ABSTRACT
Objective:To investigate the characteristics and changes of bacterial infection and drug resistance in PICU at Children′s Hospital of Fudan University from 2016 to 2020.Methods:All the strains were collected at Children′s Hospital of Fudan University from January 1 st, 2016 to December 31 st, 2020.Antimicrobial susceptibility test was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2020 breakpoints. Results:(1)Bacterial distribution: 2 551 bacteria were monitored from 2016 to 2020 in our center.The top 3 bacteria were all gram-negative bacteria.Among them, Burkholderia cepacian showed a tortuous downward trend(13.45% to 1.18%), and Klebsiella pneumoniae showed an upward trend(6.05% to 10.61%).The most common infected site was respiratory tract, although the strains in the respiratory tract decreased year by year.Baumanii was the most common bacteria in respiratory infections.Staphylococcus epidermidis was the most common bacteria from 2016 to 2017 in blood infections, but Achromobacter xylosoxidans were became the most common bacteria from 2018 to 2020.Enterococcus faecium was the most common bacteria in urinary infections.(2) Drug resistance: Baumanii had a high drug resistance rate to amikacin, gentamicin, cefepime, and cefitadine, with no obvious changes over the years, which had a gradually decreasing drus resistance rate to cefoperazone sulbactam, showing a tortuous upward trend to imipenem and meropenem.Baumanii and Pseudomonas aeruginosa had a low drug resistance to levofloxacin over the years, but with high resistance rates in 2020.Escherichia coliand and Klebsiella pneumoniae still had high resistance rates to beta-lactam antibiotics, and their resistance rates to levofloxacin were decreasing.Escherichia coli and Klebsiella pneumoniae showed decreasing resistance rates to imipenem and increased resistance rates to meropenem.The resistance rate of Enterococcus faecium to levofloxacin decreased and always showed a high susceptibility rate to polypeptide antibiotics.Neither Staphylococcus epidermidis nor Staphylococcus aureus were currently resistant to tetracycline antibiotics, and the resistance rates of aminoglycoside antibiotics, such as gentamicin, was also declining.Conclusion:The bacterial infection in PICU shows as the main characteristics of respiratory infection and gram-negative bacteria infection.Carbapenem-resistant Enterobacteriaceae bacteria, Enterococci and Staphylococcus species are becoming increasingly more resistant.
ABSTRACT
Objective:To compare the characteristics of patients undergoing blood purification treatment in PICU of a children′s tertiary hospital during 8 years, so as to analyze the changes in the development of blood purification technology in children in East China.Methods:Patients who received blood purification treatment in PICU of Children′s Hospital of Fudan University from 2014 to 2021 were included and divided into two study periods: 2014-2017 and 2018-2021.The clinical characteristics and treatment parameters of patients were collected and analyzed.Results:A total of 1 029 patients were included in the study, of which 103 were combined with extracorporeal membrane oxygenation.The 28-day survival rate of 926 patients treated with pure blood purification was 55.7%.Among them, patients with younger age, lower body weight, using mechanical ventilation, using vasoactive drugs before blood purification, and patients with multiple organ dysfunction syndrome had a higher distribution in the death group than those in survival group( P<0.05). During 8 years, a total of 3 688 cases of blood purification were performed.The main mode was continuous veno-venous hemodiafiltration (CVVHDF) (68.6%), followed by therapeutic plasma exchange (TPE) (23.8%) and hemoperfusion (HP) (4.8%); the main indication was acute kidney injury (AKI) (29.3%), followed by severe inflammatory disease (26.2%) and acute liver failure (16.2%). Compared with 2014-2017, the number of blood purification treatments in 2018-2021 increased by 47.4%, and the survival rate of patients increased significantly (48.7% vs. 58.1%, P<0.05). The distribution of blood purification patterns and indications also changed( P<0.05). The proportions of TPE (20.5% vs. 26.0%) and HP (3.1% vs. 6.0%) increased, while the proportion of CVVHDF (71.9% vs. 66.4%) decreased significantly.The proportions of AKI (29.8% vs. 38.9%) and refractory immune diseases (8.4% vs. 15.2%) were significantly higher, while severe inflammatory diseases (29.2% vs. 24.2%) and acute liver failure (19.6% vs. 13.8%) had declined. Conclusion:From 2014 to 2021, the number of blood purifications performed in our center increased significantly.Although the distribution of indications and patterns have also changed significantly, the overall survival rate is significantly improved.However, standardized practice still needs to be strengthened.
