In MCTs, the cumulative dose (PD20), not the PC20, determines bronchial responsiveness. Modern nebulizers may be used for the test if clinical interpretation is based on PD20. Clinical trial registered with www.clinicaltrials.gov (NCT01288482).

Objective. To review the critical care course of children receiving orthotopic liver transplantation (OLT). Methods. A retrospective chart review of patients admitted to the pediatric critical care following OLT performed in our center between 1988 and 2011. Results. A total of 149 transplants in 145 patients with a median age of 2.7 (IQR 0.9–7) years were analyzed. Mortality in the first 28 days was 8%. The median length of stay (LOS) was 7 (4.0–12.0) days. The median length of mechanical ventilation (MV) was 3 (1.0–6.2) days. Open abdomen, age, and oxygenation index on the 2nd day predicted LOS. Open abdomen, age, amount of blood transfused during surgery, and PRISM III predicted length of MV. 28% of patients had infection and 24% developed acute rejection. In recent group (2000–2011) OLT was performed in younger patients; the risk of infection and acute rejection was reduced and patients required longer LOS and MV compared with old group (1988–1999). Conclusion. The postoperative course of children after OLT is associated with multiple complications. In recent years OLT was performed in younger children; living donors were more common; the rate of postoperative infection and suspected rejection was reduced significantly; however patients required longer MV and LOS in the PCCU.

A 5-year-old girl presented to an ambulatory cardiology clinic with shortness of breath, described by the patient's mother and chest discomfort on exertion. At this visit, she was noted to have low baseline room air oxygen saturations of 89%. Subsequent cardiac, respiratory and haematological investigations including contrast echocardiography, CT scan of the chest, polysomnography and haemoglobin electrophoresis were unhelpful in yielding a diagnosis. A CT scan of the chest with contrast was performed which revealed a persistent left-sided superior vena cava that appeared to be draining into the left atrium, creating a right-to-left shunt. This was not revealed on contrast echocardiography as contrast (micro bubbles) had been injected into the right arm. This case report highlights the nuances of diagnostic investigations, which without a high index of suspicion may exclude a timely diagnosis and therapeutic intervention.