Twenty-one critically ill children aged between 7 days and 12 years were treated with teicoplanin (three loading dosages of 10 mg/kg at 12 h intervals, followed by a maintenance dosage of 10 mg/kg/day). Serum teicoplanin concentrations were monitored by HPLC. Mean concentrations in plasma 30 min after drug administration were 20 +/- 16.1 mg/L. The volume of distribution was 0.30 L/kg and the terminal half-life was 17.41 h. Only 11% of trough values were >10 mg/L (established as desirable values). In critically ill children a dosage of 10 mg/kg/day does not assure serum trough values >10 mg/L.

ABSTRACT Background: Nutrition is important in childhood because the child has a lower energy reserve than the adult and a higher demand for calories because of ongoing growth. In this study, the utility of transpyloric enteral feeding (TEF) in critically ill children was evaluated. Methods: A prospective, descriptive study was made in a pediatric intensive care unit of a tertiary pediatric center of 41 critically ill children, 30 after surgical procedures and 11 with nonsurgical illness, aged 8 days to 12 years, who received transpyloric enteral feeding with 8‐ or 10‐Fr weighted feeding tubes. Analysis was made of tolerance and complications (vomiting, abdominal distension, excessive gastric residual, diarrhea, and pulmonary aspiration) of TEF. Results: The mean duration of TEF was 19.5 ± 26.8 days (range, 1‐120 days). The administration of sedative agents or inotropic drugs did not alter toleration of TEF. Eight of 12 patients treated with continuous infusion of vecuronium tolerated TEF without complications. Eleven gastrointestinal complications occurred in 10 patients, abdominal distension and excessive gastric residual in 7 (17%), and diarrhea in 4 (9.7%). In 7 patients gastrointestinal complications improved, with decreasing use or transitory interruption of TEF, but in 4 patients (9.7%), TEF had to be withdrawn. Gastrointestinal complications were more frequent in postsurgical than in nonsurgical patients ( p < 0.001). No patients suffered from pulmonary aspiration, and the incidence of pulmonary infection and hepatic dysfunction diminished during TEF. Conclusions: Transpyloric enteral feeding is a good method of nutritional support in critically ill children and can be used in patients treated with neuromuscular blocking agents. The frequency and severity of complications and the risks of pulmonary infection and hepatic dysfunction related to TEF are low.

We treated 40 children, aged between 15 d and 17 y, diagnosed with acute respiratory distress syndrome and/or pulmonary hypertension, with inhaled nitric oxide. The most frequent underlying diagnosis associated with ARDS were bronchopneumonia (eight), cardiac surgery (five), and sepsis (three). Pulmonary hyper tension was secondary to cardiomyopathy in 2 patients and occurred in the postoperative period of cardiac surgery in 17 patients-the most frequent were ventricular septal defect (5), transposition of great arteries (4), and atrioventricular septal defect (3). In 11 patients, sudden discontinuation of nitric oxide induced a decrease in oxygenation associated in some of the patients with an increase in pulmonary artery pressure. In two patients discontinuation of nitric oxide induced severe pulmonary hypertension, extreme bradycardia and hypoxaemia, which required cardiopulmonary resuscitation. When exogenous nitric oxide is abruptly interrupted, hypoxaemia and pulmonary hypertension are found in some patients, due to a decrease in the nitric oxide concentration in the pulmonary circulation. This may be caused by the exogenous nitric oxide administration that may have inhibited endogenous production. We recommend making a progressive withdrawal of inhaled nitric oxide to avoid the side effects observed in the sudden discontinuation.

Introduction: Nitric oxide innalational therapy requires a dosage unit, consisting of flow controlllers for bias and NO flow as well as NO and NO, monitoring devices.Aim Of the study: We examined the accuracy Of each component as well as the accuracy Of the complete system in combination with a high frequency oscillatory ventilator (HFO-V).Materials and Methods: We Compared accuracy Of digital mass flow controllers IMFC) (BrOnkhorst Hi-Tec, Veenendaal, The Netherlands) versus Conventional analog flow controllers (Brooks Europe, Veenendaal, The Netherlands) for NO and biasFloW control.NO and NO, concentrations were measured With Chemiluminescence (CLD 700, EcoPhysics, DUrnten, Switserland) in dry gas containing 21% oxygen.Furthermore accuracy of NO measurement in clinical Conditions was assessed, with NO and bias flow MFC controlled.NO and NO, concentrations were measured using both ChemiluminescenCe (CLD 700) and electrochemical analysers (SensorNOx, Sensor Medics Europe, Bilthoven, The Netherlands).The HFO-V ventilator used was a Sensor Medics 3100-A (Sensor Medics, Yorba Linda, Ca).Results: We found major influences of used flow controllers, humidification, and measurement method used.Data are presented in the table as mean (95%Cl limits) Of the ratio Of pre-calculated to measured NO value.Dosage accuracy (Cnemiluminescence) 2 MFC 0.99 (0.983-0.998) 3100 A biasfiow, MFC (NO) 0.856 (0.835-0.877) 3100 A biasflow, rotameter (NO) 1.175 (0.793-1.74)Measurement accuracy 12 MFC) electrochemical, dry gas 1.017 (1.006-1.029)electrochemical, humid gas 1.131 (1.089-1.175)chemoluminescence, humid gas 1.136 (1.126-1.136) Conclusions:We conclude, that a system consisting of one MFC for NO dosage, rotameter for biasflOw control and electrochemical NO and NO, analyser has adequate accuracy for clinical use during HFO-V.Our electrochemical analyser uses a cell, with limited sensitivity to high oxygen levels, sampled gas was dried via permapure tubing and pressure swings were not allowed to reach the analyser.