BACKGROUND:Cross-sectional studies have suggested a rapid expansion in paediatric long-term ventilation (LTV) over the last 20 years but information on longitudinal trends is limited.METHODS:Data were collected prospectively on all patients receiving LTV over a 15-year period (1.1.95-31.12.09) in a single regional referral centre.RESULTS:144 children commenced LTV during the 15-year period. The incidence of LTV increased significantly over time, with an accompanying 10-fold increase in prevalence due to a significant increase in institution of non-invasive ventilation (NIV). There was no significant increase in invasive ventilation. 5-year survival was 94% overall and was significantly higher for patients on NIV (97%) than invasively ventilated patients (84%). 10-year survival was 91% overall. Although some children were able to discontinue respiratory support (21% at 5 years and 42% at 10 years), the number of patients transitioned to adult services increased significantly over time (26% of total cohort). Patients with neuromuscular disease were less likely to discontinue support than other patients.CONCLUSIONS:The paediatric LTV population has expanded significantly over 15 years. Future planning of paediatric hospital and community services, as well as adult services, must take into account the needs of this growing population.

Three cases of supraventricular tachycardia (SVT) associated with the use of furosemide infusion (F1) in children following cardiac surgery are reported. The SVT occurred three to seven hours after starting an infusion at 1.0 mg · kg−1 · hr−1. All three patients had a diuresis of 8–10 ml · kg−1 · hr−1 compared with a mean average of 2.5 ml · kg−1 · hr−1 in 22 other patients who had received a similar infusion. A rapid fluid shift was the most likely mechanism of the tachycardia. Sotalol was effective in controlling the tachycardia in the two patients in whom it was tried. We now recommend a starting dose of 0.3 mg · kg−1 · hr−1 in using furosemide as a continuous infusion, with hourly increments of 0.1 mg · kg−1 · hr−1 until the desired diuresis is obtained.

While neonatal transport is widespread and relatively standardized, paediatric transport is newer with more varied requirements for optimal management, equipment and personnel. Over a recent 14 month period (ending 30/9/86), our center coordinated inter-hospital transfer of 400 children.Thirty percent were neonates, with a total of 59% less than 1 year, 19% between 1-4 years, 12% between 4-8 years, and 10% older than 8 years. Major diagnoses were trauma, infection, seizures, hypoxic-ischemic injury and congenital anomalies. Eighty-two percent of the calls were emergent and 60% of children required admission to the Intensive Care Unit. Six (1.5%) died during resuscitation prior to transfer, and no children died in transit. Sixty-three percent were transported by air.Problems occurred on 20% of transports, of which 8% were predicted (due to the severity of illness, equipment limitation or poor weather). Significant problems occurred more frequently when patients were escorted by adult paramedics as compared to infant trained crews. Thirty percent of patients required major interventions by the transport team for stabilization prior to transfer and 5% required major interventions enroute.The logistics of coordinating paediatric emergency transport are complex because of the diversity of diagnoses, physical size, medication and equipment, requiring dedicated physician staff with a transport team trained to manage paediatric patients.

La fiabilité du test ďapparition ďune fuite ďair comme critère ďextubation des enfants intubés par vote nasotrachéals pour croup (laryngotrachéite) a été étudiée du ler septembre 1983 au 30 novembre 1983 lors ďune épidémie de croup en Ontario. Vingt-huit patients on eu un total de 36 extubations; 31 planifiées et cinq accidentelles. Trois des 23 (13 pour cent) extubations planifiées avec (fuite) ont nécessité une réintubation tandis que trois des huit (38 pour cent) enfants extubés électivement après sept jours ďintubation sans (fuite) ont dû être réintubés. Une fuite est un indice de pronostic utile tnais non absolu du succès ďune extubation.

Near-drowning is a cause of major neurological damage in children. Following reports of unexpected survival, vigorous measures to control intracranial pressure and minimize cerebral metabolic requirements became popular (the “HYPER” regimen). Our approach has been supportive (no barbituate coma or hypothermia) to achieve optimal oxygenation and cerebral perfusion while minimizing potential insults which raise intracranial pressure. We stress prompt resuscitation with re-warming to normothermia, fluid restriction, and diuresis. Head elevation and judicious sedation are used to avoid adverse effects on intracranial pressure from noxious stimuli. Our results are comparable to other centers. Sixty-one percent drowned in baths, hot-tubs or swimming pools, 36% in lakes or streams, and one child in the sea. The age range was from 5 months to 12 years (mean 3.2 years). Of 31 patients admitted over 46 months, 71% survived. Using Conn's classification, 10 Group A (awake) patients had a 100% intact survival. Of 5 Group B (blunted) patients, 4 survived and 1 died. From 16 Group C (comatose) patients, 4 survived (all C-1) with good neurological function, 4 were handicapped and 8 died. Important prognostic factors include cold water submersion, early resuscitation at the scene, short duration of resuscitation, transport which avoids secondary insult and meticulous intensive care.