The value of bedside ultrasound and biomarkers in the diagnosis of sepsis-induced myocardial dysfunction and prognosis of septic shock in children / 中国小儿急救医学

Objective:To evaluate the feasibility of using bedside ultrasound and serum biomarkers for the prediction of sepsis-induced myocardial dysfunction(SIMD)and mortality in septic shock patients.Methods:The patients diagnosed as septic shock were enrolled in the study from January 2019 to July 2021 in PICU at Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine.Bedside ultrasound results were recorded at day 1, 2, 3, 7 and 10.Blood samples were collected at the same time, markers of myocardial injury were detected, and prognosis was recorded at 28 days.According to the left ventricular ejection fraction (LVEF), children with septic shock were divided into SIMD group and non-SIMD group.Those with LVEF <50% or decreased by ≥10% from baseline level were defined as SIMD.Differences in cardiac ultrasound parameters and biomarkers between two groups were compared.Logistic regression analysis was performed to determine the independent risk factors for SIMD and the independent risk factors for death at 28 days after septic shock.The area under the receiver operating characteristic curve (AUC) was used to evaluate the efficacy of different indicators in predicting SIMD and the death outcome of children with septic shock on 28 days.Results:A total of 57 children were enrolled, including 28 cases in SIMD group and 29 cases in non-SIMD group.Univariate analysis showed that there were statistically significant differences in pediatric critical illness score, N-terminal B-type natriuretic peptide(NT-proBNP), LVEF and left ventricular short axis shortening rate between two groups ( P<0.05). Logistic analysis demonstrated that LVEF( OR=0.890, 95% CI 0.818-0.969, P=0.007)and NT-proBNP ( OR=1.000, 95% CI 1.000-1.000, P=0.015)could independently predict SIMD.There were 42 cases in survival group and 15 in non-survival group according to the prognosis on 28 days.Univariate analysis showed that there were significant differences in pediatric risk mortality score Ⅲ, pediatric sequential organ failure assessment, cardiac troponin I, and mitral annular plane systolic excursion(MAPSE)( P<0.05). Logistic analysis showed that only MAPSE independently predicted mortality( OR=85.670, 95% CI 1.685-4 356.736, P=0.026). Compared with MAPSE(AUC=0.727), MAPSE combined with pediatric risk mortality score Ⅲ, pediatric sequential organ failure assessment, cardiac troponin I(AUC=0.926) could be better to predict the 28 days prognosis of patients with septic shock on 28 days. Conclusion:NT-proBNP increases significantly in the early stage of SIMD.MAPSE shows no difference between SIMD and non-SIMD patients.MAPSE is correlated with the prognosis of patient with septic shock.

Implementation of individualized lung protective ventilation strategy for pediatrics acute respiratory distress syndrome guided by electrical impedance tomography and critical care ultrasound / 中国小儿急救医学

Objective:To explore the implementation of individualized lung protection ventilation strategy in pediatric acute respiratory distress syndrome(pARDS)guided by transthoracic electrical impedance tomography(EIT)and critical care ultrasound(CCU).Methods:We retrospectively analyzed the therapeutic process of protective ventilation strategy in one case of severe pARDS.EIT and CCU were used to guide the implementation of lung protective ventilation strategy.Results:EIT was used to guide lung recruitment and optimal positive end-expiratory pressure titration.CCU was used to assess hemodynamics and lung status of ARDS patient, and guide the implementation of right ventricular protective ventilation and circulatory protective ventilation.Finally, the patient eventually survived.Conclusion:The idea of ARDS protective ventilation has changed from traditional lung protective ventilation to right heart protective ventilation and circulatory protective ventilation, and finally achieved the protection of pulmonary vascular endothelium.EIT and CCU enrich the understanding of the pathophysiology and protective ventilation strategy in pARDS.

Preliminary determination of infection: clinical manifestations / 中国小儿急救医学

Infection is a major childhood disease, which is a documented or suspected systemic or local infection caused by any pathogen.Most children are mildly infected with a good prognosis, while a small part progress quickly, which causes multiple organ dysfunction, even leads to death.Infection is one of the main causes of death in children.Fever is one of the most common symptom in infection, it′s controversial to predict the severity of illness by using the fever degree.Studies pointed out that children′s symptoms of the corresponding site of infection are better for predicting the severity of infection.So it′s important to identify the symptoms of infection and intervene.Herein, we reviewed the common symptoms and signs of infection in childhood.

