Background. Copper is an essential element. Poisoning with elemental copper is infrequent and manifestations rarely include the ones that our case presented. Case report. A previously healthy 2-year-old female patient unintentionally inhaled copper dust, developed respiratory failure a few hours later, and required mechanical ventilation. On hospital day three, the patient developed acute respiratory distress syndrome and was treated with high-frequency oscillatory ventilation for six days. She also developed hemolytic anemia, liver failure, oliguric renal failure, and evidence of acute tubular injury. During her stay in the intensive care unit she received inotropic support, packed red cells transfusion, and diuretics. A sample of bronchoalveolar lavage showed macrophages that stained positive for copper. Serum and urine copper concentrations were within the normal range after several days. Extubation was successfully achieved after two weeks and the patient was discharged on day 30 without sequelae. This is the first report of acute respiratory distress syndrome secondary to copper aspiration in a pediatric patient. Conclusion. To our knowledge, this is the first case reported of acute respiratory distress syndrome secondary to elemental copper aspiration. It is important to the clinician to be aware of acute respiratory distress syndrome as a differential diagnosis to copper aspiration by treating the patient aggressively in an adequate clinical setting.

Introduccion: La ventilacion de alta frecuencia oscilatoria (VAFO) es una modalidad que emplea pequenos volumenes corrientes, habitualmente menores que el espacio muerto anatomico, con rapidas frecuencias respiratorias (> 1 Hz). Esta opcion ha sido cada vez mas frecuente de disponer en nuestro pais en los ultimos anos. Objetivos: Revisar la experiencia clinica con el uso de VAFO en nuestra UCI y describir las caracteristicas de los pacientes, estrategia de VAFO empleada y pronostico. Pacientes: Un estudio prospectivo, no controlado, de series de casos incluyo pacientes menores de 16 anos, con Sindrome de Distress Respiratorio Agudo (SDRA), frente a fracaso de Ventilacion Mecanica Convencional (VMC). Se compararon dos periodos dentro del estudio (1999-2001 y 2002-2004). Resultados: 51 episodios de empleo de VAFO, en 49 pacientes cuyo diagnostico fue SDRA de causa pulmonar en el 80%. La duracion de la VMC previo a la VAFO fue de 47 horas. El indice de oxigenacion al iniciarse la VAFO fue 24. La presion media de via aerea fue fijada en 9 cm H2O sobre el valor en VMC. Se logro una significativa mejoria en la oxigenacion y en la ventilacion. La duracion media de la VAFO fue de 102 horas. El efecto adverso mas frecuente fue la hipotension transitoria (25%). En el segundo periodo analizado hubo una disminucion de las complicaciones hemodinamicas (p < 0,05), como tambien un incremento en la duracion de la VAFO. Un 33% de los pacientes fallecieron, un 22% por causa pulmonar. Conclusion: La VAFO es una terapia eficaz de soporte ventilatorio ante fracaso de la VMC

After almost a decade since the introduction of Haemophilus influenzae type b (Hib) conjugate vaccines in Chile (in a 2-4-6 month schedule), Hib invasive infections have dramatically decreased, albeit they remain to occasionally produce disease in pediatric patients. We report our experience with children whom developed Hib invasive disease in children since 2000 to 2004. Medical records of children with Hib were reviewed in order to describe the epidemiology, main clinical and laboratory findings, management and complications. Twenty three patients (17 male), between 1 and 71 months (median 30 months) were identified: pneumonia (7), meningitis (4), pleuropneumonia (2), empyema (2), sepsis (2), cellulitis (2), meningitis and pleuropneumonia (1), purpura fulminans (1), miositis (1) and epiglottitis (1). No deaths were observed and four patients presented severe sequelae at hospital discharge. Twenty patients were considered vaccine failures. Hib remains as a sporadic cause of severe disease in Chile and thus for physicians should still keep it in mind. Case analysis and active surveillance are necessary to monitor the current immunization regimen.

El acceso venoso central es requerido frecuentemente en las Unidades de Cuidados Intensivos Pediatricos, ya sea con fines de monitorizacion o terapeuticos. En nuestro medio, el acceso venoso subclavio esta aun poco extendido en los pacientes pediatricos criticamente enfermos. Objetivo: Demostrar que la cateterizacion venosa central de la vena subclavia (VSC) en menores de 10 kg de peso es una alternativa exitosa y segura de efectuar por medicos staff de UCI. Diseno: Estudio prospectivo observacional, periodo 2003 a 2005 (34 meses). Pacientes: Todos los pacientes ingresados menores de 10 kilos de peso en quienes se instalo via infraclavicular un acceso subclavio por tecnica de Seldinger. Medicion: Se registraron las caracteristicas demograficas y antropometricas de los pacientes y sus condiciones clinicas relevantes. Se tabularon las variables tecnicas del procedimiento (lugar de acceso, numero de intentos) y las complicaciones asociadas. Se realizo analisis de subgrupos segun peso (menor o igual a 5 kg o mayores a 5 kg). Resultados: Se efectuaron 73 canulaciones en 51 pacientes, 59% masculino, rango de edad de 8 dias y 18 meses y de peso entre 2,3 y 9,6 kg (mediana 5 kg), 78% en ventilacion mecanica, 62% se ubicaron en vena subclavia derecha. Para el grupo total se canulo exitosamente la VSC en 70/73 (96%, 64% al primer intento) y fue de 97% y 95% para los menores y mayores de 5 kg respectivamente. Ocurrieron 9 (12%) complicaciones, correspondiendo a 4 (5%) mayores (neumotorax). No hubo diferencia en los dos grupos analizados para exito de canulacion y complicaciones. Conclusiones: La instalacion percutanea de la VSC es segura de emplear en ninos bajo 10 kg de peso, presentando un bajo riesgo de complicacion. Debe ser considerada como una alternativa mas de abordaje para el nino criticamente enfermo.

