Analyzing the tests we can observe that, although the PIM test was less well calibrated overall, both PRISM and PIM offer a good capacity for discriminating between survivors and moribund patients. They are tools with comparable performance at the prognostic evaluation of the pediatric patients admitted to our unit.

Resultados: Internaram na unidade de terapia intensiva pediátri-ca 498 pacientes, sendo 77 excluídos. Dos 421 pacientes estudados, 33 (7,83%) foram a óbito. A mortalidade estimada pelo PRISM foi de 30,84 (7,22%), com standardized mortality rate 1,07 (0,74-1,50), z = -0,45. Pelo PIM, foi de 26,13 (6,21%), com standardized mortality rate 1,26 (0,87-1,77), z = -1,14. O teste de ajuste de Hosmer-Lemeshow obteve um qui-quadrado 9,23 (p = 0,100) para o PRISM e 27,986 (p < 0,001) para o PIM. A área abaixo da curva ROC foi 0,870 (0,810-0,930) para o PRISM e 0,845 (0,769-0,920) para o PIM. Teste de Spearman r = 0,65 (p < 0,001).Conclusão: Na análise dos testes podemos constatar que, embora o PIM apresente uma pior calibração no conjunto dos resultados, tanto o PRISM como o PIM apresentaram boa capacidade de discriminar entre sobreviventes e não sobreviventes, constituindo-se em ferramentas de desempenho comparáveis na avaliação prognóstica de pacientes pediá-tricos admitidos em nossa unidade. AbstractObjective: To compare the performance of the PRISM (Pediatric Risk of Mortality) and the PIM (Pediatric Index of Mortality) scores at a general pediatric intensive care unit, investigating the relation between observed mortality and survival and predicted mortality and survival.Methods: A contemporary cohort study undertaken between 1 June 1999 and 31 May 2000 at the Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas pediatric intensive care unit. The inclusion criteria and the PRISM and PIM calculations were performed as set out in the original articles and using the formulae as published. Statistical analysis for model evaluation employed the Flora z test, Hosmer-Lemeshow goodness-of-fit test, ROC curve (receiver operating characteristic) and Spearmans correlation tests. The study was approved by the institutions Ethics CommitteeResults: Four hundred and ninety-eight patients were admitted to the pediatric intensive care unit, 77 of whom presented exclusion criteria. Thirty-three (7.83%) of the 421 patients studied died and 388 patients were discharged. Estimated mortality by PRISM was 30.84 (7.22%) with a standardized mortality rate of 1.07 (0.74-1.50), z = -0.45 and by PIM this was 26.13 (6.21%) with a standardized mortality rate of 1.26 (0.87-1.77), z = -1.14. The Hosmer-Lemeshow test gave a chi-square of 9.23 (p = 0.100) for PRISM and 27.986 (p < 0.001) for PIM. The area under the ROC curve was 0.870 (0.810-0.930) for PRISM and 0.845 (0.769-0.920) for PIM. The Spearman test returned r = 0.65 (p < 0.001).Conclusion: Analyzing the tests we can observe that, although the PIM test was less well calibrated overall, both PRISM and PIM offer a good capacity for discriminating between survivors and moribund patients. They are tools with comparable performance at the prognostic evaluation of the pediatric patients admitted to our unit.

Objective: To compare the performance of the PRISM (Pediatric Risk of Mortality) and the PIM (Pediatric Index of Mortality) scores at a general pediatric intensive care unit, investigating the relation between observed mortality and survival and predicted mortality and survival.Methods: A contemporary cohort study undertaken between 1 June 1999 and 31 May 2000 at the Pontifícia Universidade Católica do Rio Grande do Sul, Hospital São Lucas pediatric intensive care unit. The inclusion criteria and the PRISM and PIM calculations were performed as set out in the original articles and using the formulae as published. Statistical analysis for model evaluation employed the Flora z test, Hosmer-Lemeshow goodness-of-fit test, ROC curve (receiver operating characteristic) and Spearman s correlation tests. The study was approved by the institution s Ethics CommitteeResults: Four hundred and ninety-eight patients were admitted to the pediatric intensive care unit, 77 of whom presented exclusion criteria. Thirty-three (7.83%) of the 421 patients studied died and 388 patients were discharged. Estimated mortality by PRISM was 30.84 (7.22%) with a standardized mortality rate of 1.07 (0.74-1.50), z = -0.45 and by PIM this was 26.13 (6.21%) with a standardized mortality rate of 1.26 (0.87-1.77), z = -1.14. The Hosmer-Lemeshow test gave a chi-square of 9.23 (p = 0.100) for PRISM and 27.986 (p < 0.001) for PIM. The area under the ROC curve was 0.870 (0.810-0.930) for PRISM and 0.845 (0.769-0.920) for PIM. The Spearman test returned r = 0.65 (p < 0.001).Conclusion: Analyzing the tests we can observe that, although the PIM test was less well calibrated overall, both PRISM and PIM offer a good capacity for discriminating between survivors and moribund patients. They are tools with comparable performance at the prognostic evaluation of the pediatric patients admitted to our unit. J Pediatr (Rio J). 2005;81(3):259-64: Prognostic scores, PRISM, PIM, mortality.

