Background Very little evidence for predictive markers of fluid responsiveness has been reported in children as compared to adults. The impact of hypovolemia or hypervolemia on morbidity has driven interest in the fluid challenge titration strategy. Aim The objective of this study was to explore the ability of a 3 mL kg−1 mini‐fluid challenge over 2 minutes to predict fluid responsiveness in children under controlled ventilation. Methods Children scheduled for surgery under general anesthesia were included and received a fluid challenge of 15 mL kg−1 of crystalloid prior to incision administered over 10 minutes in two steps: 3 mL kg−1 over 2 minutes then 12 mL kg−1 over 8 minutes. Fluid responsiveness was defined as a change of ≥10% in cardiac output estimated by left ventricular outflow tract velocity time integral (VTI) as measured by transthoracic ultrasound before and after the fluid challenge of 15 mL kg−1. Results Of the 55 patients included in the analysis, 43 were fluid responders. The increase in the VTI after the mini‐fluid challenge (ΔVTIminiFC) predicted fluid responsiveness with an area under the receiver operating characteristic curve of 0.77; 95% CI (0.63‐0.87), P = .004. Considering the least significant change which was 7.9%; 95% CI (6‐10), the threshold was 8% with a sensitivity of 53%; 95% CI (38‐68); and a specificity of 77%; 95% CI (54‐100). Conclusion ΔVTIminiFC weakly predicted the effects of a fluid challenge of 15 mL kg−1 of crystalloid in anesthetized children under controlled mechanical ventilation.

Background. Leptospirosis is a zoonosis caused by pathogenic spirochetes of the genus Leptospira. Although it may be limited to nonspecific fever, leptospirosis may also be responsible for neurological symptoms or fulminant diseases such as Weil’s disease. Diagnosis is challenging due to the difficulty in isolating the organism and the delays required for performing the serological test. Case Presentation. Two cases of leptospirosis are presented here. The clinical picture differed from a real Weil’s disease in the first case and from a neuro-leptospirosis in the second. However, both patients underwent liver transplantation because of the severity of the associated acute liver failure. Unfortunately, one of the cases had a fatal outcome. Conclusion. Antibiotic treatment for leptospirosis should not be delayed by the lack of a positive serology test for this potentially lethal disease. In the context of a history of exposure to risk factors for leptospirosis, a negative serology must be repeated 7 days to 2 weeks following the first test. Although not always present, acute liver injury may, in rare cases, require liver transplantation.

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