Background: Improved understanding of the relationship between patient age and acute respiratory distress syndrome (ARDS) development and mortality following traumatic injury may help facilitate generation of new hypotheses about ARDS pathophysiology and the role of novel treatments to improve outcomes across the age spectrum. Methods: We conducted a retrospective cohort study of trauma patients included in the National Trauma Data Bank who were admitted to an intensive care unit from 2007-2016. We determined ARDS incidence and mortality across eight age groups for the entire 10-year study period and by year. We used generalized linear Poisson regression models adjusted for underlying mortality risk (injury mechanism, Injury Severity Score, admission Glasgow Coma Scale score, admission heart rate, and admission hypotension). Results: ARDS occurred in 3.1% of 1,297,190 trauma encounters. ARDS incidence was lowest among pediatric patients and highest among adults ages 35-64. ARDS mortality was highest among patients ≥80 years (43.9%) followed by 65-79 years (30.6%) and ≤4 years (25.3%). The relative risk of mortality associated with ARDS was highest among the pediatric age groups, with an adjusted relative risk (aRR) of 2.06 (95% CI 1.72-2.70) among patients ≤4 years old compared to an aRR of 1.51 (95% CI 1.42-1.62) for the entire cohort. ARDS mortality increased over the

Objective The international scope of critical neurological insults in children is unknown. Our objective was to assess the prevalence and outcomes of children admitted to pediatric intensive care units (PICUs) with acute neurological insults. Design Prospective study. Setting Multicenter (n=107 PICUs) and multinational (23 countries, 79% in North America and Europe). Patients Children aged 7d–17y admitted to the ICU with new traumatic brain injury, stroke, cardiac arrest, central nervous system infection or inflammation, status epilepticus, spinal cord injury, hydrocephalus, or brain mass. Interventions None. Measurements and main results We evaluated the prevalence and outcomes of children with pre-determined acute neurological insults. Child and center characteristics were recorded. Unfavorable outcome was defined as change in pre-post insult Pediatric Cerebral Performance Category (PCPC) score ≥ 2 or death at hospital discharge or 3 months, whichever came first. Screening data yielded overall prevalence of 16.2%. Of 924 children with acute neurological insults, cardiac arrest (23%) and traumatic brain injury (19%) were the most common. All-cause mortality at hospital discharge was 12%. Cardiac arrest subjects had highest mortality (24%), and TBI subjects had the most unfavorable outcomes (49%). The most common neurological insult was infection/inflammation in South America, Asia, and the single African site but cardiac arrest in the remaining regions. Conclusions Neurological insults are a significant pediatric international health issue. They are frequent and contribute substantial morbidity and mortality. These data suggest a need for an increased focus on acute critical neurological diseases in infants and children including additional research, enhanced availability of clinical resources, and the development of new therapies.

Vasospasm that occurs after subarachnoid hemorrhage (SAH), despite successful surgical or radiological intervention remains with an ominous prognostic recovery period. 1 We investigated the correlation of S100B protein in CSF and serum with incident of vasospasm and neurological outcome in patients undergoing intracerebral aneurysm clipping. Twenty five patients were enrolled. All patients received combined anesthetic techniques. Brain protection was provided by isoflurane. A CSF sample (2 cc) and blood sample (5 cc) were drawn 3 times (before skin incision, 30 minutes and 24 hours after clipping). Patients were followed for the incidence of vasospasm in Neurosurgical Intensive Care Unit and the neurological status at discharged was assessed using Glasgow Outcome Scale. Compared with baseline level (at 0 minute) we found that early changes in CSF S100 B level at 30 minutes significantly correlate with vasospasm (P = 0.005, sensitivity 90% and specificity 90%) but the correlation dissipated at 24 hours. In addition, early changes in S100B in CSF at 30 minutes significantly correlate with neurological outcome (P = 0.003). The relationship persisted at 24 hours (P , 0.011). In Serum we found no significant correlation between S100B at 30 minutes or 24 hours with either vasospasm or neurological outcome. We conclude that changes of S100B level in CSF in patients undergoing intracerebral aneurysm clipping surgery are strongly correlated with vasospasm and can be a reliable diagnostic tool to identified patients who are endangered with evolving vasospasm after a successful securing aneurysm surgery. Reference: 1. Pluta RM. Delayed cerebral vasospasm and nitric oxide: review, new hypothesid, and proposed treatment.

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