"Perimortem" total body CT-scan examination in severely injured children: an informative insight into the causes of death.

Objective: To report routine practice of "perimortem" CT-scan imaging to determine the causes of death in children dying from severe accidental injuries within the first hours following hospital admission.

Settings: Trauma center of a University Pediatric Hospital.

Methods: A retrospective study was conducted in children (0 to 15 years old) referred for severe trauma (GCS ≤ 8) to a regional pediatric trauma center, presenting with at least spontaneous cardiac rhythm and dying within the first 12 h after admission.

Noninvasive cardiac output measurement using bioreactance in postoperative pediatric patients.

Background: Thoracic bioreactance is a noninvasive and continuous method of cardiac output (CO) measurement that is being developed in adult patients. Very little information is available on thoracic bioreactance use in children.

Objective: The aim of the study was to evaluate the ability of a bioreactance device (NICOM(®) ; Cheetah Medical, Tel Aviv, Israel) to estimate CO and to track changes in CO induced by volume expansion (VE) in children.

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age.

Object: Subdural hematoma (SDH) is the most common finding on cranial CT in pediatric victims of abusive head trauma (AHT). The hematomas are commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages. There is no consensus regarding the best surgical treatment in such cases nor are there standardized surgical protocols.

Transcranial Doppler can predict intracranial hypertension in children with severe traumatic brain injuries.

Purpose: The purpose of this study is to evaluate the accuracy of emergency Transcranial Doppler (TCD) to predict intracranial hypertension and abnormal cerebral perfusion pressure in children with severe traumatic brain injury (TBI).

Patients And Methods: A descriptive and retrospective cross-sectional study was designed through data collected from medical records of children with severe TBI (Glasgow coma scale ≤ 8), admitted to a level I pediatric trauma center, between January 2000 and December 2005. Early TCD examination was performed upon admission, and TCD profiles were considered as altered using previously validated threshold values for diastolic velocity (<25 cm/s) and pulsatility index (>1.

Hemorrhagic shock and encephalopathy syndrome in a quadriplegic child: an argument for the triggering role of impaired thermoregulatory response.

Study Design: A case presentation of hemorrhagic shock and encephalopathy syndrome (HSES).

Objective: To describe an unusual complication of uncontrolled fever in a tetraplegic child and to discuss possible pathophysiological mechanisms in these circumstances.

Summary Of Background Data: HSES is a rare and dramatic disorder of unknown origin occurring mainly in infants and young children.

Emergency tracheal intubation of severely head-injured children: changing daily practice after implementation of national guidelines.

Objective: To report daily practice of scene emergency tracheal intubation performed by physicians and changes induced by implementation of national guidelines, with special attention to rapid sequence induction (RSI) and control of assisted ventilation.

Design: Observational study.

Setting: Pediatric intensive care unit of a university hospital.

Hypothermia therapy after traumatic brain injury in children.

Background: Hypothermia therapy improves survival and the neurologic outcome in animal models of traumatic brain injury. However, the effect of hypothermia therapy on the neurologic outcome and mortality among children who have severe traumatic brain injury is unknown.

Methods: In a multicenter, international trial, we randomly assigned children with severe traumatic brain injury to either hypothermia therapy (32.

Management of critically ill children with traumatic brain injury.

The management of critically ill children with traumatic brain injury (TBI) requires a precise assessment of the brain lesions but also of potentially associated extra-cranial injuries. Children with severe TBI should be treated in a pediatric trauma center, if possible. Initial assessment relies mainly upon clinical examination, trans-cranial Doppler ultrasonography and body CT scan.

Use of recombinant activated factor VII in intractable bleeding during pediatric neurosurgical procedures.

Objective: To report the use of recombinant activated factor VII (NovoSeven; Novo Nordisk A/S, Bagsvaerd, Denmark) in children undergoing major neurosurgical procedures and experiencing massive uncontrolled hemorrhagic shock.

Design: Retrospective review of patients and analysis of clinical and biological effects of an intravenous administration of recombinant activated factor VII.

Setting: Neurosurgical anesthesia and critical care unit of a pediatric university hospital.

Use of recombinant activated factor VII in intractable bleeding during pediatric neurosurgical procedures.

OBJECTIVE:: To report the use of recombinant activated factor VII (NovoSeven; Novo Nordisk A/S, Bagsvaerd, Denmark) in children undergoing major neurosurgical procedures and experiencing massive uncontrolled hemorrhagic shock. DESIGN:: Retrospective review of patients and analysis of clinical and biological effects of an intravenous administration of recombinant activated factor VII. SETTING:: Neurosurgical anesthesia and critical care unit of a pediatric university hospital.

Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French pediatric trauma center.

Objective: To describe the results of an integrated pre- and in-hospital approach to critical care in a large population of children with severe traumatic brain injury and to identify the early predictors of their outcome.

Design: A 9-yr retrospective review of the data of a trauma data bank.

Setting: Level III pediatric trauma center.

Grand mal seizures: an unusual and puzzling primary presentation of ruptured hepatic hydatid cyst.

We report a case of hepatic hydatidosis where the first clinical manifestations, generalized seizures after minor head and abdominal trauma, and delayed anaphylaxis, made the primary diagnosis difficult. Severe anaphylaxis has been reported as initial presentation of quiescent hepatic hydatidosis. In endemic areas, the diagnosis must be carefully ruled out in patients experiencing abrupt anaphylactic shock of uncertain etiology.

Surgical evacuation of acute subdural hematoma improves cerebral hemodynamics in children: a transcranial Doppler evaluation.

Objective: The objective was to evaluate cerebral hemodynamics in young children with acute subdural hematoma (SDH) and the impact of surgical treatment using transcranial Doppler (TCD).

Design: The design was a prospective study of infants with SDH requiring surgical evacuation.

Setting: The setting was the neuro intensive care unit of a university hospital.

Comparison of perioperative blood salvage and postoperative reinfusion of drained blood during surgical correction of craniosynostosis in infants.

Background: The surgical correction of craniosynostosis may be associated with extensive blood loss and transfusion. The aim of this study was to compare the efficacy of the perioperative use of the continuous autotransfusion system (CATS group) and of the postoperative use of the CBCII ConstaVac(R) system (CV group) to reduce homologous transfusion in infants during repair of craniosynostosis.

Methods: Two groups of consecutive infants, weighing <10 kg, and scheduled for the surgical correction of craniosynostosis, were compared retrospectively according to the blood salvaging system used: CATS group and CV group.

The prognostic value of transcranial Doppler studies in children with moderate and severe head injury.

Objective: To assess the potency of transcranial Doppler (TCD) to predict prognosis in children with moderate and severe head trauma.

Design And Setting: Prospective single-center study in a level I pediatric trauma center.

Patients: Thirty-six consecutive patients with a prehospital diagnosis of moderate or severe head trauma admitted over a 6-month period.