In the field of paediatric critical care, there is considerable uncertainty and variation in the area of analgesia and sedation in critically ill children. Consensus guidelines on sedation and analgesia in critically ill children are available since 2006, although clinical practice reveals variations both in pharmacological agents and regimens used.

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The review presents literature data and focuses on the acclaimed need for transition from general to dedicated Neurosurgical/Νeurological or Neuroscience Intensive Care Units (NSICU). There are solid data from well designed metanalyses showing that at least in the United States, the wider implementation of intensivists in the ICUs, led to significant reductions in ICU and hospital mortality and patient’s length of stay (LOS). Given the variation in ICU physician staffing plans and the potential for reduced mortality implied by these studies, a more rigorous evaluation of the optimal ICU organization is essential. Highly specialized vs. less specialized ICU physician staffing is associated with reduced hospital and ICU mortality and LOS.

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We present two cases of pregnant women with placenta percreta invading the bladder, along with a short review of the literature. The two women sustained early and late major haemorrhagic complications requiring massive transfusion (up to 142 PRBC and 353 blood product units) and urgent reoperation. They were both treated in the ICU and discharged in good state.

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