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This study compares the correlation between two methods for the determination of cardiac output-the pulmonary arterial thermodilution technique using the Swan-Ganz catheter and the femoral arterial thermodilution technique using a pulse contour analysis computer (PiCCO) catheter. We performed a prospective animal study using 16 immature Maryland pigs weighing 9 to 16 kg. A 5.5- or 7.5-Fr Swan-Ganz catheter was introduced into the femoral or jugular vein, and a 4- or 5-Fr arterial PiCCO catheter was introduced into the femoral artery. In each animal, we made measurements of cardiac output at 30-minute intervals, simultaneously by pulmonary arterial thermodilution and femoral arterial thermodilution, before, during, and after hemodiafiltration carried out via different venous catheters, recording a total of 78 measurements. The mean Swan-Ganz cardiac output was 2.22 +/- 0.94 L/min, and mean PiCCO cardiac output was 1.94 +/- 0.80 L/min (no significant difference). The mean difference (bias) of differences (limits of agreement) was 0.2812. The differences between the methods increased with higher cardiac output, but the percentage differences in relation to cardiac output remained stable. Good correlation was found between the two methods: single-measure intraclass correlation was 0.8892 (95% confidence interval, 0.54-0.95). There were no differences between the 5.5- and 7.5-FR Swan-Ganz catheters or between the 4- and 5-Fr PiCCO catheters. Femoral arterial thermodilution cardiac output measurements correlated well with pulmonary arterial thermodilution cardiac output measurements in a pediatric animal model.

Objective. To assess the nutritional status of critically ill children and its modification after enteral nutrition. Design. Prospective observational study. Setting. Pediatric Intensive Care Unit of a University Hospital. Subjects. 42 critically ill children with mechanical ventilation. Interventions. At least four days of enteral nutrition. Endpoints. Change of nutritional status. Measurements and main results. Anthropometric [weight, height, cephalic circumference, skin fold thickness and nutritional indices], and biochemical [full blood count, glucose, cholesterol, triglycerides, free fatty acids, total proteins, albumin, prealbumin, fibronectine, transferrin, creatinine, urea, uric acid, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, alkaline phosphatase, nitrogen balance, and calculation of the height/creatinine index and of the stress index] nutritional assessment was carried out before starting the enteral nutrition, after 4 to 7 days, at 14 days, at 21 days and at the end of treatment. Prior to starting the nutrition, 54% presented a weight below the 3rd centile. No significant changes were observed in the anthropometric parameters after enteral nutrition. In the biochemical parameters, significant increases were observed in total proteins, albumin, prealbumin, transferrin, cholesterol and triglycerides, whereas the blood glucose, fatty acids and nitrogen balance did not alter. The transpyloric enteral nutrition was well tolerated. No relationship was found between any of the nutritional parameters and tolerance to the nutrition or mortality. Conclusions. A significant percentage of critically ill children present with malnutrition. The serum concentrations of total proteins, albumin, prealbumin, transferrin, cholesterol and triglycerides are more sensitive nutritional parameters than the anthropometric parameters or the nitrogen balance.

BackgroundPersistent interstitial pulmonary emphysema (PIE) is a rare disease and it is even more uncommon in full-term infants, like our patient. When conservative management is not successful, surgical treatment should be considered. In our case, ECMO support was iniciated to keep the patient ventilated in order to allow the lung to heal using lung protection strategies.Case presentationWe report an 18-day-old male infant with bronchiolitis that required mechanical ventilation with high positive airway pressures due to severe respiratory insufficiency. Chest X-rays and computed tomography scan revealed a severely hyperinflated left lung with extensive destructive changes and multiple small bullae. These findings were consistent with diffuse persistent interstitial emphysema (PIE), probably due to mechanical ventilation. The patient required high frequency oscillatory ventilation, inotropic support and continuous renal replacement therapy. He eventually suffered a cardiac arrest that required cardiopulmonary resuscitation and ECMO during 5 days with progressive clinical improvement and normalization of the X-ray.ConclusionWe present a patient with diffuse persistent interstitial emphysema who, despite an unfavorable evolution with different mechanical ventilation strategies, had a good response after ECMO assistance.

Intrathoracic and intracardiac volume values obtained by arterial thermodilution are lower than those considered normal in the adult, whereas the extravascular lung water is higher. These values must be taken into account when the PiCCO method is used in small children.