] > HFG: 1 [0-5] > CG: 0 [0-3]; P < 0.05), and lower lung oxidative stress than CMVG (CG: 59.4 ± 4.52 = HFG: 69.0 ± 4.99 > CMVG: 47.6 ± 2.58% protection/g protein, P < 0.05). This study showed that HFOV had an important protective role in ALI. It improved oxygenation, reduced inflammatory process and histopathological damage, and attenuated oxidative lung injury compared with protective CMV under these experimental conditions considering the study limitations.

Objective: To asses the values of echocardiographic measurements in normal children without cardiopathy and to build percentile curves, relating them to the body surface (BS, m 2 ). Methods:We analyzed M-mode echocardiographic measurements for children between one and 144 months of age. We assessed right ventricular diastolic diameter (RVDd, mm) and left ventricular diastolic diameter (LVDd, mm), LV systolic diameter (LVSd, mm), right ventricular outflow tract diameter (RVOT, mm), aortic diameter (AoD, mm) and left atrial diameter (LAD, mm); left ventricular ejection fraction (LVEF, %); percentage of variation of left ventricular diameter (∆LV, %); interventricular septum diastolic thickness (IVSDT, mm) and LV posterior wall diastolic thickness (PWDT, mm); left ventricular mass (LVM, g) and LV mass index (LVMI, g/m2). Results:At the end of the study, 595 children (326 male) were assessed. The values of echocardiographic measurements showed a good correlation with BS and allowed the constructing of percentile curves (3%, 25%, 50%, 75% and 97%). Statistically significant differences between the genders were evidenced for the following variables: LVSd, LVDd, RVOT, AoD, LVM and LVMI, and the highest values were observed in male children. Conclusion:The percentile curves of the values obtained can be used as a reference to assess children with suspicion of cardiopathy or to follow-up on those with diagnosed cardiopathy or under treatment with potentially cardiotoxic drugs.

Objective:To determine the acute and sustained effects of early inhaled nitric oxide on some oxygenation indexes and ventilator settings and to compare inhaled nitric oxide administration and conventional therapy on mortality rate, length of stay in intensive care, and duration of mechanical ventilation in children with acute respiratory distress syndrome.Design: Observational study. Setting: Pediatric intensive care unit at a university-affiliated hospital.Patients: Children with acute respiratory distress syndrome, aged between 1 month and 12 yrs.Interventions: Two groups were studied: an inhaled nitric oxide group (iNOG, n ‫؍‬ 18) composed of patients prospectively enrolled from November 2000 to November 2002, and a conventional therapy group (CTG, n ‫؍‬ 21) consisting of historical control patients admitted from August 1998 to August 2000.Measurements and Main Results: Therapy with inhaled nitric oxide was introduced as early as 1.5 hrs after acute respiratory distress syndrome diagnosis with acute improvements in PaO 2 / FIO 2 ratio (83.7%) and oxygenation index (46.7%). Study groups were of similar ages, gender, primary diagnoses, pediatric risk of mortality score, and mean airway pressure. PaO 2 /FIO 2 ratio was lower (CTG, 116.9 ؎ 34.5; iNOG, 62. 5 ؎ 12.8, p < .0001) and oxygenation index higher (CTG, 15.2 [range, 7.2-32.2]; iNOG, 24.3 [range, 16.3-70.4], p < .0001) in the iNOG. Prolonged treatment was associated with improved oxygenation, so that FIO 2 and peak inspiratory pressure could be quickly and significantly reduced. Mortality rate for inhaled nitric oxide-patients was lower (CTG, ten of 21, 47.6%; iNOG, three of 18, 16.6%, p < .001). There was no difference in intensive care stay (CTG, 10 days [range, 2-49]; iNOG, 12 [range, 6 -26], p > .05) or duration of mechanical ventilation (TCG, 9 days [range, 2-47]; iNOG, 10 [range, 4 -25], p > .05). Conclusions: Early treatment with inhaled nitric oxide causes acute and sustained improvement in oxygenation, with earlier reduction of ventilator settings, which might contribute to reduce the mortality rate in children with acute respiratory distress syndrome. Length of stay in intensive care and duration of mechanical ventilation are not changed. Prospective trials of inhaled nitric oxide early in the setting of acute lung injury in children are needed. (Pediatr Crit Care Med 2004; 5:469 -474) KEY WORDS: inhaled nitric oxide; acute respiratory distress syndrome; children; mechanical ventilation; respiratory failure; intensive care

Both ventilatory techniques with iNO improve oxygenation. HFOV causes earlier FiO(2) reduction and increased PO(2)/FiO(2) ratio compared to PCACV at 8 hr. However, at the end of the protocol, there was no significant difference and no clinical improvement derived from the application of both ventilatory strategies with iNO. It is not possible to say what would have happened if a different conventional ventilatory mode and a fully protective ventilatory strategy had been used, given the fact that our study is non-blind, and that a limited number of patients were included in each group.

Objetivos: Estudar o comportamento da procalcitonina e verificar se é capaz de diferenciar crianças com quadros sépticos. Métodos: Crianças de 28 dias a 14 anos de idade, admitidas de 01/2004 a 12/2005 na unidade de tratamento intensivo pediátrica da UNESP com sepse ou choque séptico, foram incluídas prospectivamente. Dois grupos foram constituídos: grupo sepse (GS; n = 47) e grupo choque séptico (GCS; n = 43). Procalcitonina foi medida à admissão (T0) e depois de 12 h (T12h), e os resultados apresentados em classes: < 0,5 ng/mL = sepse improvável; ≥ 0,5 a < 2 = sepse possível; ≥ 2 a < 10 = inflamação sistêmica e ≥ 10 = choque séptico. Resultados: No T0, foi maior a freqüência de pacientes do GCS na classe mais alta de procalcitonina, comparada às crianças do GS [GCS: 30 (69,7%) > GS: 14 (29,8%); p < 0,05]. Para o GCS, a freqüência de pacientes que ocupou a classe mais elevada foi maior que a de pacientes em outras classes (≥ 10 = 69,7%; ≥ 2 a < 10 = 18,6%; ≥ 0,5 a < 2 = 11,6%; < 0,5 = 0,0%; p < 0,05). No T12h, o comportamento da procalcitonina foi semelhante ao T0. O escore pediatric risk of mortality (PRISM) dos pacientes do GCS na classe mais alta de procalcitonina foi mais elevado que o das crianças do GS [GCS: 35,15 (40,5-28,7) versus GS: 18,6 (21,4-10,2); p < 0,05]. Conclusão: Procalcitonina permite diferenciar sepse de choque séptico, pode auxiliar no diagnóstico de quadros sépticos em crianças e pode estar relacionada à gravidade dos pacientes.