Diagnostics and treatment of children with acute seizures on paediatric intensive care unit.

218 children were admitted to paediatric clinic for acute seizures within last 5 years. Out of them, 14 children (7%) were admitted to paediatric intensive care unit (PICU) with repeated or prolonged seizures. Two children were hospitalized twice. The average age of children in time of admission was 12 months, most of the children were healthy before admission, had normal psychomotor development. The most frequent seizure manifestation was asymmetric clonic seizure. Hypoventilation and/or unconsciousness was the most frequent indication for PICU admission in addition to seizures. Febrile seizure was the most frequent diagnosis in children with shorter or less frequent episodes of seizure. Children with severe course and pharmacoresistant seizure were likely to have genetic diagnosis. The MRI scan was normal in most of the children, interictal EEG was mostly without specific finding. Midazolam was the first lime anticonvulsive medication used in most of the children, while phenobarbital, levetiracetam or phenytoin were the preferred second line drugs. Keywords: acute seizures, asymmetric clonic seizure, febrile seizure, children, paediatric intensive care unit.

Endobronchial stenting on VV-ECMO in a 6-month-old girl with right lung agenesis and severe stenosis of the left main bronchus.

INTRODUCTION: Lung agenesis is a rare disorder with a variable, but potentially very bad clinical course. It necessitates complex clinical management, especially in life-threatening situations. CASE REPORT: We describe a case of a 6-month-old girl with right lung agenesis who required venovenous extracorporeal membrane oxygenation (VV-ECMO) due to pneumonia complicated by exacerbated previously diagnosed left main bronchus stenosis. The stenosis was resolved by endobronchial intervention and X-ray-guided stent insertion, which enabled weaning from ECMO and was aimed at preventing such a life-threatening respiratory failure in the future. Unfortunately, even with the functional stent, the baby died 2 months post-procedure due to unresolvable bronchial spasms. DISCUSSION: Despite high endobronchial stenting-related mortality in children, in cases where no effective pharmacological or surgical alternatives exist, stenting may be safely performed during VV-ECMO support and be a viable option to overcome critical respiratory failure caused by bronchial stenosis.

Management of severe pulmonary hemorrhage in a neonate on veno-arterial ECMO by the temporary clamping of the endotracheal tube - a case report.

Severe pulmonary hemorrhage in the newborn is an infrequent, but life-threatening, event. A newborn with persistent pulmonary hypertension and a large persistent ductus arteriosus and open foramen ovale presented with hypoxemia and progressive right heart failure shortly after birth, requiring veno-arterial extracorporeal membrane oxygenation (ECMO) support. Twenty minutes after the initiation of ECMO, the patient developed severe pulmonary hemorrhage refractory to conventional treatment. As a last resort, the endotracheal tube was clamped. After transport to the ECMO center, repeated attempts to open the endotracheal tube resulted in continued blood loss and the endotracheal tube was clamped for a total of 63 hours without any mechanical ventilation. On the third postnatal day, the endotracheal tube was reopened, large amounts of clot were removed by bronchoscopy and mechanical ventilation was resumed followed by improved general condition and favorable outcome.

Effects of high tidal volume mechanical ventilation on production of cytokines, iNOS, and MIP-1ß proteins in pigs.

The aim of this study was to investigate longitudinal changes of the pulmonary inflammatory process as a result of mechanical stress due to mechanical ventilation. The concentrations of IL-8, TNF-α, MIP-1ß, nitrites/nitrates, and inducible nitric oxide synthases (iNOS) were investigated indicate in bronchoalveolar lavage (BAL). Twenty-three piglets were divided into three groups. Group I: animals breathing spontaneously; group II: mechanical ventilation (tidal volume (TV) = 7 mL/kg, PEEP = 5 cmH(2)O); group III: mechanical ventilation (TV = 15 mL/kg, PEEP = 0 cmH(2)0). Concentrations of BAL nitrites/nitrates from groups II and III increased during the first hour of mechanical ventilation (P = .03 and .02, respectively). The highest expression of iNOS was observed during the first hour in groups II and III. IL-8 concentration increased significantly in groups II and III. Production of TNF-α increased significantly in group III during the second and third hour (P = .01). Concentration of MIP-1ß was significantly increased in groups II and III after the first hour (P = .012 and P = .008, respectively).