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The clinical presentation of chronic myeloid leukemia (CML) at diagnosis differs in children compared to adults. At younger age, anemia appears to be frequent at diagnosis, but its prevalence and its impact on prognosis are not well known. In the International Registry of Childhood CML, we selected children and adolescents in chronic phase at diagnosis of CML and treated upfront with imatinib. We examined their hemoglobin level at diagnosis according to the WHO grades to assess the prevalence of anemia and its impact on response to tyrosine kinase inhibitors (TKIs). Data on 430 patients were included. Anemia at diagnosis was observed in 350 patients (81%), with a mean hemoglobin level of 96.4 g/l (SD 23.6). Among them, 182 patients (52%) presented with moderate anemia and 110 (31%) with severe anemia while 58 (17%) had mild anemia. Compared with mild and no anemia, moderate and severe forms were significantly associated with younger age at diagnosis, asthenia, splenomegaly, and increased leukocyte and basophil counts. Delays in achieving major and deep molecular responses were significantly increased for patients with moderate and severe anemia, and also failure of imatinib treatment was more frequent in these two sub-cohorts. However, hemoglobin level was not significantly associated with survival. Anemia at diagnosis of pediatric CML was frequent and may be considered as a prognostic factor.

We aimed to evaluate the association between proton pump inhibitor (PPI) exposure and nosocomial infection (NI) during PICU stay.Propensity score matched analysis of a single-center retrospective cohort from January 1, 2017, to December 31, 2018.Tertiary medical and surgical PICU in France.Patients younger than 18 years old, admitted to the PICU with a stay greater than 48 hours.Patients were retrospectively allocated into two groups and compared depending on whether they received a PPI or not.Seven-hundred fifty-four patients were included of which 231 received a PPI (31%). PPIs were mostly used for stress ulcer prophylaxis (174/231; 75%), but upper gastrointestinal bleed risk factors were rarely present (18%). In the unadjusted analyses, the rate of NI was 8% in the PPI exposed group versus 2% in the nonexposed group. After propensity score matching ( n = 184 per group), we failed to identify an association between PPI exposure and greater odds of NI (adjusted odds ratio 2.9 [95% CI, 0.9-9.3]; p = 0.082). However, these data have not excluded the possibility that there is up to nine-fold greater odds of NI.This study highlights the prevalent use of PPIs in the PICU, and the potential association between PPIs and nine-fold greater odds of NI is not excluded.

International audience; BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is the most severe clinical entity associated with pediatric SARS-CoV-2 infection with a putative role of the spike protein into the immune system activation. Whether COVID-19 mRNA vaccine can induce this complication in children is unknown. We aimed to assess the risk of hyper-inflammatory syndrome following COVID-19 mRNA vaccine in children. METHODS: We conducted a post-authorization national population-based surveillance using the French enhanced pharmacovigilance surveillance system for COVID-19 vaccines. All cases of suspected hyper-inflammatory syndrome following COVID-19 mRNA vaccine in 12-17-year-old children between June 15(th), 2021 and January 1(st), 2022, were reported. Cases were reviewed according to WHO criteria for MIS-C. The reporting rate of this syndrome was compared to the MIS-C rate per 1,000,000 12-17-year-old children infected by SARS-CoV-2. FINDINGS: Up to January 2022, 8,113,058 COVID-19 mRNA vaccine doses were administered to 4,079,234 12-17-year-old children. Among them, 12 presented a hyper-inflammatory syndrome with multisystemic involvement. Main clinical features included male predominance (10/12, 83%), cardiac involvement (10/12, 83%), digestive symptoms (10/12, 83%), coagulopathy (7/12, 58%), cytolytic hepatitis (6/12, 50%), and shock (5/12, 42%). 4/12 (33%) required intensive care unit transfer, and 3/12 (25%) hemodynamic support. All cases recovered. In eight cases, no evidence of previous SARS-CoV-2 infection was found. The reporting rate was 1.5 (95%CI [0.8; 2.6]) per 1,000,000 doses injected, i.e. 2.9 (95%CI [1.5; 5.1]) per 1,000,000 12-17-year-old vaccinated children. As a comparison, 113 MIS-C (95%CI [95; 135]) occurred per 1,000,000 12-17-year-old children infected by SARS-CoV-2. INTERPRETATION: Very few cases of hyper-inflammatory syndrome with multi-organ involvement occurred following COVID-19 mRNA vaccine in 12-17-year-old children. The low reporting rate of this syndrome, compared to the rate of post-SARS-CoV-2 MIS-C in the same age-group, largely supports the vaccination in a context of an important circulation of SARS-CoV-2. FUNDING: ESPID Fellowship Award; Grandir-Fonds de Solidarité Pour L'enfance.

