Sepsis is a leading cause of morbidity, mortality, and healthcare utilization for children worldwide. More than 4% of all hospitalized patients less than 18 years and ~8% of patients admitted to PICUs in high-income countries have sepsis.
Mortality for children with sepsis ranges from 4% to as high as 50%, depending on illness severity, risk factors, and geographic location.
The major new recommendation in the 2014 update for hemodynamic support of neonatal and pediatric septic shock is consideration of institution—specific use of bundles. The SSC2020 pediatric sepsis guideline provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction.
Improved compliance with the guidelines to improve early septic shock recognition and first-hour management reduced hospital mortality from 4% to 2% in two tertiary pediatric centers. Follow the guidelines in order to improve the mortality of pediatric sepsis!

Pain is not just an unpleasant emotional experience. It can also lead to imbalance in homeostasis, persistent hyperalgesia, and disruption of the physiological development of the neuroanatomical apparatus. It can cause long-term dysfunction, hyperalgesia and a permanent decrease in the pain threshold in the plastic nervous system of children. One of the most intense and lasting pain is caused by surgical interventions. Multimodal perioperative analgesia, according to the path of pain, prevents the spread of pain at multiple points of attack, with multiple drugs and methods, thus preventing sensitization and the development of chronic pain syndrome. Its application requires a great
deal of practical skill and knowledge of the point of attack of analgesics. The aim of this publication is to review aspects of perioperative analgesia.

The present summary contains the most important details of the infant and paediatric basic and advanced life support
with special emphasis on the changes and new recommendations according to the European Resuscitation Council Guidelines 2021. The main goal of this summary is to emphasise that we need to to improve our practical skills via training ourselves as well as our colleagues in addition to provide the reader with the details of the algorithms.

Optimising type and quantity of intravenous fluids is an important task of paediatric anaesthesia. Perioperative fluid requirements are reduced and the use of isotonic electrolyte solution is advised due to ADH overproduction. A thorough knowledge is expected about the following: composition of various electrolyte solutions, fluid requirements according to patient and surgical factors, and modern fasting times (6 hours for solids and formula, 4 hours for breast milk, 1 hour for clear fluids). Fluid guidelines should be simple and easy to comply with to provide safe and efficient operating room workflow.

The present summary contains some novelties of paediatric anaesthesia what has now become part of the daily routine and may be the subject of interest for readers of different professional fields of medicine.

ECMO can be life-saving in patients who are resistant to conservative medical treatment, but thorough patient selection is needed to avoid futile care. In Hungary, based on the relative small number of pediatric ECMO runs, it seems reasonable to centralise this therapeutic modality to a few well equiped centres where the technological and personal
conditions are given for succesful therapy. The knowledge of indications and contraindications can be important for every healthcare providers working on the pediatric intensive care field for the timely referral of potential candidates to the ECMO centres. In this article we try to summarize the technical pros and cons of veno-venous and veno-arterial ECMO therapy.

The invasive meningococcal disease (IMD) is rare, but severe, life-threatening disease, most common in infants and young children (1-4 years). The rapid recognition, early parenteral antibiotic treatment are critical importance to patient survival and outcomes. Success is critically dependent on prompt recognition of two important complications:
shock and raised intracranial pressure. This article summarizes the clinical features and treatment of this devastating infection. It is important to emphasize that it is associated with high mortality even in the case of early, complete intensive care.

In the past few years continuous renal replacement therapy (CRRT) has become an available therapeutic possibility in several Hungarian pediatric intensive care units. There were several lectures, discussions about the introduction of CRRT and first steps with it but we did not emphasize important issues that we have to consider in connection with
CRRT. In this paper we would like to outline topics related to everyday practice, like anticoagulation, cannulation. We discuss some management issues and reveal not only the benefits but also the limitations of this extracorporeal therapy.
We show you that the indications to start a therapy can be quite clear, but the difficulties of timing and making a good cost-benefit decision in high-risk patients is not easy. We aimed to give an experience-based overview of CRRT related topics, thus outline the current possibilities and limitations of this treatment modality.

The seventeen-year-old girl demanded extended hospitalisation (within it thirty-eight days of intensive care) due to autoimmune encephalitis complicated with super refractory status epilepticus. Overviewing her case gives us a scope for summing up of the neurological nomenclature, the potentials of intensive therapy regarding pharmacological and supportive care. Henceforth it draws attention to the multisystem effects of this neurological disease, presenting a great challenge for every pediatric intesive care therapists in prevention, on time diagnosis, treatment and provoking factors.

Children with coronavirus disease 2019 being reported to have manifestations of multisystem inflammatory syndrome.
The symptoms in children often overlaps with Kawasaki disease. We present two cases with multiorgan involvement and markedly elevated inflammatory markers. Treatment involves supportive care and measures to reduce inflammation in any affected vital organs to protect them from permanent damage.