Invasive aspergillosis is a severe disease, with an increased incidence in last decades. It occurs mainly in immunocompromised patients and rarely affects immunocompetent hosts. We describe a previously healthy 8 -year-old boy who acquired an invasive aspergillosis of abdominal origin associated with an opened laparotomy; within three weeks the patient progressed to a multiple organic failure syndrome and died despite amphotericin B deoxycolate plus voriconazole treatment and aggressive surgical debridement. Necropsy revealed multiple parenchyma involvement with characteristic findings of angioinvasive aspergillosis. Invasive aspergillosis must be considered an emergent infection in critical pediatric patients, including previously immunocompetent hosts; it is associated with high mortality despite adequate and opportune therapy.

Invasive multisystemic aspergillosis in an immunocompetent child. Case reportInvasive aspergillosis is a severe disease, with an increased incidence in last decades.It occurs mainly in immunocompromised patients and rarely affects immunocompetent hosts.We describe a previously healthy 8 -year-old boy who acquired an invasive aspergillosis of abdominal origin associated with an opened laparotomy; within three weeks the patient progressed to a multiple organic failure syndrome and died despite amphotericin B deoxycolate plus voriconazole treatment and aggressive surgical debridement.Necropsy revealed multiple parenchyma involvement with characteristic findings of angioinvasive aspergillosis.Invasive aspergillosis must be considered an emergent infection in critical pediatric patients, including previously immunocompetent hosts; it is associated with high mortality despite adequate and opportune therapy.

Tras nueve anos desde la introduccion en Chile de la vacuna conjugada contra Haemophilus influenzae tipo b (Hib) a las edades de 2-4 y 6 meses, las infecciones por este agente han disminuido notoriamente, pero aun son causa de morbilidad de importancia en algunos pacientes. Se reportan los ninos con enfermedad invasora por Hib ocurridas entre los anos 2000 y 2004. Para esto se analizaron los egresos del Hospital Padre Hurtado, consignandose epidemiologia, clinica, laboratorio, terapia y complicaciones para cada paciente. Durante este periodo, 23 pacientes (17 varones), con una mediana de edad de 30 meses (rango 1-71 meses) presentaron enfermedad invasora por Hib. Estas se presentaron como neumonia (7), meningitis (4), pleuroneumonia (2), empiema pleural (2), sepsis (2), celulitis (2), meningitis y pleuroneumonia (1), purpura fulminans (1), miositis (1) y epiglotitis (1). No se registraron fallecimientos, pero 4 pacientes presentaron secuelas graves al momento del alta. Veinte pacientes fueron catalogados como falla de vacuna. Hamophilus influenzae b es aun un agente causal de enfermedad grave y con morbilidad asociada en nuestro pais, por lo que es importante tener un alto indice de sospecha. Su estudio y notificacion son relevantes para la evaluacion del esquema de vacunacion anti-Hib actualmente utilizado

Introduction : Neonatal arterial hypertension is unusual, mainly in previously healthy newborn children. Clinical presentations vary widely and, in some cases, it is a dramatic life-threatening event. Case report : A 6 days-old girl admitted to intensive care unit with severe cardiogenic shock and metabolic acidosis. Mechanical ventilation was initiated and inotropic support administered due to low systolic function (shortening fraction = 20%). After initial improvement, severe arterial hypertension was evidenced (systolic pressure 50 mmHg above 95 percentile). She had no umbilical catheterization. Renal doppler was normal. Laboratory analysis showed low platelet count and a raised D-dimer. Technecium 99-MAG 3 renal scan showed a decrease in renal flow in the upper right kidney, although magnetic angioresonance was normal. Myocardial function and arterial pressure returned to normal after digital and angiotensin-converting enzyme inhibitor therapy. After infections, low blood flow and anatomic causes were excluded, a believe that a perinatal microangiopathic event may lead to renal lesions with renovascular hypertension. Conclusion : Arterial hypertension must be included in the differential diagnosis of newborns with heart failure and acidosis, due to its severe clinical evolution and specific therapy.

Introduction: Infants with severe Pertussis infection in the first weeks of life show a high mortality risk. A poor prognosis is associated with high white blood cell count and severe pulmonary hypertension. The mechanisms of this severe complication are not completely understood; pulmonary vascular occlusion by leukocyte thrombi is reported. In the last years, new therapeutic options have been reported to reduce leukocyte mass, including the exchange transfusion. Case report: We report 2 infants under six month-old with severe Pertussis, presenting with cardiogenic shock, hypoxemia and pulmonary hypertension. During hospitalization in PICU, they presented hyperleukocytosis (45-106 x 109/l). Exchange transfusion (double volume) was performed; through the procedure the white blood cell decreased, the cardiopulmonary condition improved and the patients finally survived. Conclusion: In our experience, the clinical course and prognosis were different compared to the common evolution seen in infants with severe Pertussis infection. In the future, exchange transfusion could be considered as a therapy in severe Pertussis infection with hyperleukocytosis.