BACKGROUND: Mathematical models based on the physiology when programmed as a software can be used to teach cardiorespiratory physiology and to forecast the effect of various ventilatory support strategies. We developed a cardiorespiratory simulator for children called “SimulResp”. The purpose of this study was to evaluate the quality of SimulResp. METHODS: SimulResp quality was evaluated on accuracy, robustness, repeatability and reproducibility. Blood gas values (pH, PaCO , PaO and SaO ) were simulated for several subjects with different characteristics and in different situations and compared to expected values available as reference. The correlation between reference and simulated data was evaluated by the coefficient of determination and Intraclass correlation coefficient. The agreement was evaluated with the Bland & Altman analysis. RESULTS: SimulResp produced healthy child physiological values within normal range (pH 7.40 +/- 0.5; PaCO2 40 +/- 5 mmHg, PaO2 90 +/- 10 mmHg; SaO2 97% +/- 3%) starting from a weight of 25 to 35 kg, regardless of ventilator support. SimulResp failed to simulate accurate values for subjects under 25 kg and/or affected with pulmonary disease and mechanically ventilated. Based on the repeatability was considered as excellent and the reproducibility as mild to good. SimulResp’s prediction remains stable within time. CONCLUSIONS: The cardiorespiratory simulator SimulResp requires further development before future integration into a clinical decision support system.

Best strategies for managing severe pediatric traumatic brain injury (TBI) are not established, with wide variations among professional practices. The main objective of this study was to assess compliance with updated pediatric TBI management guidelines (2019). A survey was distributed among French-speaking pediatric intensive care physicians from April 1 to June 30, 2019. The survey was based on a clinical case with a total of 70 questions that cover the 15 items of the 2019 TBI guidelines. The questions evaluated the assessment and management of TBI during the acute and intensive care phases. Of 487 e-mails sent, 78 surveys were included. Guidelines were adhered to (> 60%) for 10 of 15 items in the guidelines. Strong adherence to recent guideline changes was achieved for seizure prophylaxis with levetiracetam (n = 21/33, 64%) and partial pressure of carbon dioxide threshold (n = 52, 67%). However, management of the sodium and glucose thresholds and the role of transcranial Doppler were not consistent with the guidelines. Assessment of brain tissue oxygenation (n = 12, 16%) and autoregulation (n = 35, 45%) was not a common practice. There was strong agreement among clinicians on the intracranial pressure (> 80%) and cerebral perfusion pressure (> 70%) thresholds used according to age. Overall, stated practices for the management of TBI appear to be relatively standardized among responders. Variations persist in areas with a lack of evidence and pediatric-specific recommendations.

