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Objective:To investigate the risk factors for death in children with severe adenovirus pneumonia (SAP) in pediatric intensive care unit (PICU), and to provide reference basis for clinical reasonable treatment and reducing the adverse outcome.Methods:The clinical data of 68 children with SAP hospitalized in PICU, Children′s Hospital of Chongqing Medical University from August 2018 to September 2019 were retrospectively analyzed.They were divided into the death group and the survival group according to their condition.The age, basic diseases, complications and laboratory examination results of children were collected for univariate analysis, and multivariate Logistic regression analysis was performed for those with significant univariate analysis. Results:Among the 68 children with SAP, 50 were males and 18 were females, and 46 cases (67.6%) aged between 6 months and 2 years.Fifty-five cases(80.9%) of SAP occurred in spring and summer.There were 61 cases (89.7%) with the spike over 39 ℃ and 21 cases (30.9%) had fever for over 2 weeks; 42 cases (61.8%) were infected with mixed other pathogens.Intrapulmonary and extrapulmonary complications at varying severity were observed.There were 23 cases (33.8%) deaths.Univariable Logistic regression analysis showed that the rates of congenital heart disease(13 cases vs. 9 cases), alanine transaminase >100 U/L(12 cases vs. 8 cases), acute respiratory distress syndrome (ARDS)(13 cases vs. 9 cases) and severe extrapulmonary complications (19 cases vs. 14 cases) were significantly higher in the death group than those in the survival group (all P<0.05). Multivariate Logistic regression analysis showed that congenital heart disease, ARDS and severe extrapulmonary complications were independent risk factors for death in children with SAP (all P<0.05). Conclusions:Children with SAP in PICU are mostly 6 months to 2 years old.SAP mainly occurs in spring and summer, which is featured by the high spike of fever, long duration of fever, easy to be infected with other pathogens, high incidences of systemic complications, and high mortality.The combination of congenital heart disease, ARDS and severe extrapulmonary complications increases the risk of death in children with SAP in PICU.
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Objective:To investigate the efficacy and safety of hydromorphone for postoperative analgesia in children with congenital heart disease, and provide a suitable reference dose for postoperative analgesia in children.Methods:Using a prospective study, 157 patients with congenital heart disease(ASA Ⅱ- Ⅳ) admitted to pediatric intensive care unit at Children′s Hospital of Chongqing Medical University from November 2019 to November 2021 were randomly divided into five groups.Low-dose hydromorphone group (H1 group, 30 cases): hydromorphone dose ≥2 and <3 μg/(kg·h), hydromorphone medium-dose group (H2 group, 30 cases): hydromorphone dose ≥3 and <4 μg/(kg·h), high-dose hydromorphone group (H3 group, 31 cases): hydromorphone dose ≥4 and ≤5 μg/(kg·h), sufentanil group (S group, 36 cases): the dose of sufentanil was 0.08 μg/(kg·h), morphine group (M group, 30 cases): the dose of morphine was 20 μg/(kg·h). The five groups of children received midazolam 2 μg/(kg·min) intravenously at the same time as sedative therapy.Pain score and sedation score were scored at 1 h, 4 h, 8 h, 12 h, and 24 h after operation.Heart rate, mean arterial pressure, blood glucose, lactate, and serum cortisol levels were also monitored and detected, and the occurrence of adverse reactions, the number of cases requiring additional analgesic and sedative drugs, as well as the duration of mechanical ventilation were compared.Results:(1) There were no significant differences regarding the age, body weight, cardiopulmonary bypass time, pediatric critical illness score and ASA score among five groups (all P>0.05). (2) There was no significant difference in the levels of respiration, heart rate, blood sugar, lactate and serum cortisol among five groups after operation.There was no significant difference in preoperative mean arterial pressure among the groups, but there was significant difference in the postoperative mean arterial pressure among the groups at 4 h and 8 h( P<0.05). (3) The analgesic satisfaction of H1 group, H2 group and H3 group at 1 h, 4 h, 12 h and 24 h after operation was significantly higher than that in M group ( P<0.05). There was no significant difference in analgesic satisfaction among H1 group, H2 group and H3 group at each time point.(4) The sedation satisfaction of H1 group, H2 group and H3 group at 4 h and 24 h after operation was significantly higher than that in M group ( P<0.05). There was no significant difference in sedation satisfaction among H1 group, H2 group and H3 group at each time point.(5) There was no significant difference in postoperative analgesia satisfaction and sedation satisfaction between H1 group, H2 group, H3 group and S group.(6) Children in H1 group[1(0, 2)], H2 group[1(0, 2)], H3 group[1(0, 2)] had fewer additional doses within 24 hours than that in M group[2(2, 3)]( P<0.05), and fewer children in H1 group, H2 group and H3 group had been given analgesic sedatives than that in M group ( P<0.05); The extubation time was shortest in H2 group and S group[H2 group(88.3±2.9) h, S group(85.9±3.0) h]. (7) There were no adverse reactions in H1 group, H2 group, H3 group and S group, and there were two cases of apnea in M group. Conclusion:The analgesic effect of hydromorphone in children with congenital heart disease after surgery is better than that of morphine, and the effect of hydromorphone is comparable to that of sufentanil.Hydromorphone 3-4 μg/(kg·h)+ midazolam 2 μg/(kg·min) can achieve satisfactory analgesic and sedative effects in children after congenital heart surgery, with few adverse reactions, safe and reliable, which is an excellent choice for postoperative analgesia and sedation in children.
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Objective To evaluate the efficacy and safety of remifentanil (RF) for analgesia of post-operative children with congenital heart disease in pediatric intensive care unit.Methods A total of 250 patients were enrolled and divided into 5 groups by random numerical table method.Patients in group RF1, RF2,RF3,SF and M was treated with at the doses of reminfentanil 1-3 μg/(kg·h),3-6 μg/(kg·h), 6-9 μg/(kg·h),sufentanil 0.08 μg/(kg·h) and morphine 20 μg/(kg·h) respectively.All the analgesias were given intravenously with midazolam 2 μg / ( kg·min) for sedative.We recorded the faces pain scale, Ramsay,vital signs(mean arterial pressure,heart rate),blood gas analysis,cortisol,ventilation time,times of contemporary sedation drugs and incidence of side effects in 24 hours after operation(1 h,4 h,8 h,12 h,24 h).Results The analgesic satisfaction in group M were lower than those in the other four groups at 1 h,4 h (P＜0.05),and the analgesic satisfaction in group RF3 were higher than those in group RF1 and RF2 at 1 h, 4 h,8 h(P＜0.05).Compared with group M and SF,group RF1,group RF2 and group RF3 had a more sta-ble hemodynamics (mean arterial pressure,heart rate).The times of contemporary sedative in group M were maximum among the 5 groups.The incidence of low blood pressure in group M was higher than those in the other four groups(P=0.06),while the incidence of respiratory depression in group RF3 was the most(P=0.06).There were also no significant differences in blood gas analysis,cortisol and ventilation time among each group.Conclusion The efficacy of remifentanil is superior to morphine.Compared with sufentanil and morphine,remifentanil has less influence on hemodynamics. We recommend the dose of remifentanil 3-6 μg/(kg·h),compound with midazolam 2 μg/(kg·min),which is more reliable and durable.
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The use of analgesics and sedatives are mostly beyond drug instructions. In this article,we described the types,indications,populations,dosages,frequencies,and the ways of delivery of analgesia and sedative drugs which usually used in pediatrics.