In neurologically injured patients, predictors for extubation success are not well defined. Abnormal breathing patterns may result from the underlying neurological injury. We present three patients with abnormal breathing patterns highlighting failure of successful extubation as a result of these neurologically driven breathing patterns. Recognizing abnormal breathing patterns may be predictive of extubation failure and thus need to be considered as part of extubation readiness.

Postextubation stridor is associated with significant morbidity. It commonly results in extubation failure after established medical treatment fails, such as nebulized epinephrine and/or intravenous steroids. The role of heliox (i.e., combination of helium and oxygen) in managing patients with postextubation stridor has not been fully established. We report two cases of postextubation stridor successfully treated with heliox delivered with bilevel positive airway pressure (BiPAP) after failure of standard medical therapy.

No abstract

Multiple sclerosis (MS) is described as an inflammatory, demyelinating, and neurodegenerative disorder of the central nervous system and is uncommonly seen in pediatric patients [1][2][3][4]. Pediatric MS also referred to as pediatric onset MS, is defined as MS with an onset before 16 years of age. Pediatric MS represents about 2.2-4.4% of all MS cases. In late childhood, affects more girls than boys, and is characterized by a relapsing-remitting course in almost all cases [5][6][7][8]9].Pediatric MS has distinctive features and the disease course is different from adults. Children are less likely to develop primary or secondary progressive MS in childhood. Guidelines for pediatric MS recommended that treatment can be started early in the disease course. Disease modifying therapies can also be used in treatment for Pediatric MS. This report describes the case of 12 years and 11-month-old boy with MS and discusses the current knowledge for the diagnosis of MS and therapeutic possibilities.