The ideal fluid for intravenous maintenance fluid therapy (IV-MFT) in acutely and critically ill children is controversial, and evidence-based clinical practice guidelines are lacking and current prescribing practices remain unknown. We aimed to describe the current practices in prescribing IV-MFT in the context of acute and critically ill children with regard to the amount, tonicity, composition, use of balanced fluids, and prescribing strategies in various clinical contexts. A cross-sectional electronic 27-item survey was emailed in April-May 2021 to pediatric critical care physicians across European and Middle East countries. The survey instrument was developed by an expert multi-professional panel within the European Society of Pediatric and Neonatal Intensive Care (ESPNIC). A total of 154 respondents from 35 European and Middle East countries participated (response rate 64%). Respondents were physicians in charge of acute or critically ill children. All respondents indicated they routinely use a predefined formula to prescribe the amount of IV-MFT and considered fluid balance monitoring very important in the management of acute and critically ill children. The use of balanced solution was preferred if there were altered serum sodium and chloride levels or metabolic acidosis. Just under half (42%, 65/153) of respondents believed balanced solutions should always be used. Respondents considered the use of isotonic IV solutions as important for acute and critically ill children. In terms of the indication and the composition of IV-MFT prescribed, responses were heterogeneous among centers. Almost 70% (107/154) respondents believed there was a gap between current practice and what they considered ideal IV-MFT due to a lack of guidelines and inadequate training of healthcare professionals. Conclusions: Our study showed considerable variability in clinical prescribing practice of IV-MFT in acute pediatric settings across Europe and the Middle East. There is an urgent need to develop evidence-based guidelines for IV-MFT prescription in acute and critically ill children. What is Known: • The administration of maintenance intravenous fluid therapy is a standard of care for a lot of hospitalized children • Maintenance intravenous fluid therapy prescriptions are often based on Holliday and Segar's historical guidelines even if this practice has been associated with several complications. What is New: • This study provided information on the prescribing practice regarding fluid restriction, fluid tonicity, and balance. • This study showed considerable variability in clinical prescribing practice of intravenous maintenance fluid therapy across Europe and the Middle East.

Tuberculous meningitis (TBM) is now uncommon in high-income countries. It is the most severe form of extrapulmonary tuberculosis with high rates of mortality and morbidity if diagnosis and treatment are delayed. An 8-month-old girl with TBM who was treated with high-dose intravenous anti-tuberculous drugs (ATD) is reported. Therapeutic drug monitoring (TDM) of isoniazid and rifampicin was undertaken by measuring serial drug concentrations in serum and cerebrospinal fluid (CSF). There was rapid eradication of

OBJECTIVE The main purpose of our study was to subjectively assess the quality of a paediatric intensive care unit (PICU) database according to the Directory of Clinical Databases (DoCDat) criteria. DESIGN AND SETTING A survey was conducted between April 1 and June 15, 2018, among the Sainte Justine PICU research group. POPULATION Every member of this group whose research activity required the use of the database and/or who was involved in the development/validation of the database. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All 10 research team members (one Information Technology specialist, one junior medical student, and eight clinician researchers) who used the high-resolution database fulfilled the survey (100% response rate). The median quality level of the Sainte Justine PICU database across all the 10 criteria was 3 (2-4), rated on a 1 (worst) to 4 (best) numeric scale. When compared with previously assessed databases through the DoCDat criteria, we found that the Sainte Justine PICU database performance was similar. CONCLUSIONS The PICU high-resolution database appeared of good quality when subjectively assessed by the DoCDat criteria. Further validation procedures are mandatory. We suggest that data quality assessment and validation procedures should be reported when creating a new database.

The purpose of the study was to evaluate the influence of establishing a protocol for the use of combined sodium benzoate and sodium phenylacetate (SBSP) (Ammonul®) to treat acute hyperammonemia. This was a retrospective, single-center study in a 24-bed medical and surgical pediatric intensive care unit (PICU) in a tertiary care teaching maternal-child hospital in Canada. Inclusion criteria were age 18 years, PICU admission between 1 January 2000 and 30 June 2016, and SBSP treatment. An SBSP delivery protocol was implemented in our hospital on 30 August 2008 in order to improve management of acute hyperammonemia. Patients were assigned to one of the two groups, without or with protocol, depending on date of admission. SBSP was ordered 34 times during the study period, and 23 orders were considered for analysis (14 with and 9 without protocol). Patient characteristics were similar between groups. The median time from diagnosis to prescription was significantly shorter in the protocol group [40 min (21-82) vs 100 min (70-150), p = 0.03)] but the median time from diagnosis to administration of the treatment was equivalent [144 min (90-220) vs 195 (143-274), (p = 0.2)]. Other clinical outcomes did not differ. This study is the first to compare two SBSP delivery strategies in the treatment of acute hyperammonemia in this PICU setting. Implementation of a delivery protocol shortened the time from diagnosis of hyperammonemia to prescription of SBSP and helped us identify other parameters that can be improved to optimize treatment delivery.

