Neuromonitoring in Children with Traumatic Brain Injury.

Traumatic brain injury remains a major cause of mortality and morbidity in children across the world. Current management based on international guidelines focuses on a fixed therapeutic target of less than 20 mm Hg for managing intracranial pressure and 40-50 mm Hg for cerebral perfusion pressure across the pediatric age group. To improve outcome from this complex disease, it is essential to understand the pathophysiological mechanisms responsible for disease evolution by using different monitoring tools.

Conservative approach of a paediatric tracheal rupture.

A girl was brought into the emergency room after a non-penetrating cervical trauma. On physical examination, a rapidly progressing chest subcutaneous emphysema was denoted. The child was immediately intubated and mechanical ventilation was initiated.

Extracorporeal Membrane Oxygenation in an Adolescent with Multisystem Inflammatory Syndrome in Children.

Multisystem inflammatory syndrome in children is a rare and potentially life-threatening disease that is associated with SARS-CoV-2 infection, characterized by hyperinflammation and multiorgan involvement. Cardiovascular involvement is common, including myocardial dysfunction often leading to cardiogenic shock. We present the case of a 17-year-old boy with fever, odynophagia, maculopapular rash and abdominal pain who developed a cardiogenic shock.

The parental psychological distress caused by separation from their critically ill child during the COVID-19 pandemic: A tale of two cities.

Introduction: A child's critical illness is a stressful event for the entire family, causing significant emotional distress among parents and changes to family functioning. The Severe Acute Respiratory Syndrome-Related Coronavirus 2 (SARS-CoV-2) pandemic has abruptly caused modifications in visitation policies of Pediatric Intensive Care Units (PICUs) in many countries. We hypothesized that caregivers with no or severely restricted access to PICUs would demonstrate increased psychological distress as compared to those who had limitless access (LA) to PICUs.

Time course of lung ultrasound findings in patients with COVID-19 pneumonia and cardiac dysfunction.

Background: Lung ultrasound (LUS) is a valuable tool to predict and monitor the COVID-19 pneumonia course. However, the influence of cardiac dysfunction (CD) on LUS findings remains to be studied. Our objective was to determine the effect of CD on LUS in hospitalized patients with COVID-19 pneumonia.

Transfusion policy in pediatric extracorporeal membrane oxygenation patients: Less could be more.

Objective: To evaluate a restrictive transfusion policy of red blood cells (RBC) and platelets in pediatric patients submitted to extracorporeal membrane oxygenation (ECMO).

Methods: Retrospective descriptive study of pediatric patients supported with ECMO, from January 2010 to December 2019. Hemoglobin, platelet, lactate and mixed venous oxygen saturation (SvO2) values of each patient while on ECMO, were collected.

Eosinophilic Ascites: An Infrequent Presentation of Eosinophilic Gastroenteritis.

Eosinophilic gastroenteritis (EGE) is an unusual and benign inflammatory disorder that mainly affects the digestive tract. Its main symptoms are cramp-like abdominal pain, nausea, vomiting, diarrhea, gastrointestinal bleeding, and weight loss. Laboratory results show peripheral eosinophilia.

Extracorporeal Membrane Oxygenation: The First 10 Years Experience of a Portuguese Pediatric Intensive Care Unit.

Introduction: In Portugal, extracorporeal membrane oxygenation (ECMO) is used in pediatric patients since 2010. The aim of this study was to describe the clinical characteristics of patients, indications, complications and mortality associated with the use of ECMO during the first 10-years of experience in the Pediatric Intensive Care Unit located in Centro Hospitalar Universitário Lisboa Norte.

Material And Methods: Retrospective observational cohort study of all patients supported with ECMO in a Pediatric Intensive Care Unit, from the 1st of May 2010 up to 31st December 2019.

Posterior reversible encephalopathy syndrome: characteristics, diagnostic accuracy, prognostic factors and long-term outcome in a paediatric population.

Posterior reversible leukoencephalopathy syndrome (PRES) is a rare entity among children, characterised by acute neurological symptoms and radiological findings. The role of clinical symptoms and neuroimaging in predicting the prognosis of PRES have not been well-characterised. A retrospective descriptive study of children with PRES, admitted to a Paediatric Intensive Care Unit during a 10-year period, was performed to describe its characteristics, compare the accuracy of computed tomography (CT) scan and MRI on diagnosis and identify prognostic factors on paediatric population.

Monitoring cerebrovascular reactivity in pediatric traumatic brain injury: comparison of three methods.

Purpose: To study three different methods of monitoring cerebral autoregulation in children with severe traumatic brain injury.

