Background Management and monitoring of pain and sedation to reduce discomfort as well as side effects, such as over- and under-sedation, withdrawal syndrome and delirium, is an integral part of pediatric intensive care practice. However, the current state of management and monitoring of analgosedation across European pediatric intensive care units (PICUs) remains unknown. The aim of this survey was to describe current practices across European PICUs regarding the management and monitoring of pain and sedation. Methods An online survey was distributed among 357 European PICUs assessing demographic features, drug choices and dosing, as well as usage of instruments for monitoring pain and sedation. We also compared low- and high-volume PICUs practices. Responses were collected from January to April 2021. Results A total of 215 (60% response rate) PICUs from 27 European countries responded. Seventy-one percent of PICUs stated to use protocols for analgosedation management, more frequently in high-volume PICUs (77% vs 63%, p = 0.028). First-choice drug combination was an opioid with a benzodiazepine, namely fentanyl (51%) and midazolam (71%) being the preferred drugs. The starting doses differed between PICUs from 0.1 to 5 mcg/kg/h for fentanyl, and 0.01 to 0.5 mg/kg/h for midazolam. Daily assessment and documentation for pain (81%) and sedation (87%) was reported by most of the PICUs, using the preferred validated FLACC scale (54%) and the COMFORT Behavioural scale (48%), respectively. Both analgesia and sedation were mainly monitored by nurses (92% and 84%, respectively). Eighty-six percent of the responding PICUs stated to use neuromuscular blocking agents in some scenarios. Monitoring of paralysed patients was preferably done by observation of vital signs with electronic devices support. Conclusions This survey provides an overview of current analgosedation practices among European PICUs. Drugs of choice, dosing and assessment strategies were shown to differ widely. Further research and development of evidence-based guidelines for optimal drug dosing and analgosedation assessment are needed.

Extrapontine myelinolysis is characterized by symmetric demyelination following rapid shifts in serum osmolality in the supratentorial compartment. Extrapontine myelinolysis in children is rare compared to adults. The most common underlying pathophysiology is rapid correction of hyponatremia. Only 2 cases were published after diabetic ketoacidosis without electrolyte imbalance in the English literature. This study presents an unusual and possibly the youngest case of extrapontine myelinolysis that occurred in the setting of diabetic ketoacidosis and complicated cerebral edema without electrolyte imbalance, along with a review of the literature.

In this study serum levels of calprotectin were found to be higher in children with indoor ETS exposure where no relation was detected with BMI and serum levels of leptin and ghrelin. Increased serum levels of calprotectin might be an indicator of inflammation related to ETS exposure.

Objectives: To investigate conventional mechanical ventilation weaning characteristics of patients requiring conventional mechanical ventilation support for greater than 48 hours within the PICU. Design: The prospective observational multicenter cohort study was conducted at 15 hospitals. Data were being collected from November 2013 to June 2014, with two designated researchers from each center responsible for follow-up and data entry. Setting: Fifteen tertiary PICUs in Turkey. Patients: Patients between 1 month and 18 years old requiring conventional mechanical ventilation for greater than 48 hours were included. A single-center was not permitted to surpass 20% of the total sample size. Patients with no plans for conventional mechanical ventilation weaning were excluded. Interventions: Conventional mechanical ventilation Measurements and Main Results: Pertinent variables included PICU and patient demographics, including clinical data, chronic diseases, comorbid conditions, and reasons for intubation. Conventional mechanical ventilation mode and weaning data were characterized by daily ventilator parameters and blood gases. Patients were monitored until hospital discharge. Of the 410 recruited patients, 320 were included for analyses. A diagnosis of sepsis requiring intubation and high initial peak inspiratory pressures correlated with a longer weaning period (mean, 3.65 vs 1.05–2.17 d; p < 0.001). Conversely, age, admission Pediatric Risk of Mortality III scores, days of conventional mechanical ventilation before weaning, ventilator mode, and chronic disease were not related to weaning duration. Conclusions: Pediatric patients requiring conventional mechanical ventilation with a diagnosis of sepsis and high initial peak inspiratory pressures may require longer conventional mechanical ventilation weaning prior to extubation. Causative factors and optimal weaning for this cohort needs further consideration.

Brain death is defined as the irreversible loss of consciousness and all functions of the brain stem. The accuracy and urgency of a diagnosis of brain death in children are highly important, because of the increasing rate of organ transplantation. Our objective was to describe the features of cases where "brain death" was diagnosed in the last five years. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Demographical, clinical, electroencephalographic (EEG), Doppler ultrasonography and static single-photon emission computerized tomography (SPECT) characteristics were evaluated retrospectively in hospitalized with loss of brain stem functions and deep coma. R Re es su ul lt ts s: : Twenty eight patients (8 girls/20 boys) were evaluated in this study. The median age was 72 months (10-210 months). Transcranial Doppler ultrasonography was performed in 18 (64%) patients. The cerebral catheter angiography was used in one patient. SPECT was used in eleven (40%) patients as a confirmatory test. Diabetes insipidus was present in 75% (n=21) and hypothermia was present in 50% (n=14) of the patients. C Co on nc cl lu us si io on n: : We observed that serial Doppler Ultrasonography and SPECT benefited us more than other techniques in our study. Transcranial Doppler is useful and has some advantages: such as noninvasiveness, rapid application, easy bedside operation, portability, no disturbance from sedatives, repeatability and relatively low price. We conclude that diabetes insipidus may be an indicator of brain death, and an observation of diabetes insipidus should accelerate confirmatory tests and treatment immediately. K Ke ey y W Wo or rd ds s: : Brain death; child; diabetes insipidus; hypothermia; transplantation Ö ÖZ ZE ET T A Am ma aç ç: : Beyin ölümü, solunum dâhil tüm beyin sapı işlevlerinin ve bilincin geri dönüşümsüz olarak kaybedilmesi şeklinde tanımlanmaktadır. Çocukluk çağında organ transplantasyonu yapılan olguların sayısındaki artış, beyin ölümü tanısını daha önemli hâle getirmiştir. Bu çalışmanın amacı, son beş yılda "beyin ölümü" tanısı alan olguların demografik ve klinik özelliklerini tanımlamaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Beyin sapı fonksiyon kaybı ve derin koma nedeni ile yatışı yapılan hastaların demografik, klinik, elektroensefalografik (EEG), Doppler ultrasonografi ve "single-photon emission computerized tomography (SPECT)" görüntüleme özellikleri restrospektif olarak değerlendirildi. B Bu ul lg gu ul la ar r: Çalışmaya sekizi kız,20'si erkek olmak üzere 28 hasta dâhil edildi. Ortanca yaş 72 (10-210 ay) ay idi. Transkraniyal Doppler ultrasonografi18 (%64) hastaya uygulanmıştı. Serebral kateter anjiyografi bir hastada kullanılmıştı. On bir (%40) hastaya destekleyici test olarak SPECT uygulanmıştı. Hastaların %75 (n=21)'inde diabetes insipidus, %50 (n=14)'sinde ise hipotermi saptandı. S So on nu uç ç: Bu çalışmada, serebral perfüzyonu göstermek için en sık transkraniyal Doppler ve SPECT'ten faydalanıldığını gördük. Transkraniyal Doppler ultrasonografinin seçilmesi...