Ventilator-associated pneumonia is the second most common nosocomial infection in pediatric intensive care. The Centers for Disease Control and Prevention recently issued diagnosis criteria for pediatric ventilator-associated pneumonia and for ventilator-associated events in adults. The objectives of this pediatric study were to determine the prevalence of ventilator-associated pneumonia using these new Centers for Disease Control and Prevention criteria, to describe the risk factors and management of ventilator-associated pneumonia, and to assess a simpler method to detect ventilator-associated pneumonia with ventilator-associated event in critically ill children.Retrospective, observational, single-center.PICU in a tertiary-care university hospital.Consecutive critically ill children mechanically ventilated for greater than or equal to 48 hours between November 2013 and November 2015.None.Of 304 patients mechanically ventilated for greater than or equal to 48 hours, 284 were included. Among them, 30 (10.6%) met clinical and radiologic Centers for Disease Control and Prevention criteria for ventilator-associated pneumonia, yielding an prevalence of 7/1,000 mechanical ventilation days. Median time from mechanical ventilation onset to ventilator-associated pneumonia diagnosis was 4 days. Semiquantitative culture of tracheal aspirates was the most common microbiological technique. Gram-negative bacteria were found in 60% of patients, with a predominance of Haemophilus influenzae and Pseudomonas aeruginosa. Antibiotic therapy complied with adult guidelines. Compared with patients without ventilator-associated pneumonia, those with ventilator-associated pneumonia had significantly longer median durations of mechanical ventilation (15 vs 6 d; p0.001) and PICU stay (19 vs 9 d; p0.001). By univariate analysis, risk factors for ventilator-associated pneumonia were younger age, reintubation, acute respiratory distress syndrome, and continuous enteral feeding. Among the 30 patients with ventilator-associated pneumonia, 17 met adult ventilator-associated event's criteria (sensitivity, 56%).Ventilator-associated pneumonia is associated with longer times on mechanical ventilation and in the PICU. Using the ventilator-associated event criteria is of interest to rapidly screen for ventilator-associated pneumonia in children. However, sensitivity must be improved by adapting these criteria to children.

RATIONALE High data quality is essential to ensure the validity of clinical and research inferences based on it. However, these data quality assessments are often missing even though these data are used in daily practice and research. AIMS AND OBJECTIVES Our objective was to evaluate the data quality of our high-resolution electronic database (HRDB) implemented in our paediatric intensive care unit (PICU). METHODS We conducted a prospective validation study of a HRDB in a 32-bed paediatric medical, surgical, and cardiac PICU in a tertiary care freestanding maternal-child health centre in Canada. All patients admitted to the PICU with at least one vital sign monitored using a cardiorespiratory monitor connected to the central monitoring station. RESULTS Between June 2017 and August 2018, data from 295 patient days were recorded from medical devices and 4645 data points were video recorded and compared to the corresponding data collected in the HRDB. Statistical analysis showed an excellent overall correlation (R2 = 1), accuracy (100%), agreement (bias = 0, limits of agreement = 0), completeness (2% missing data), and reliability (ICC = 1) between recorded and collected data within clinically significant pre-defined limits of agreement. Divergent points could all be explained. CONCLUSIONS This prospective validation of a representative sample showed an excellent overall data quality.

Acute hyperammonemia may induce a neurologic impairment leading to an acute life-threatening condition. Coma duration, ammonia peak level, and hyperammonemia duration are the main risk factors of hyperammonemia-related neurologic deficits and death. In children, hyperammonemia is mainly caused by severe liver failure and inborn errors of metabolism. In an acute setting, obtaining reliable plasma ammonia levels can be challenging because of the preanalytical difficulties that need to be addressed carefully. The management of hyperammonemia includes 1) identification of precipitating factors and cerebral edema presence, 2) a decrease in ammonia production by reducing protein intake and reversing catabolism, and 3) ammonia removal with pharmacologic treatment and, in the most severe cases, with extracorporeal therapies. In case of severe coma, transcranial Doppler ultrasound could be the method of choice to noninvasively monitor cerebral blood flow and titrate therapies.

