[The evolution of care for the critical child: pediatric intensive care]. / L'evoluzione dell'assistenza al bambino critico: la terapia intensiva pediatrica.

Pediatric intensive care units (PICUs) have been developed to provide intensive care for children between post-neonatal age and adolescence. These units have largely been developed in North America, mainly in tertiary hospitals. In Italy, critically ill children are still often nursed on adult ICU's, where medical and nursing staff often lack pediatric training. Here we report the first 5-year experience of the multidisciplinary PICU developed at the Department of Pediatrics, University of Padua, focusing on PICU and patients characteristics, as well as on the evaluation of outcome by means of the Pediatric Risk of Mortality (PRISM) score.

Use of fiberoptic bronchoscopy in asthmatic children with lung collapse.

Segmental atelectasis during asthmatic attacks as a consequence of bronchospasm and hypersecretion are very frequent in children. The collapse of a lung instead is a very rare occurrence. We report two patients with acute exacerbation of asthma, showing an in complete response to bronchodilatory therapy. The clinical findings and chest X-ray were suggestive for collapse of a lung. An urgent fiberoptic bronchoscopy revealed obstruction of a stem main bronchus caused by sticky mucopurulent secretions. The aspiration improved dramatically the respiratory distress and the radiological picture. In these cases we recommended to perform an immediate bronchial aspiration by means of a flexible instrument without waiting a further deterioration of respiratory function before taking this decision.