Invasive haemodynamic monitoring (PiCCO2, Pulsion Medical Systems, Munich, Germany) showed a cardiac index of 2·0 L min−1 m−2 (normal 3·3–5·5); troponin T concentration peaked at 0·11 μg/L (<0·03), ...and initial signs of kidney injury were seen. After fluid loading under haemodynamic monitoring, the ejection fraction and cardiac index were normal on day 2, but our patient developed massive muscle oedema mainly of the legs, buttocks, and face, and pulmonary oedema (figure A, B), for which helmet-delivered non-invasive ventilation over 36 h was needed. Systemic capillary leak syndrome is a rare idiopathic disorder, characterised by transient spontaneous episodes of macromolecular hyperpermeability with increased capillary leakage and pronounced shifts of plasma from the intravascular to the extravascular space.1 Hypotension and haemoconcentration are characteristic in paediatric patients.2 Attacks vary in intensity, duration, and frequency, and swelling all over the body can be misdiagnosed as due to sepsis.3 The precise mechanism of the syndrome remains unclear; increased permeability in the capillary bed of skeletal muscles could be related to classic pathway complement activation, low-grade overstimulation of arachidonic acid metabolism, or cytokine-induced retraction of vascular endothelial cells.4 It is important to obtain vascular access for crucial fluid replacement as early as possible,5 and conduct strict surveillance of the increased intracompartmental pressure leading to muscle damage.
Abstract Study Objective To describe our 10 years of experience with childhood choroid plexus tumors (CPTs). Design Retrospective chart analysis. Setting Operating room and pediatric intensive care ...unit (PICU) of a university hospital. Patients 18 infants and children undergoing CPT surgery from 1995 to 2004, 11 of whom were younger than 12 months. Measurements Perioperative hematologic and coagulation data were measured as well as estimated red cell volume variations (as a reliable index of blood loss) in the perioperative period, together with coagulation parameters. Results Greater blood loss was recorded in the infant group vs older children (percentage of estimated red cell volume loss, 1.31 ± 1.79% vs 0.20 ± 0.17% P < 0.01 and 1.50 ± 1.86% vs 0.29 ± 0.21% P < 0.01 on PICU admission and after 72 hours, respectively). Platelet count decrease was similarly noted (51.60 ± 28.06 vs 27.57 ± 11.98, P < 0.05, as percentage of preoperative count). Patients operated on in the neonatal period showed the highest blood loss and related coagulation impairment. Conclusion Younger CPT surgery patients present an increased risk versus their older counterparts of massive bleeding resulting in hemodynamic instability and coagulative impairment.