Our objective was to construct a prospective high-quality and high-frequency database combining patient therapeutics and clinical variables in real time, automatically fed by the information system and network architecture available through fully electronic charting in our PICU. The purpose of this article is to describe the data acquisition process from bedside to the research electronic database.Descriptive report and analysis of a prospective database.A 24-bed PICU, medical ICU, surgical ICU, and cardiac ICU in a tertiary care free-standing maternal child health center in Canada.All patients less than 18 years old were included at admission to the PICU.None.Between May 21, 2015, and December 31, 2016, 1,386 consecutive PICU stays from 1,194 patients were recorded in the database. Data were prospectively collected from admission to discharge, every 5 seconds from monitors and every 30 seconds from mechanical ventilators and infusion pumps. These data were linked to the patient's electronic medical record. The database total volume was 241 GB. The patients' median age was 2.0 years (interquartile range, 0.0-9.0). Data were available for all mechanically ventilated patients (n = 511; recorded duration, 77,678 hr), and respiratory failure was the most frequent reason for admission (n = 360). The complete pharmacologic profile was synched to database for all PICU stays. Following this implementation, a validation phase is in process and several research projects are ongoing using this high-fidelity database.Using the existing bedside information system and network architecture of our PICU, we implemented an ongoing high-fidelity prospectively collected electronic database, preventing the continuous loss of scientific information. This offers the opportunity to develop research on clinical decision support systems and computational models of cardiorespiratory physiology for example.

BackgroundIn an intensive care units, experts in mechanical ventilation are not continuously at patient's bedside to adjust ventilation settings and to analyze the impact of these adjustments on gas exchange. The development of clinical decision support systems analyzing patients' data in real time offers an opportunity to fill this gap.ObjectiveThe objective of this study was to determine whether a machine learning predictive model could be trained on a set of clinical data and used to predict transcutaneous hemoglobin oxygen saturation 5 min (5min SpO2) after a ventilator setting change.Data sourcesData of mechanically ventilated children admitted between May 2015 and April 2017 were included and extracted from a high-resolution research database. More than 776,727 data rows were obtained from 610 patients, discretized into 3 class labels (< 84%, 85% to 91% and c92% to 100%).Performance metrics of predictive modelsDue to data imbalance, four different data balancing processes were applied. Then, two machine learning models (artificial neural network and Bootstrap aggregation of complex decision trees) were trained and tested on these four different balanced datasets. The best model predicted SpO2 with area under the curves < 0.75.ConclusionThis single center pilot study using machine learning predictive model resulted in an algorithm with poor accuracy. The comparison of machine learning models showed that bagged complex trees was a promising approach. However, there is a need to improve these models before incorporating them into a clinical decision support systems. One potentially solution for improving predictive model, would be to increase the amount of data available to limit over-fitting that is potentially one of the cause for poor classification performances for 2 of the three class labels.

As a result of innovations in informatics over the last decades, physiologic models elaborated in the second half of the 20th century could be transformed into specific virtual patients called computational models. These models, developed initially for teaching purposes, are of great potential interest in responding to current concerns about improving patient care and safety. However, even if there are obvious advantages to using computational models in cardiorespiratory management, major concerns persist as to their reliability and their ability to recreate real patient physiologic evolution over time. Once developed, these models require complex validation and configuration phases prior to implementation in daily practice. This article focuses on the development of computational models, and reviews the methodologies to clinically validate the models including specific patient databases (perpetual patients) and the use in clinical practice including very high fidelity simulation.

Mortality and morbidity related to traumatic brain injury (TBI) present a major health care burden. Patients with severe TBI must be managed rapidly and efficiently to minimize secondary brain injury potentially leading to permanent sequelae. This is especially important in young patients, whose brain is still in development, making them particularly susceptible to secondary insults. The complexity of both brain injury pathophysiology and the intensive care unit environment makes the management of these patients challenging, with a risk of delayed response and/or patient instability contributing to worsened outcome. Computerized assistance in TBI appears likely to improve patient management, by helping clinicians quickly analyze and respond to ongoing clinical changes and optimizing patient status by guiding management. Currently, computerized decision support systems (CDSSs) do not feature continuous medical assistance with individualized treatment plans. This review presents new developments in CDSSs specialized in TBI. We also present the framework for future CDSSs needed to improve TBI management in real time, taking into account individual patient characteristics.

