High-frequency oscillatory ventilation may be safely utilized. It has a 66 % overall survival rate in pediatric AHRF of various etiologies. Patients with morbidity limited to the respiratory system and optimized oxygenation indices are most likely to survive on HFOV.

AECs isolated from septic rats are more vulnerable to mechanical deformation injury than AECs from nonseptic animals.

Previous studies have indicated that paediatric patients with type 1 diabetes mellitus are presenting with more severe diabetic ketoacidosis (DKA) during the COVID-19 pandemic. This study was performed to determine the effect that access to health care had on DKA severity and outcomes in children and young people (CYP) with new-onset diabetes mellitus. This is a retrospective cohort analysis comparing pre-pandemic and pandemic patients admitted to a 30-bed paediatric intensive care unit (PICU) in the United States with DKA. A database query identified patients and clinical data were extracted and analysed. Additionally, phone interviews focusing on challenges with health care access during the COVID-19 pandemic were performed with the parents of CYP admitted during the pandemic.A total of 50 pre-pandemic and 43 pandemic patients met inclusion criteria and were included in the analysis. Pandemic patients had more severe acidosis (pH 7.10 versus 7.17), a longer duration of insulin infusion (19 versus 15 hours) and increased PICU length of stay (1 versus 0.75 days, all p<0.05) than pre-pandemic patients. Patients whose families felt the pandemic affected their child's ability to see a physician had a longer PICU length of stay (1.5 versus 0.9 days, p=0.004) and a trend towards a lower pH (7.01 versus 7.13, p=0.106). Patients with a social vulnerability index ≥0.75 were less likely to see a physician before coming to the hospital (p=0.017).In conclusion, CYP with new-onset type 1 diabetes who were admitted with DKA during the COVID-19 pandemic had more severe acidosis and a longer PICU stay. Variable access to health care during the COVID-19 pandemic may be contributing to this.

Nine surgeons from rural and remote communities in the United States share early experiences preparing for the COVID-19 pandemic. Relating experiences remarkably different from health care providers in urban areas in America most affected by the first stages of the outbreak, they tell the challenges of organizing resources in facilities already struggling with poverty-stricken communities far from established health care resources and supplies. From Alaska to Appalachia and the Navajo Nation to the rural midwest, they show the leadership and professionalism that exemplify rural surgery.