Renal replacement therapy after cardiac surgery with extracorporeal circulation Objective: Acute kidney injury (AKI) is a frequent complication of cardiac surgery with cardiopulmonary bypass (CPB). The aim of this study was to determine the incidence of renal replacement therapy (RRT) requirement in children undergoing surgical repair for congenital cardiopathies and identify the risk factors for requiring RRT. Patients and Methods: A retrospective, descriptive study was performed. The records of patients under 18 years undergoing cardiac surgery with CPB (January 2001 to July 2008) who required RRT (n = 15) and from a random patients sample that did not require it (n = 57) were analysed. Results: Fifteen children out of 942 required acute RRT (1.6%). Initial RRT was peritoneal dialysis (PD) in all of them. The main indications were hypervolemia and/or oligoanuria. Ten patients experienced complications associated to therapy and 14 patients had a history of serious intraoperative events. In multivariated analysis, hypotension (OR 36.0, CI 95%: 5.5-235.6) and serious low cardiac output (LCO) (OR 14.1, CI 95%: 1.47-135.32) were signifi cant risk factors for RRT requirement. In turn, the presence of intraoperative events was signifi cantly associated with the occurrence of hypotension (OR 28.9, CI 95%: 3.6-233.9) and LCO (OR 5.3, CI 95%: 1.1-26.6) during the post-surgical evolution. Conclusion: In this experience, severe hypotension and low cardiac output were signifi cant risk factors for RRT requirement. The incidence of RRT was 1.6%. Renal function should be closely evaluated in those patients with surgical events. RRT should be early considered in those patients with risk factors for renal failure.

Non-invasive ventilation in acute respiratory failure Background: Non-invasive ventilation (NIV) has become a therapeutic tool for acute respiratory failure in pediatric patients. Objective: To describe NIV experience at a Pediatric Intensive Care Unit, identifying factors associated to modality failure. Methods: Patients cohort who received NIV in acute respiratory failure during 2005-2007. Recolection of clinical and gasometrical variables previous and subsequent to connection to NIV. Descriptive statistic and logistic regression analysis were performed. Results: 51 events of NIV, where 55% cases were congenital cardiopathies. NIV main indication was respiratory distress post-extubation (31.4%). 15 patients (29.4%) required CMV. In univariate logistic regression for variables, an independent association was found between FiO2 pre-connection and FiO2 subsequent to NIV connection, with necessity of CMV. 9% presented complications and mortality was not related to ventilatory modality. Conclusions: NIV is useful in pediatric patients with acute respiratory insufficiency, with low risk of complications. The variables associated with failure are easy to obtain and interpretate.

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Infant Botulism: Case-report and literature review Background: Infant botulism is a rare and potentially lethal neurological disease produced by the ingestion of a neurotoxin secreted by Clostridium botulinum, causing diffuse paralysis. Objective: Describe the first case in Chile since the establishment of an obligatory report and describe the diagnosis, clinical presentation and outcome. Case-report: A 2 months-old male with 48 hours of poor feeding and swallowing, weak cry, listlessness and constipation. He was admitted for hospitalization with probable sepsis and required tracheotomy due to apnea with failed endotracheal intubation, requiring mechanical ventilation for 150 days and hospitalization during 180 days. The diagnosis was confirmed by isolating Clostridium botulinum toxin from stool. Conclusion: The diagnosis of infant botulism requires a high suspicion index and the treatment includes intensive care monitorization with general support.

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