The objective was to compare the impact of an early goal-directed hemodynamic therapy based on cardiac output monitoring (Endotracheal Cardiac Output Monitor, ECOM) with a standard of care on postoperative outcome following coronary surgery. This prospective, controlled, parallel-arm trial randomized 100 elective primary coronary artery bypass grafting patients to a study group (ECOM; n = 50) or a control group (control; n = 50). In the ECOM group, hemodynamic therapy was guided by respiratory stroke volume variation and cardiac index given by the ECOM system. A standard of care was used in the control. Goal-directed therapy was started immediately after induction of anesthesia and continued until arrival in the intensive care unit (ICU). The primary endpoint was the time when patients fulfilled discharge criteria from hospital (possible hospital discharge). Secondary endpoints were the hospital discharge, the time to reach extubation, the length of stay in ICU, the number of major adverse cardiac events, and in-hospital mortality. Patients in the ECOM group received more often fluid loading and dobutamine. The time to reach extubation was reduced in the ECOM group: 510 min [360-1,110] versus 570 min [320-1,520], P = 0.005. No significant differences were found between both groups for possible hospital discharge [Hazard Ratio = 0.96 (95 % CI 0.64-1.45)] and hospital discharge [Hazard Ratio = 1.20 (95 % CI 0.79-1.81)]. A mini-invasive early goal-directed hemodynamic therapy based on ECOM can reduce the time to reach extubation but fails to significantly reduce the length of stay in hospital and the rate of major cardiac morbidity.

BACKGROUND: Recent findings suggest that using alveolar PCO2 (PACO2) estimated by volumetric capnography in the Bohr equation instead of PaCO2 (Enghoff modification) could be appropriate for the calculation of physiological dead space to tidal volume ratio (VD/VT Bohr and VD/VT Enghoff, respectively). We aimed to describe the relationship between these 2 measurements in mechanically ventilated children and their significance in cases of ARDS. METHODS: From June 2013 to December 2013, mechanically ventilated children with various respiratory conditions were included in this study. Demographic data, medical history, and ventilatory parameters were recorded. Volumetric capnography indices (NM3 monitor) were obtained over a period of 5 min preceding a blood sample. Bohr9s and Enghoff9s dead space, S2 and S3 slopes, and the S2/S3 ratio were calculated breath-by-breath using dedicated software (FlowTool). This study was approved by Ste-Justine research ethics review board. RESULTS: Thirty-four subjects were analyzed. Mean VD/VT Bohr was 0.39 ± 0.12, and VD/VT Enghoff was 0.47 ± 0.13 (P = .02). The difference between VD/VT Bohr and VD/VT Enghoff was correlated with PaO2/FIO2 and with S2/S3. In subjects without lung disease (PaO2/FIO2 ≥ 300), mean VD/VT Bohr was 0.36 ± 0.11, and VD/VT Enghoff was 0.39 ± 0.11 (P = .056). Two children with status asthmaticus had a major difference between VD/VT Bohr and VD/VT Enghoff in the absence of a low PaO2/FIO2. CONCLUSIONS: This study suggests that VD/VT Bohr and VD/VT Enghoff are not different when there is no hypoxemia (PaO2/FIO2 > 300) except in the case of status asthmaticus. In subjects with a low PaO2/FIO2, the method to measure VD/VT must be reported, and results cannot be easily compared if the measurement methods are not the same.

Objectives The aim of our pilot study was to develop a model to better predict Paco2 in mechanically ventilated children using noninvasive parameters including volumetric capnography. Design Prospective clinical pilot study. Setting Level III PICU. Patients Sixty-five mechanically ventilated children. Interventions None. Materials and methods We conducted a prospective clinical pilot study that included all children admitted to the PICU ( 3 kg; mechanically ventilated, > 6 hr; with an arterial line). A predictive model for PaCO2 was developed using linear multivariable regression. Among the data collected in PICU patients, candidate predictors of PaCO2 were defined by a panel of experts and included end-tidal partial pressure of carbon dioxide, ventilation parameters, and data resulting from the analysis of volumetric capnogram recorded 5 minutes before an arterial blood gas. Children with tidal volume less than 30 mL were excluded because of technical limits. Results A total of 65 children (43 boys, 65%) (65 [21-150] mo old) were analyzed. By linear multivariable regression, the best model included the mean airway pressure, end-tidal partial pressure of carbon dioxide, FIO2, and the capnographic index with an R equal to 0.90, p value less than 0.001. After correction, 95% (n = 62) of children had an estimated PaCO2 at ± 5 mm Hg. Conclusion Our model developed provides an accurate estimation of the PaCO2 using end-tidal CO2 and noninvasive variables. Studies are needed to validate the equation in PICUs.

