Do not resuscitate orders in a Saudi pediatric intensive care unit

To determine the percentage of deaths in the pediatric intensive care unit [PICU] attributed to do not resuscitate [DNR] orders, and to compare our DNR practice with the international experience. Retrospective chart review of all children less than 14 years of age who died in the PICU at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia from January 2007 to June 2009 [n=154]. The main mode of death was attributed to DNR orders in 79 cases [51%], failed cardiopulmonary resuscitation in 60 cases [39%], and brain death in 15 cases [10%]. Of the 79 DNR orders, 46 [58%] were related to withdrawal of life support measures. The DNR is the most common cause of death in the PICU in tertiary hospitals in Saudi Arabia. To minimize the suffering of the dying child, life support limitation should be considered for children with terminal or untreatable diseases with low chances of survival

Minimal exhaled nitric oxide production in the lower respiratory tract of healthy children aged 2 to 7 years

Exhaled nitric oxide [eNO] is elevated in inflammatory airway conditions, e.g. asthma. We measured eNO levels in normal preschool children for whom there is little data available and in whom the prevalence of asthma is high. Fifty children, 2-7 years old, undergoing elective surgery, excluding airway procedures, were recruited. Children with known respiratory disease or acute viral infections were excluded. Gas for eNO measurement was collected in a non-diffusion bag via 1] the mask after inhalation induction of anesthesia, 2] endotreacheal tube [ETT] or laryngeal mask airway [LMA], and 3] during emergence. Measurement was off-line by chemiluminescent analyzer. Mean eNO level by mask was 10.23 ppb [mean value +/- SD of 8.8-11.1 ppb] after induction and 8.35 ppb [mean value +/- SD of 5.9-10.8 ppb] on emergence. Mean eNO for the intubated group [n=25] was 0.75 ppb [mean value [SD of 0.4-1 ppb] [P<0.0001 vs mask]; mean eNO for the LMA group [n=25] was 2.6 ppb [mean value +/- SD of 2-3.2 ppb], which differed from the mask [P<0.0001], and from ETT values [P< 0.0001]. Most eNO is produced by the upper airway in healthy pre-school children. The lower airway constitutive eNO production is very low. The LMA does not completely isolate the upper airway and current mask collection techniques allow significant contamination of samples by sino-nasal eNO production in young children