ResumoObjetivo: descrever os possíveis efeitos clínicos e laboratoriais da instilação traqueal de surfactante exógeno a um lactente com bronquiolite viral aguda grave e submetido a ventilação mecânica.Relato: menina de 2 meses de idade com diagnóstico clínico de bronquiolite viral aguda e submetida a ventilação mecânica, necessitando de altos picos de pressão inspiratória positiva (35 a 45 cmH 2 O) e elevada fração de oxigênio inspirado (FiO 2 = 0,9), sem resposta clínica favorável ou melhora na gasometria arterial. Optouse por instilar surfactante exógeno endotraqueal (Exosurf ® , Glaxo -50 mg/kg) para permitir utilizar um regime ventilatório menos agressivo.Resultados: quatro horas após a administração do surfactante, foi possível reduzir o pico inspiratório de pressão (PIP) de 35 para 30 cmH 2 O; a FiO 2 de 0,9 para 0,6 e aumentar a pressão positiva ao final da expiração (PEEP) de 6 para 9 cmH 2 O. Neste período observou-se uma elevação na relação paO 2 /FiO 2 de 120 para 266. Ao completar 24 horas, a FiO 2 pôde ser reduzida até 0,4.Discussão: neste relato pretendemos demonstrar que a inativação do surfactante pode ser um fator decisivo na evolução desfavorável de alguns casos graves de bronquiolite. A instilação traqueal de surfactante, nestes casos, além de promover uma rápida resposta clínica, permite que se adotem técnicas ventilatórias menos agressivas.J Pediatr (Rio J) 2001; 77 (2): 143-7: bronquiolite, insuficiên-cia respiratória, respiração artificial, cuidados intensivos. AbstractObjective: to describe the possible clinical and laboratory effects of exogenous surfactant instillation into the tracheal tube of a child with severe acute bronchiolitis undergoing mechanical ventilation.Case report: a 2-month-old girl with clinical diagnosis of acute viral bronchiolitis underwent mechanical ventilation. She required high positive inspiratory peak pressure (35 to 45 cmH 2 O) and high inspiratory fraction of oxygen (FiO 2 = 0.9), but showed no clinical response or improvement in the arterial blood gas analysis. An exogenous surfactant (Exosurf ® , Glaxo -50 mg/kg) was used to facilitate the use of a less aggressive ventilatory strategy.Results: four hours after surfactant administration, it was possible to reduce the positive peak inspiratory pressure (PIP) from 35 to 30 cmH 2 O, and FiO 2 from 0.9 to 0.6; and to increase the positive end-expiratory pressure (PEEP) from 6 to 9 cmH 2 O. During this period the paO 2 /FiO 2 ratio increased from 120 to 266. At the end of 24 hours, FiO 2 could be reduced to 0.4. Discussion: surfactant inactivation may be a decisive factor in the unfavorable evolution of some severe cases of acute bronchiolitis. The tracheal instillation of exogenous surfactant, in these cases, allows us to adopt less aggressive ventilatory strategies, and promotes rapid clinical responses. IntroduçãoO surfactante é uma lipoproteina complexa cuja conformação estrutural lhe confere uma potente propriedade de reduzir a tensão superficial. É produzido pelos pneumóci-tos alveolares tipo II e células ...

We describe a simple and effective rat model of empyema. TNF-α levels above 150 pg/ml in the pleural fluid are useful to confirm empyema, but cannot predict the severity of the inflammatory response. TNF-α levels below 150 pg/ml are useful to rule out empyema.

Objective: Review the theoretical bases of the therapeutic approach for volumetric resuscitation of the infant in shock and the evolutionary process that take to the pharmacological support to the circulation Methods: References were obtained from computerized searches on the National Library of Medicine (Medline), recent review articles and personal files.Results: Shock and septic shock is the leading cause of mortality in critically ill patients. The septic shock is an extremely complex disease process leading to progressive multiple organ failure. Its presentation may be subtle or catastrophic. Successful management depends on an understanding of the pathophysiology of the syndrome, allowing rapid, appropriate resuscitation. Treatment often requires aggressive correction of volume deficit, maintenance of adequate perfusion pressure with inotropic and vasopressor, mechanical ventilation and others therapies.Conclusions: The management of the shock in children presents a challenge for the pediatrician. Hemodynamic and respiratory instability should be anticipated. Management requires multisystemic and careful intervention.J. pediatr. (Rio J.). 1999; 75 (Supl.2): S185-S196: shock, colloid, crystalloid, resuscitation, cathecholamine, intensive care.