Background In paediatric intensive care unit (PICU), the relationship between end-tidal partial pressure of carbon dioxide (PetCO 2 ) and arterial partial pressure of carbon dioxide (PaCO 2 ) may vary dramatically (PetCO 2 -PaCO 2 difference between -36 and 63 mmHg) (1) . The aim of our study was to develop a model using volumetric capnography (VolCap) to better predict PaCO 2 in mechanically ventilated children. Material and methods We conducted a prospective clinical study that included all children admitted at Ste-Justine hospital, age 3 kg, mechanically ventilated > 12 h, with an arterial cannula. After literature review, we collected specific data from medical record including demographic data, clinical informations, ventilation, VolCap (NM3, Respironics, Philips, USA) and biological parameters. VoCap was recorded 15 min before an arterial blood gas and analysed breath-by-breath using a specific software (FlowTool, Philips, USA). The predictive model for PaCO 2 was developed using a linear multivariable regression with the best determination coefficient (R2). Results 43 children (26 boys, 60%) age of 52 [9–137] months were included. Children with Tidal volume less than 30 ml were excluded because of technical bias in VolCap interpretation by the software. In linear multivariable regression, the best model included the mean airway pressure (p = 0.01), PetCO 2 (p 2 (p = 0.014) and the capnographic index (100*Slope SIII/Slope SII) (p = 0.003) with a R 2 = 0.85. Conclusion Our preliminary results show that VoCap can help to improve the non-invasive estimation of PaCO 2 . Further research is necessary to validate the accuracy of our model. Reference McDonald et al . Pediatr Crit Care Med 2002;3:244-249

Objective: To evaluate the association of Proton Pump Inhibitors (PPIs) with the occurrence of nosocomial infections (NI) and hyponatremia in the pediatric intensive care unit (PICU). Method: A retrospective monocentric cohort study in the pediatric intensive care of the Universitary Hospital of Caen. All pediatric patients (er janvier 2017 au 31 décembre 2018 et répartis en 2 groupes : prise d’IPP et non-IPP. Résultats : 768 patients ont été inclus : 234 patients avaient reçu des IPPs (30,6%) contre 534 (60,6%). Après ajustement pour les facteurs de risques d’IN identifiés dans notre cohorte par analyse multivariable, l’ORa (Odds-Ratio ajusté) est de 2,42, IC95% 1,17 – 5,14, p

