Back ground:End-tidal carbon dioxide (ETCO₂) is a surrogate, non-invasive measurement of arterial carbon dioxide (PaCO₂); however, its clinical applicability in the intensive care unit setting remains unclear in pediatric population. Objectives:This study aims at assessing the effect of severity of lung disease and correlation between ETCO₂ and PaCO₂ Materials and methods: This was a prospective, nonrandomised study carried in pediatric intensive care unit of a tertiary care unit on 104 children requiring mechanical ventilation. Simultaneous ETCO₂ and PaCO₂ recording were taken, data on ventilator parameters recorded. Severity of lung disease was estimated by alveolar- arteriolar oxygen gradient, ventilation index and PaO2/FiO₂ ratio. The PaCO₂ and ETCO₂ difference and its variability were studied. Results:208 samples were analysed where the mean PaCO₂ value 28.9±9.7 mmhg was higher than mean ETCO₂ value of 27.8±9.6 mmHg. The mean difference between PACO₂ and ETCO₂ was 1.6±3.23 mmHg. There was significant level of correlation between PACO₂ and ETCO₂ ( r=0.941, r² = 0.886 , 95% CI= 0.95-0.97) for mild to moderate lung disease than severe lung disease. Systemic diseases, Ventilator index and alveolar arterial oxygen gradient did not have any significant correlation with the PACO₂ and ETCO₂ difference in our study. Conclusion: Significant correlation was found between the PaCO₂ and ETCO₂ value irrespective of the disease conditionand ETCO₂ can be validated to predict PACO₂.

Objectives: The present study was conducted to compare digital technique and suction catheter guided technique for Proseal laryngeal mask airway insertion regarding ease of insertion, number of attempts for successful insertion and insertion time in children. Methods: This prospective randomised study included one hundred children of age 1-12 years divided into two groups. In group I, Proseal laryngeal mask airway insertion was inserted using digital technique and in group II, suction catheter guided technique was used for insertion. Results: In group I, Proseal laryngeal mask airway insertion was successfully inserted in 45 patients (90%), while in group II, insertion was successful in 49 patients (98%). Insertion was successful in 37 patients (74%) in first attempt and 8 patients (16%) required 2nd attempt in group I, whereas in group II, 1st attempt was successful in 47 patients (94%) and 2nd attempt was required in 2 patients (4%). Proseal laryngeal mask airway insertion failed in 5 patients (10%) in group I while it failed in only 1 patient (2%) in group II. Mean insertion time was 23.88 ± 2.58 sec in group I, whereas in group II, time was 19.34 ± 1.81 sec (p=0.001), the difference being statistically significant. Conclusion: Suction catheter guided technique is easier and more successful as compared to digital technique in children. It is less traumatic and insertion time is also less with this technique.

The evolving changes in the “definition” of sepsis reflect both a new emphasis on precision, needed for research, and an ever-expanding knowledge of its pathophysiology. Even with the recent revision of sepsis definitions, identification of patients with early sepsis remains a significant challenge. Newer definitions and clinical criteria should clarify long-used descriptors and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing it. This process, however, remains a work in progress.

Sepsis in children is a global problem causing significant mortality and morbidity. Early identification and prompt treatment is the key to better survival. Sometimes the symptoms are not clear cut and culture sensitivity takes time. Infections lead to synthesis of various biomarkers. These biomarkers can be used as a screening tool to diagnose infections. Some of the markers can help in risk stratification of the disease. Use of biomarkers to monitor drug response is also an important function. The commonly used biomarkers are erythrocyte sedimentation rate, C-reactive protein and Procalcitonin, which have been studied well in children. There are many more biomarkers which are being evaluated.

Septic shock is a major cause of mortality in children. Myocardial dysfunction in severe sepsis and septic shock is well recognized but its pathogenesis could be multifactorial. As a result of complex interplay of various factors, hemodynamic changes observed in pediatric age group may be different from those observed in adult. Sepsis induced myocardial dysfunction (SIMD) is a known consequence of severe sepsis and septic shock. Although there is no universally accepted definition of this entity, it can be best defined as reversible intrinsic myocardial systolic and diastolic dysfunction of both the left and right sides of the heart induced by sepsis. In this review we discuss the pathogenesis, pathophysiology of clinical manifestations, diagnosis and management of SIMD in children.

Background : Arterial Tortuosity Syndrome (ATS) is a rare, autosomal recessive connective tissue disorder characterized by elongated and tortuous large and medium-sized arteries involving aorta and pulmonary arteries along with dysmorphic facial features, skin and joint laxity and hernia formation. We present here one case of ATS.

Respiratory distress is common problem seen in new born and infants due to anatomical and physiological differences from adult. Infant can present with respiratory distress, inspiratory stridor, feeding difficulty, and cyanosis. At birth usually congenital malformation, hyaline membrane diseases, nasal block are common disorders leading to respiratory distress. Retropharyngeal abscess is uncommon in neonatal period.

Triple A syndrome (All grove syndrome) is a rare autosomal recessive disorder characterized by the clinical triads of adrenal insufficiency, achalasia cardia and alacrimia with variable association of autonomic and neurological manifestations. Nearly100 cases have been reported all over world however in India, only 2 to 3 cases have reported. We present 13 years old boy with chronic recurrent sinusitis with failure to thrive without lacrimation since birth who had presented recurrent chronic sinusitis with pneumonia, septic shock, and acute meningoencephalitis with adrenal insufficiency. Catastrophic complications can be prevented with adequate cortisol and specific measures such as cardiac pneumatic dilatation or myotomy along with other supportive management.

Oxygen is life and falls in the category of essential drug. It is vital for cellular function. Oxygen therapy is the administration of oxygen in acute or chronic conditions above higher concentration than atmospheric air to prevent hypoxemia. The delivery of oxygen depends on various factors. Oxygen is full of advantage but injudicious use or hyperxaemia (FiO2>0.5) may be harmful to human body. Care should be taken while prescribing the oxygen. Hypoxemia should be avoided as such to prevent mortality.

Thesis writing is an essential component of postgraduate training in India. The primary intention is to train the student in research methodology which is different from doctoral dissertation. Writing a thesis protocol is the first written document of the proposed research. It not only gives a glimpse of the topic under plan but also paves the path of proposed research by setting the rules, boundaries and limits of the research. It safeguards not only the researcher but the volunteers/ subjects also.