Methods: Prospective cohort study of all children admitted to the pediatric intensive care unit at a university-affiliated hospital with severe TBI over a 4-year period to study three different methods of monitoring cerebral autoregulation: pressure-reactivity index (PRx), transcranial Doppler derived mean flow velocity index (Mx), and near-infrared spectroscopy derived cerebral oximetry index (COx).

Results: Twelve patients were included in the study, aged 5 months to 17 years old.

Hypercalcaemia: An Extremely Rare Presentation of Hepatosplenic T-Cell Lymphoma.

Unlabelled: Hypercalcaemia is a frequent finding in malignancies including lymphomas. However, there are no reports of hypercalcaemia in hepatosplenic T-cell lymphoma (HSTCL). HSTCL is a rare and aggressive neoplasm which is usually difficult to diagnose.

[ECMO in Neonates with Congenital Diaphragmatic Hernia: The Experience of a Portuguese ECMO Referral Center].

Introduction: The use of extracorporeal membrane oxygenation (ECMO) is considered by many authors as one of the most important technological advances in the care of newborns with congenital diaphragmatic hernia. The main objective of this study was to report the experience of a Portuguese ECMO center in the treatment of congenital diaphragmatic hernia.

Material And Methods: Descriptive retrospective study of newborns with congenital diaphragmatic hernia requiring ECMO support in a Pediatric Intensive Care Unit from January 2012 to December 2019.

Inborn Errors of Metabolism in a Tertiary Pediatric Intensive Care Unit.

Few studies exist describing resources and care of pediatric patients with inborn errors of metabolism (IEM) admitted to pediatric intensive care unit (PICU). This study aims to characterize the PICU admissions of these patients to provide better diagnostic and therapeutic care in the future. Retrospective analysis of pediatric patients with IEM admitted to the PICU of a tertiary care center at a metabolic referral university hospital from 2009 to 2019 was included.

The Impact of Focused Cardiac Ultrasound Performed by Pediatric Intensivists: A Prospective Study.

Objectives: Focused cardiac ultrasound is an echocardiographic method used by medical intensivists for fast and reliable hemodynamic assessment. Prospective studies and guidelines have defined its role in adult critical care. Data regarding its use in pediatric critical care are scarce.

Transcranial Doppler as a non-invasive method to estimate cerebral perfusion pressure in children with severe traumatic brain injury.

Introduction: Cerebral perfusion pressure (CPP) is one of the most important parameters in preventing ischemic brain insults. Guidelines have used CPP values to guide treatment of traumatic brain injury (TBI) for many years. We tested the feasibility of a novel non-invasive method for CPP estimation (nCPP) in children with severe TBI.

Ultrasound non-invasive intracranial pressure assessment in paediatric neurocritical care: a pilot study.

Background: The assessment of intracranial pressure (ICP) is essential in the management of neurocritical care paediatric patients. The gold standard for invasive ICP is an intraventricular catheter or intraparenchymal microsensor but is invasive and carries some risks. Therefore, a non-invasive method for measuring ICP (nICP) would be desirable especially in the paediatric population.

Transcranial Doppler in pediatric emergency and intensive care unit: a case series and literature review.

Purpose: Transcranial Doppler (TCD) has been used for more than 30 years in clinical practice. Although adult intensive care is relatively well covered, pediatric cases are still underrepresented. We intend to review a series of pediatric cases where TCD was determinant in clinical decisions and a literature review on this topic.

[Erratum to "Translation and Validation of the FOUR Scale for Children and its Use as Outcome Predictor: A Pilot Study"].

The article "Translation and Validation of the FOUR Scale for Children and its Use as Outcome Predictor: A Pilot Study", published by Acta Médica Portuguesa on September 2017 [Acta Med Port 2017 Sep;30(9):599-607] exhibited the mistake detailed here below: On page 600, paragrapah 4, where it reads: "(...

Salicylate Intoxication in an Infant: A Case Report.

In children, the most common cause of an elevated anion gap (AG) with ketonemia, ketonuria, hyperglycemia, and glycosuria is diabetic ketoacidosis. However, when the clinical history is not clear, other causes must be considered. A 9-month-old girl was transferred to our pediatric intensive care unit (PICU) because of severe metabolic acidosis.

Unwitnessed head trauma: the bamboo did it.

Unwitnessed penetrating head injuries (PHIs) are often challenging. The inability to locate a foreign body should not exclude this diagnosis nor should it delay treatment. Attempts must be made to clarify the mechanism of injury, as this may allow for a better understanding of the patient's condition.