Analysis of clinical characteristics and prognostic factors of childhood sepsis in pediatric intensive care unit / 临床儿科杂志

Objective To explore the clinical features and prognostic factors of sepsis in children without underlying diseases in pediatric intensive care unit (PICU). Methods The clinical data of 110 children with sepsis who had no underlying diseases and were hospitalized in PICU from February 2014 to June 2016 were reviewed. According to the severity of sepsis, the children were divided into sepsis group, severe sepsis group, and septic shock group. According to the prognosis on 28 d after hospitalized in PICU, the children were divided into survival group and death group. The differences among different groups were compared. Results In 110 children with sepsis and no underlying diseases (74 males and 36 females) a median age was 0.42 years. Pulmonary infection is the main source of infection. The overall mortality rate was 14.55%. The mortality rates of sepsis, severe sepsis, and septic shock were 2.94%, 27.27%, and 35.48% respectively, and the difference was statistically significant (P<0.001). The difference in procalcitonin (PCT), white blood cell (WBC), creatinine (Cr), activated partial thromboplastin time (APTT), international normalized ratio (INR), multiple organ dysfunction (MODS), the pediatric critical illness score (PCIS), pediatric multiple organ dysfunction score (P-MODS), mechanical ventilation within 6 h, the duration of mechanical ventilation and the prognosis on 28 days were statistically among those three groups (P all<0.05). The difference in level of PCT, lactic acid (Lac), APTT, INR, MODS, PCIS, P-MODS, mechanical ventilation within 6 h, the duration of mechanical ventilation, PICU stay time, hospitalized time, the severity of sepsis were statistically different (P all<0.05) between survival group and death group. Logistic regression analysis showed that children with higher PCIS and longer hospitalized time had a better prognosis on 28 d, while those with longer mechanical ventilation had a poorer prognosis on 28 d (P<0.05). Conclusions The levels of PCT, WBC, Cr, APTT, INR, MODS, PCIS, PCT, P-MODS, 6 h mechanical ventilation, and mechanical ventilation time were helpful in determining the severity of sepsis in children without underlying diseases hospitalized in PICU. PCIS, mechanical ventilation time, and hospitalized time affect prognosis.

Analysis of clinical characteristics and prognostic factors of childhood sepsis in pediatric intensive care unit / 临床儿科杂志

Objective To explore the clinical features and prognostic factors of sepsis in children without underlying diseases in pediatric intensive care unit (PICU). Methods The clinical data of 110 children with sepsis who had no underlying diseases and were hospitalized in PICU from February 2014 to June 2016 were reviewed. According to the severity of sepsis, the children were divided into sepsis group, severe sepsis group, and septic shock group. According to the prognosis on 28 d after hospitalized in PICU, the children were divided into survival group and death group. The differences among different groups were compared. Results In 110 children with sepsis and no underlying diseases (74 males and 36 females) a median age was 0.42 years. Pulmonary infection is the main source of infection. The overall mortality rate was 14.55%. The mortality rates of sepsis, severe sepsis, and septic shock were 2.94%, 27.27%, and 35.48% respectively, and the difference was statistically significant (P<0.001). The difference in procalcitonin (PCT), white blood cell (WBC), creatinine (Cr), activated partial thromboplastin time (APTT), international normalized ratio (INR), multiple organ dysfunction (MODS), the pediatric critical illness score (PCIS), pediatric multiple organ dysfunction score (P-MODS), mechanical ventilation within 6 h, the duration of mechanical ventilation and the prognosis on 28 days were statistically among those three groups (P all<0.05). The difference in level of PCT, lactic acid (Lac), APTT, INR, MODS, PCIS, P-MODS, mechanical ventilation within 6 h, the duration of mechanical ventilation, PICU stay time, hospitalized time, the severity of sepsis were statistically different (P all<0.05) between survival group and death group. Logistic regression analysis showed that children with higher PCIS and longer hospitalized time had a better prognosis on 28 d, while those with longer mechanical ventilation had a poorer prognosis on 28 d (P<0.05). Conclusions The levels of PCT, WBC, Cr, APTT, INR, MODS, PCIS, PCT, P-MODS, 6 h mechanical ventilation, and mechanical ventilation time were helpful in determining the severity of sepsis in children without underlying diseases hospitalized in PICU. PCIS, mechanical ventilation time, and hospitalized time affect prognosis.

Clinical diga nosis of sepsis-induced myocardial depression / 中国小儿急救医学

Sepsis is defined as the systemic inflammatory response to infection,with high morbidity, high mortality and high cost, which is the most common cause of death in ICU.The morbidity of sepsis-induced myocardial depression is about 37%~50%, and the mortality is 20% higher than simple sepsis. Although the research in sepsis-induced myocardial depression is deeper than ever before, the diagnostic standard of sepsis-induced myocardial depression is still unclear,the early diagnosis of sepsis-induced myocra-diald eprse sion seems patr icularly important.Nowd ays,ht e diga nostci ways include ce hocardiography,ivn asive andn oninvasive hemodynamic monitoring, electrocra diogram andb iological markers are the most common diang ostic methosd .This review discussed the diagnostic methdo s used in sepsis-induced myocardial deper ssion.

Hemodynamic changes of fulminant myocarditis / 中国小儿急救医学

Fulminant myocarditis is one of the most common diseases causing sudden cardiac death in pediatrics and young adults.The pathophysiology of fulminant myocarditis involves both direct myocyte dysfunction and immune-mediated tissue injury,which result in severe damage in cardiac structure and func-tion.It always rapidly developed into cardiogenic shock in several hours.Despite the high mortality rate,if pa-tient response well to a series of progressive treatment,most of them would get complete resolution.Better understanding of the hemodynamic changes of fulminant myocarditis is the key point of rapid diagnosis and proper interventional treatment.In this article we made a summary introduction of those hemodynamic chan-ges in fulminant myocarditis.