Traumatic brain injury (TBI) is one of the most frequent causes of mortality in childhood. The treatment of patients with severe TBI is directed to prevention, early detection and treatment of secondary injuries due to extra and/or intracranial etiologies. Brain ischemia is a central cause of brain damage and its prevention has become a primary goal for intensivists. New techniques have developed to detect brain ischemia directly bedside the patient, through the monitoring of oxygen tissue pressure (P ti O 2 ). Our objective is to report 2 pediatric patients with severe TBI and P ti O 2 monitoring, in order to ilustrate the possibility that offers this technique in early detection of brain ischemia and review the current literature. We analyzed the clinical records of the patients with coma Glasgow score below 8. The intracranial pressure and P ti O 2 monitoring was made through a catheter implanted in the encephalic matter. The device allowed early detection of secondary injuries and an optimal therapeutic approach in the patients, both with good outcome at discharge. The P ti O 2 monitoring showed high safety and reliability.

Background: In 2001, dutch researchers reported a new virus able to cause high and low acute respiratory infection (ARI) in children. It belongs to the Paramyxoviridae family and constitutes the first human pathogen in the genus Metapneumovirus: human Metapneumovirus (hMPV). Objective: Report a retrospective review of 4 infants with hMPV low ARI with severe respiratory failure, admitted in Pediatric Intensive Care Unit between November 2005 and September 2006 and review the literature. Patients and Methods: Common respiratory virus and Bordetella pertussis were ruled out. Polymerase chain reaction was performed to detect the fusion protein(f)of hMPV and Adenovirus cellular culture. Results: All 4 cases had obstructive bronchial syndrome (OBS), 3 required invasive mechanical ventilation and 2 cases presented spontaneous pneumotorax. Co-infection with Adenovirus was detected in 2 cases. Bacterial cultures were negative. No patients died. Conclusion: hMPV must be suspected in infants with severe acute respiratory failure. The co-infection with Adenovirus must be ruled out.

Resumen 5e describe uno cucitoria clinicc de a medicion continue de a p-es : 6n intracraneana a o largo de cuatro ahos enuna unidcd ce cuidados intensive^ ped ctr.ca de un hospital pfivado de Santiago, Chile, de la infor-nocion registradaen las hislorias clinicas de 21 n.nos (14 varones] de jn mes a 15 anas de edad, en que e; metodo fje enpleado. Lasenfermedades pnncioales eran tumor cerebral (n=7], l raurratisrno craneoencefolico (n=5), malfornaciones del sisternanerviosc centre! |n=4), asfix'a oor i-mersion jn=3) y rrenmgitis bactenana aguda (n-2). Lcs razones pcra indicar elprccedimien r o fueron hidrocefclio agudc [n=13i, contusion cerebral multiple [n=5] y edema cerebral difuso |n=3). Entodos los casos se realize torrog'aiia axicl comoutadonzcda cerebral antes y despues de instalcr los cate^eres yexaTien citoauirrico y cu'livo diarios de liquido cerebroesp'nal. La h pertensio.n ; n'racraneana (presion mayor que 15mm de Hgj se reg'stro en 19 casos que

The clinical course of one hundred and fifty children (one mcnih to 14 years old] admitted to a pediatric intensive care unit of a private hospital at Santiago, Chile, along an 18 mentis period because of head trauma alone or combined with other organ trauma is described. One hundred and six patients [70.6%) were older than four years of age and 34 [22.6%) were under two years. Ninety accidents (60%) occurred at home and 35 (23%) were caused by motor vehicles. wenty six patients hod intracranial complications consisting of surgical haemorragic lesions in 1 1 (7.3%), non surgical haemorragic lesions in nine (6%) and cerebral edema in six (4%) cases. Complications were recorded in 16 [44%) of 36 patients with skull fractures but in only 10 (8.7%| of 1 14 patients without skull fractures. All seven patients with Glasgow coma score under 7 at admission had some intracraneal complication at CT scan, all needed respiratory assistance by mechanical ventilation and in six of "hem intracranial pressure monitorization was also necessary. Glasgow coma score was 15 ("normal") in 1 1 1 parients at admission, but later 12 of these subjets (10.8%) had some cerebral complication, which was detected only by routine cerebral CT scan in six cases. Two patients remained with some definite neurological sequel, one with a motor and visual defect and the other one with a subdural chronic hygroma that requirea a ventriculopentoneal shunt. There were no fatalities in this series.