ABSTRACT
Respiratory therapist is a new profession in medicine, who works therapeutically with people suffering from pulmonary disease.Their timely treatments of patients with cardiopulmonary insufficiency can significantly reduce mortality in pediatric intensive care units.This review focused on the responsibilities of respiratory therapists, the importance of respiratory support therapy in children, and the most updated development in China as well as the problems to be solved.
ABSTRACT
Mechanical ventilation is becoming more and more common in clinical practice.It certainly helps patients to overcome the respiratory failure in children, but in the meantime, also lead to ventilator-induced diaphragm dysfunction(VIDD). VIDD is common in mechanical ventilation patients and are associated with prolonged duration of mechanical ventilation, difficult weaning, pulmonary infection and the mortality.With the development of clinical medical technology, more and more convenient devices are applied to monitor diaphragm function.This review expounded the latest monitoring technology and assessment indices of VIDD, including pressure-generating capacity, imaging examination and diaphragm electrical activity.
ABSTRACT
Objective:To investigate the status of cognition and clinical management of prolonged mechanical ventilation(PMV) among medical staffs in pediatric intensive care unit(PICU) in China, and in order to improve the awareness of PICU medical staffs on PMV and standardize the management of PMV.Methods:The cross-sectional study was conducted with doctors and nurses in PICUs of the collaborative group as the survey objects from July 12 to September 12, 2020.The questionnaire was issued, collected and checked by the Children′s Hospital of Fudan University.Results:(1) PMV related settings: Nine out of eleven hospitals had established PMV multidisciplinary teams, respiratory techniques such as diaphragm ultrasound and airway peak flow monitoring could be respectively executed in 72.7% and 36.4% of PICU.Pulmonary rehabilitation techniques such as airway clearance techniques, induced spirometer exercise, external diaphragm pacemaker stimulation, transfer bed exercise, balloon blowing, hyperbaric oxygen therapy could be respectively executed in 100.0%, 9.1%, 9.1%, 9.1%, 27.3% and 27.3% of PICU, respectively.(2) The cognitive status quo of children′s PMV: The most medical staffs agreed with the view that PMV referred to the children′s continuous mechanical ventilation for more than two weeks.Sixty percent of medical staffs believed that children with PMV had basic central nervous system diseases, and 62.7% of medical staffs believed that the most common causes of difficulty in PMV weaning was abnormal brain function.(3) The cognitive status quo of the children′s PMV management in PICU: Respondents believed that the most commonly used mechanical ventilation mode was synchronized intermittent mandatory ventilation+ pressure support ventilation in children′s PMV during stable disease.Ninety-two percent of medical staffs performed the spontaneous breathing test when weaning.And 58.7% of the respondents agreed to perform tracheotomy for the children during 3 to 4 weeks of mechanical ventilation.More than half of medical staffs would execute diaphragm function assessment, bedside rehabilitation training, nutritional assessment, analgesia and sedation assessment for children with PMV.(4) The cognitive status quo of the children′s PMV management of transition from hospital to family: 54.5% of PICU provided family care training to the family members before the children were discharged from the hospital.One center established the PMV specialized outpatient clinic.45.5% of PICU would follow up these discharged children one month later.Conclusion:At present, PICU medical staffs have different awareness of children′s PMV related problems in China.And children′s PMV lacks a systematic plan regarding diagnosis, treatment and management.
ABSTRACT
Rehabilitation and multidisciplinary team management are very important to improve the prognosis of children with prolonged mechanical ventilation(PMV). The current status of rehabilitation intervention including physical therapy, neuromuscular electrical stimulation and inspiratory muscle training in adult patients with PMV were discussed, aiming to provide some evidence for the implementation of rehabilitation in children with PMV.
ABSTRACT
The main reason for prolonged mechanic ventilation in children staying in PICU for a long time is that it cannot weaning.The reasons for prolonged mechanic ventilation are complex and diverse, and how to deal with it is a difficult problem faced by clinicians.This review summarized the etiology and weaning strategies of prolonged mechanic ventilation in children, so as to provide evidence for clinicians to deal with this problem.
ABSTRACT
In recent years, the number of children with prolonged mechanical ventilation has increased rapidly, and they have been in intensive care units for a long time, resulting in a heavy disease burden and high mortality.Families and society are also paying more and more attention to this special group.The United States and Canada have issued a management consensus on mechanical ventilation for children at home, but the allocation of medical resources in China and other countries is very different, and the domestic family-centered management plan is still difficult at this stage.This review summarized the current status of long-term mechanical ventilation in children in China and other countries, and hoped to learn from foreign experience to help domestic children with long-term mechanical ventilation better.