ResumoObjetivo: Revisar as bases teóricas da manutenção do equilí-brio ácido-básico, a fisiopatologia dos pricipais distúrbios e sua terapêutica na criança.Métodos: Foram obtidas referências em artigos recentes de revisão e arquivos pessoais através de busca computadorizadas na Biblioteca Nacional de Medicina (Medline).Resultados: Distúrbios ácido-básico são freqüentemente encontrados em pacientes criticamente doentes. Sua fisiopatologia e principais causas são um processo complexo e multifatorial. O tratamento deve ser ajustado para cada distúrbio e sua causa de base. Freqüentemente requer correção agressiva e monitorização contí-nua.Conclusões: O entendimento da fisiologia do equilíbrio ácido básico bem como a compreensão da fisiopatologia dos principais distúrbios associados às situações clínicas representam um desafio para o pediatra. Seu manejo requer intervenção adequada e cuidadosa.J. pediatr. (Rio J.). 1999; 75 (Supl.2): S234-S243: equilíbrio ácido-básico, distúrbios do equilíbrio ácido-básico, anion-gap. AbstractObjective: Review the theoretical bases on the maintenance of the acid-basic balance, the pathophysiology of the disturbances and its therapeutics in the child.Methods: References were obtained from computerized searches on the National Library of Medicine (Medline), recent review articles and personal files.Results: Acid-basic disturbances are frequently found in critical ill children. Their pathophysiology and main causes are a complex and multifactorial process. The management depends on precocious diagnosis and of the understanding of the base cause. The treatment should be adjusted for each disturbance and its base cause. Frequently it requests an aggressive correction and continuous monitoring.Conclusions: The knowledge of the physiology of the acidbasic balance as well as the understanding of the pathophysiology of the main disturbances associated to the clinical situations represent a challenge for the pediatrician. The management of acidbasic balance demands appropriate and careful intervention.J. pediatr. (Rio J.). 1999; 75 (Supl.2): S234-S243: acid-basic balance, disturbances of the acid-basic balance, anion-gap.

ResumoObjetivo: descrever os possíveis efeitos clínicos e laboratoriais da instilação traqueal de surfactante exógeno a um lactente com bronquiolite viral aguda grave e submetido a ventilação mecânica.Relato: menina de 2 meses de idade com diagnóstico clínico de bronquiolite viral aguda e submetida a ventilação mecânica, necessitando de altos picos de pressão inspiratória positiva (35 a 45 cmH 2 O) e elevada fração de oxigênio inspirado (FiO 2 = 0,9), sem resposta clínica favorável ou melhora na gasometria arterial. Optouse por instilar surfactante exógeno endotraqueal (Exosurf ® , Glaxo -50 mg/kg) para permitir utilizar um regime ventilatório menos agressivo.Resultados: quatro horas após a administração do surfactante, foi possível reduzir o pico inspiratório de pressão (PIP) de 35 para 30 cmH 2 O; a FiO 2 de 0,9 para 0,6 e aumentar a pressão positiva ao final da expiração (PEEP) de 6 para 9 cmH 2 O. Neste período observou-se uma elevação na relação paO 2 /FiO 2 de 120 para 266. Ao completar 24 horas, a FiO 2 pôde ser reduzida até 0,4.Discussão: neste relato pretendemos demonstrar que a inativação do surfactante pode ser um fator decisivo na evolução desfavorável de alguns casos graves de bronquiolite. A instilação traqueal de surfactante, nestes casos, além de promover uma rápida resposta clínica, permite que se adotem técnicas ventilatórias menos agressivas. J Pediatr (Rio J) 2001; 77 (2): 143-7: bronquiolite, insuficiência respiratória, respiração artificial, cuidados intensivos. AbstractObjective: to describe the possible clinical and laboratory effects of exogenous surfactant instillation into the tracheal tube of a child with severe acute bronchiolitis undergoing mechanical ventilation.Case report: a 2-month-old girl with clinical diagnosis of acute viral bronchiolitis underwent mechanical ventilation. She required high positive inspiratory peak pressure (35 to 45 cmH 2 O) and high inspiratory fraction of oxygen (FiO 2 = 0.9), but showed no clinical response or improvement in the arterial blood gas analysis. An exogenous surfactant (Exosurf ® , Glaxo -50 mg/kg) was used to facilitate the use of a less aggressive ventilatory strategy.Results: four hours after surfactant administration, it was possible to reduce the positive peak inspiratory pressure (PIP) from 35 to 30 cmH 2 O, and FiO 2 from 0.9 to 0.6; and to increase the positive end-expiratory pressure (PEEP) from 6 to 9 cmH 2 O. During this period the paO 2 /FiO 2 ratio increased from 120 to 266. At the end of 24 hours, FiO 2 could be reduced to 0.4.Discussion: surfactant inactivation may be a decisive factor in the unfavorable evolution of some severe cases of acute bronchiolitis. The tracheal instillation of exogenous surfactant, in these cases, allows us to adopt less aggressive ventilatory strategies, and promotes rapid clinical responses.J Pediatr (Rio J) 2001; 77 (2): 143-7: bronchiolitis, respiratory insufficiency, artificial respiration, intensive care. Uso de surfactante exógeno no tratamento da bronquiolite viral grave: relato de caso