Best strategies for the management of severe paediatric traumatic brain injury (TBI) are not clearly established with wide variations among professional practices. This study's main objective was to assess the adequacy between professional practices and paediatric TBI guidelines 2019. A survey was conducted among French-speaking pediatric intensive care clinicians from April 1st to June 30th, 2019. The survey was conducted as a progressive clinical case with 70 questions based on guidelines 2012. The questions related to the assessment and management of TBI during the acute and intensive care phase. Seventy-eight surveys were included. The adherence to guidelines 2019 was good, with 11 items out of 15 obtaining an adherence rate of more than 60%. There was strong agreement among clinicians on the intracranial pressure (> 80%) and cerebral perfusion pressure (> 70%) thresholds used according to age. Strong adherence to recent guidelines was achieved: seizure prophylaxis with levitracetam (n=21/33, 64%) and capnia threshold (n=52, 67%). On the other hand, the natremia and glycemia thresholds and the role of transcranial doppler were not consistent. Assessment of brain tissue oxygenation (n=12, 16%) and autoregulation (n=35; 45%) was not a common practice. Overall, practices for the management of TBI appear to be standardised. Variations persist in areas where there is a lack of literature and guidelines in paediatrics, so clinicians seem to refer to adult guidelines.; Les stratégies optimales de prise en charge du traumatisme crânien grave pédiatrique (TCG) ne sont pas clairement établies et il existe de grandes variations de pratiques entre professionnels. L'objectif de ce travail était d’évaluer l’adéquation des pratiques professionnelles aux recommandations pédiatriques de prise en charge du TCG 2019. Une enquête de pratique a été adressée aux médecins seniors exerçant dans un service de réanimation pédiatrique francophone du 1er 1 avril au 30 juin 2019. L’enquête consistait en un cas clinique évolutif de 70 questions élaboré à partir des recommandations 2012. Elles portaient sur la prise en charge des TCGs lors de la phase aigüe et réanimatoire. Soixante-dix-huit questionnaires ont été inclus. L’adhésion des praticiens aux recommandations 2019 était bonne avec 11 items sur 15 obtenant une adhésion de plus de 60%. Les praticiens étaient en accord fort sur les valeurs cibles de pression intracrânienne (> 80%) et pression de perfusion cérébrale (> 70%) en fonction de l’âge. Une adhésion forte à certaines recommandations récentes était obtenue : prophylaxie anti-convulsivante par lévitéracétam (n=21/33, 64%) et le seuil de capnie (n=52, 67%). Les seuils de natrémie, de glycémie et le rôle du doppler transcrânien restaient controversés. L’évaluation de la pression en O2 du tissu cérébral (n=12, 16%) et de l’autorégulation (n=35 ; 45%) n’était pas une pratique courante. Dans l’ensemble, les pratiques de prise en charge du TCG pédiatrique semblent uniformisées. Les variations persistent concernant les domaines dont la littérature fait défaut en pédiatrie, les praticiens semblent alors s’appuyer sur les recommandations adultes.

Objective: MRI requires patient’s immobility and justifies use of general anesthesia or sedation in children. Recently, national drug safety agencies have warned physicians about the risk of neurotoxicity of conventional anesthetic agents. We reported the potential usefulness of dexmedetomidine sedation for pediatric MRI and we investigated anesthetic management for pediatric MRI in France. Methods: we reported a single center experience of six pediatric patients sedated with dexmedetomidine for MRI in an emergency context. We carried out a national survey asking questions about anesthetic management for pediatric MRI in French university hospitals. Results: dexmedetomidine sedation was successful for all patients, without adverse effect. The image qualities were rated as good. General anesthesia appears to be the most used management for pediatric MRI in France with no reported use of dexmedetomidine. Conclusion: dexmedetomidine appears to be a promising alternative to general anesthesia. The use of procedural sedation remains rare in France compared to other countries.; Introduction : la réalisation d’une IRM en pédiatrie peut nécessiter le recours à une anesthésie générale ou sédation afin de permettre l’immobilité de l’enfant. Récemment des agences nationales du médicament ont averti les praticiens du risque potentiel des agents anesthésiques usuels sur le neurodéveloppement du jeune enfant. L’objectif de ce travail était d’évaluer d’une part l’utilisation d’un autre agent sédatif, la dexmedetomidine, pour la sédation à l’IRM, et d’autre part de réaliser un panorama des pratiques anesthésiques pour les IRMs pédiatriques (programmées) en France. Matériel et méthode : nous avons rapporté une série de 6 patients sédatés par dexmédétomidine pour la réalisation d’une IRM en urgence. Tous ces patients étaient hospitalisés dans l’unité de réanimation pédiatrique du CHU de CAEN. Dans un second temps, nous avons réalisé une enquête nationale, à partir d’un questionnaire, sur les pratiques anesthésiques pour les IRMs pédiatriques dans les différents CHU français. Résultats : la sédation par dexmédétomidine a été un succès pour les 6 patients de l’étude, sans effet indésirable et avec une bonne qualité des images. L’anesthésie générale est apparue au travers de l’enquête nationale comme la pratique la plus utilisée en France par les anesthésistes pédiatriques pour les IRM programmées, avec une absence de recours à la dexmédétomidine. Conclusion : la dexmédétomidine semble être une alternative prometteuse à l’anesthésie générale pour la réalisation des IRMs pédiatriques. Le recours à la sédation procédurale pour l’IRM pédiatrique reste néanmoins peu utilisé en France, en comparaison aux pratiques dans d’autres pays notamment nord-américains.