Background: Treatment of acute respiratory distress syndrome (ARDS) in children is largely based on extrapolated knowledge obtained from adults and which varies between different hospitals. This study explores ventilation treatment strategies for children with ARDS in the Nordic countries, and compares these with international practice. Methods: In October 2012, a questionnaire covering ventilation treatment strategies for children aged 1 month to 6 years of age with ARDS was sent to 21 large Nordic intensive care units that treat children with ARDS. Pre-terms and children with congenital conditions were excluded. Results: Eighteen of the 21 (86%) targeted intensive care units responded to the questionnaire. Fifty per cent of these facilities were paediatric intensive care units. Written guidelines existed in 44% of the units. Fifty per cent of the units frequently used cuffed endotracheal tubes. Ventilation was achieved by pressure control for 89% vs. volume control for 11% of units. Bronchodilators were used by all units, whereas steroids usage was 83% and surfactant 39%. Inhaled nitric oxide and high frequency oscillation were available in 94% of the units. Neurally adjusted ventilator assist was used by 44% of the units. Extracorporeal membrane oxygenation could be started in 44% of the units. Conclusion: Ventilation treatment strategies for paediatric ARDS in the Nordic countries are relatively uniform and largely in accordance with international practice. The use of steroids and surfactant is more frequent than shown in other studies.

Aim Formulas for empirical body surface area (BSA), which is used to estimate body size and standardise physiological parameters, may disagree in children. We compared six commonly used BSA formulas—Du Bois, Boyd, Costeff, Haycock, Meban and Mosteller—in a surgical cohort. Methods This retrospective single‐centre cohort study comprised 68 children who had corrective heart surgery at Skåne University Children's Hospital, Lund, Sweden, from February 2010 to March 2017. Results The children (51% female) underwent surgery at a mean weight of 7.0 kilograms (range 2.7‐14.1 kg) and a mean age 11 months (range 0‐43 months). All the BSA formulas showed good correlation with mean BSA, but there were considerable variations between them. Mosteller's formula was exactly the same as the mean BSA (bias 0.000). The Du Bois and Boyd formulas had the largest mean BSA deviations (bias −0.012 and 0.015). Costeff's formula showed good agreement with mean BSA, Haycock's formula showed minimal overestimation and Meban's formula demonstrated a systemic error in older children. Conclusion Commonly used BSA formulas did not agree in young children undergoing heart surgery, but they were all close to the overall mean of the six formulas, with the Mosteller formula producing the same value.

Editor’s Perspective What We Already Know about This Topic To date, there are not clinically practical, accurate, and precise noninvasive methods for measuring cardiac output in small children What This Article Tells Us That Is New This study describes a noninvasive method by which ultrasound can be used in small children to determine cardiac output with good precision After surgery in 43 small children for repair of atrial or ventricular septal defects, cardiac output measurements performed using saline bolus injections and ultrasound detection of the expected blood dilution showed similar precision for measuring cardiac output as a cardiac outputs measured using periaortic flow probe Background Technology for cardiac output (CO) and blood volume measurements has been developed based on blood dilution with a small bolus of physiologic body temperature saline, which, after transcardiopulmonary mixing, is detected with ultrasound sensors attached to an extracorporeal arteriovenous loop using existing central venous and peripheral arterial catheters. This study aims to compare the precision and agreement of this technology to measure cardiac output with a reference method, a perivascular flow probe placed around the aorta, in young children. The null hypothesis is that the methods are equivalent in precision, and there is no bias in the cardiac output measurements. Methods Forty-three children scheduled for cardiac surgery were included in this prospective single-center comparison study. After corrective cardiac surgery, five consecutive repeated cardiac output measurements were performed simultaneously by both methods. Results A total of 215 cardiac output measurements were compared in 43 children. The mean age of the children was 354 days (range, 30 to 1,303 days), and the mean weight was 7.1 kg (range, 2.7 to 13.6 kg). The precision assessed as two times the coefficient of error was 3.6% for the ultrasound method and 5.0% for the flow probe. Bias (mean COultrasound 1.28 l/min − mean COflow probe 1.20 l/min) was 0.08 l/min, limits of agreement was ±0.32 l/min, and the percentage error was 26.6%. Conclusions The technology to measure cardiac output with ultrasound detection of blood dilution after a bolus injection of saline yields comparable precision as cardiac output measurements by a periaortic flow probe. The difference in accuracy in the measured cardiac output between the methods can be explained by the coronary blood flow, which is excluded in the cardiac output measurements by the periaortic flow probe.

This has potentially important implications in clinical practice. A recent report from Italy suggests that the prevalence of arterial hypertension is significantly higher amongst COVID-19 patients admitted to ICU who do not survive. 7 Our study has several limitations related to the observational nature of the studies reviewed with all inherent biases. Few investigations have examined the link between arterial hypertension and ICU admission in COVID-19 patients, limiting the number of the studies included in the metaanalysis. No formal definition of arterial hypertension was given in the included studies. The need for ICU admission may have depended on local resources that are often different between units. No adjustments for confounders were made for other risk factors such as age or other baseline cardiovascular or chronic comorbidities. All included studies were performed in China, so we cannot exclude significant differences between other populations. Because we considered only published studies in English, we cannot exclude missing some investigations with interesting findings published only in Chinese in particular. In our analysis, the degree of increased risk of ICU admission in hypertensive patients was strongly influenced by a single study, that of Guan and colleagues. 2 The identification of those predictors indicating a need for intensive care admission could be helpful in managing the early phase of the pandemic both for clinical and ICU management. However, our results should be considered preliminary, and further research is necessary to confirm our findings. 8 Declarations of interest The authors declare that they have no conflicts of interest.