Guidelines regarding ineffective maintenance of organ functions (futile therapy) in paediatric intensive care units.

In Poland, guidelines for the management of ineffective treatment of children in neonatal and paediatric departments developed by the Polish Neonatal Society and the Polish Paediatric Society, have been published. The specific problems of futile therapy in paediatric anaesthesiology and intensive care units should be defined and solved separately. For this purpose, the guidelines presented below were prepared.

A new endotracheal tube for infants--laboratory and clinical assessment: a preliminary study.

Background: Conventional endotracheal pediatric tubes offer high resistance due to their small diameters and relatively high flow during ventilation. Any increase of the diameter of the tube lumen decreases the airway resistance and subsequently, the work of breathing (WOB). We compared ventilation mechanics using a new, cone-shaped endotracheal tube of our design to the Cole and standard tubes.

Successful complex management of a congenital diaphragmatic hernia--a case report.

Congenital diaphragmatic hernia is a very serious congenital defect associated with high mortality rate. The syndrome is characterized by migration of abdominal viscera to thoracic cavity a variable degree of pulmonary hypoplasia associated with pulmonary hypertension caused by alteration of pulmonary vessels diameter increased muscularisation of pulmonary arteries and decreased compliance of the lungs resulting in increased afterload of the right ventricle, decreased cardiac output and impaired oxygenation. We describe a case of congenital diaphragmatic hernia with migration of the stomach, the small and the large bowels and the left hepatic lobe into the left pleural space, diagnosed by ultrasound in utero at 24 weeks of gestation.

The place of suxamethonium in pediatric anesthesia.

Suxamethonium is a drug that promotes very strong views both for and against its use in the context of pediatric anesthesia. As such, the continuing debate is an excellent topic for a 'Pro-Con' debate. Despite ongoing efforts by drug companies, the popular view still remains that there is no single neuromuscular blocking drug that can match suxamethonium in terms of speed of onset of neuromuscular block and return of neuromuscular control.

[Procedures for CV catheters insertion in children with congenital coagulation disorders].

Unlabelled: The aim of this study is to present our experiences in inserting CV catheters in patients with congenital coagulation disorders.

Materials And Methods: Between 1997 and 2008 27 Port-a-cath catheters were inserted in our department in 20 patients with severe congenital coagulation disorders in order to infuse coagulation factor concentrates. 18 patients had haemophilia A, including 13 with factor VIII inhibitor, one haemophilia B and one von Willebrand's disease type 3.

[Recommendations for analgesia and sedation in neonatal intensive care].

The purpose of the study was to present recommendations, relevant to the management of neonates and infants aged 0-1 years, treated in intensive care settings. They include general principles and recommendations for pain and sedation assessment, sedation and pain management and advice on the use of pharmacological strategies. The bolus (on demand) administration of sedative agents should be avoided because of increased risk of cardiovascular depression and/or neurological complications.

[Weaning newborns from noninvasive ventilation].

The purpose of the study was to propose the recommendations for weaning infants from nasal continuous positive airway pressure (nCPAP) and nasal intermittent positive pressure ventilation (NIPPV). Despite the fact that both methods are commonly used for respiratory insufficiency in infants, detailed recommendations for weaning have not been described so far. The proposed recommendations are based on previously described data and a wide survey conducted among Polish neonatologists and intensive therapy paediatricians.

[Indications for endotracheal intubation].

The purpose of the study was to propose recommendations for endotracheal intubation and respiratory support in newborn and in infants. The recommendations for endotracheal intubation are preceeded by a short history of intubation, basic anatomy of the upper airway in infants and children and the most common methods of airway control. The main indications for intubation are airway protection and control of the airway.

[Recommended treatment of apnea in premature infants. A review based on literature and own experience].

The authors reviewed the literature concerning different methods of treatment of apnea in premature infants. The authors consider that, apart from pharmacological treatment, noninvasive respiratory support methods play an important role in the prevention and treatment of newborns with apnea. The aim of the study is to present current recommendations concerning the principles of prevention and treatment of apnea in premature infants.

Percutaneous tracheotomy in children.

We present three cases of the Fantoni percutaneous translaryngeal tracheostomy (TLT) performed under direct rigid bronchoscopy. The surgeries were performed in the near-drowned 5-year-old boy, and 15-year-old lupus erythematosus girl with a permanent brain damage resulted from a cardiac arrest, 11-year-old cardiac girl with postintubation laryngeal stenosis. In the first two cases, the procedure went uneventful; in one case the tube was accidentally pulled out during the rotation phase and surgical tracheostomy was performed.

Recombinant human activated protein C for severe sepsis in a neonate.

Background: Neonatal sepsis is frequently associated with pathological activation of the coagulation system, leading to multiple organ dysfunction. Activated protein C has been shown to prevent thrombin generation during this process and improve microcirculation.

Case Report: We present the case of a full term septic neonate admitted for tertiary intensive care with multiple organ failure, including ARDS with severe pulmonary hypertension, renal failure, and disseminated intravascular coagulation.