ABSTRACT
Objective:To explore the effects of external diaphragm electrical stimulation on the diaphragm thickness and function in mechanically ventilated children.Methods:A randomized controlled trial was conducted in children who were admitted to PICU at Children′s Hospital of Fudan University and received mechanical ventilation between June 2021 and April 2022.The control group was given the routine treatment of mechanical ventilation, and the intervention group was given external diaphragm electrical stimulation in the early stage of mechanical ventilation in addition to routine treatment.Diaphragm thickness was continuously measured by bedside ultrasound every day for one week after mechanical ventilation, and the changing trend of diaphragm thickness was observed, and the diaphragmatic thickening fraction (DTf) and the incidence of ventilator-induced diaphragmtic dysfunction(VIDD) were calculated at the same time.Results:A total of 32 valid samples were included, including 15 cases in intervention group (10 males) and 17 cases in control group (11 males). The median age of the patients was 33 (10, 77) months, and the median duration of mechanical ventilation was 12 (8, 21) days.The reasons for mechanical ventilation in children included respiratory insufficiency in ten cases, brain dysfunction in ten cases, heart failure in eight cases, and postoperative surgery in four cases.The diaphragm end-expiratory thickness (DTe) in intervention group and the control group showed a gradually decreasing trend from the 1st day to the 7th day.The left thickness was reduced by 11% on the 7th day compared to 1st day in intervention group, which was reduced by 18% in control group; the average daily DTe was reduced by 2% per day in intervention group and by 3% per day in control group.The trends on the right and left were similar.The DTe thickness in the intervention group was greater than that in control group, among which, the mean DTe thickness in the left side of the intervention group on the 7th day was (0.110 7±0.023 7)cm, which was greater than that in control group (0.093 5±0.016 9)cm, and the difference was statistically significant ( t=-2.372, P<0.05); On the second day, the mean DTe thickness on the right side in the intervention group was (0.1267±0.0277) cm, which was greater than that in control group (0.104 7±0.018 1)cm, and the difference was statistically significant ( t=-2.688, P<0.05). DTf in the intervention group was lower than that in control group at 7th day, but the difference was not statistically significant(left DTf: adjusted mean difference was -0.117, P=0.088; right DTf: adjusted mean difference was -0.065, P=0.277). The incidence of VIDD in the intervention group was lower than that in control group(33.3% vs.41.2%), but the difference was not statistically significant ( χ2=0.005, P=0.946). Conclusion:External diaphragmatic electrical stimulation may be helpful for alleviating diaphragmatic atrophy in mechanically ventilated children.However, whether the improvement of diaphragm atrophy is beneficial to clinical outcome still needs further study.
ABSTRACT
Objective:To prospectively investigate the prevalence of heparin-induced thrombocytopenia (HIT) in critically ill children during extracorporeal membrane oxygenation(ECMO) and explore the clinical characteristics and prognosis of HIT during ECMO.Methods:A total of 22 critically ill children, who had received ECMO support for more than 96 hours in the Intensive Care Unit at the Children′s Hospital of Fudan University from March 2019 to December 2020, were enrolled.According to the 4T score and the heparin/platelet factor 4(PF4) antibody, children whose 4T scores were not less than 6 and heparin/ PF4 antibodies were positive, were classified into HIT group ( n=6), and non-HIT group ( n=16). The clinical outcomes and the incidence of thrombotic events were compared between two groups. Results:The incidence of HIT during ECMO in critically ill children was 27% in this study.The incidence of thrombosis in the ECMO circuit in the HIT group was higher (100% vs.63%, P=0.133), and the average time to the first thrombosis in ECMO circuit in the HIT group was shorter than that in the non-HIT group (3.70 d vs.5.44 d, P=0.06). During the first 14 days of ECMO, the proportion of children with thrombotic events no less than twice was higher in the HIT group (67% vs.19%, P=0.054). There was no significant difference regarding the survival rate at 28 days after ECMO withdrawal between two groups (33% vs.50%, P=0.664). Conclusion:The prevalence of HIT during ECMO in critically ill children is high.Thrombosis events tend to occur earlier and more extensively in children with HIT during ECMO.No significant effect of HIT on the survival rate of children during ECMO is found.Whether HIT has effect on the survival rate of children with ECMO requires a prospective and large clinical study.
ABSTRACT
Objective:To summarize the experience of the precise prevention and control strategy of novel coronavirus infection in the pediatric intensive care unit(PICU)during the epidemic of the Omicron variant.Methods:A retrospective analysis was performed on the strategies and management experience of precise prevention and control of novel coronavirus infection in PICU at Pediatric Hospital of Fudan University from March 1 to May 10, 2022.Results:According to the national and Shanghai novel coronavirus infection prevention and control standards, the PICU in our hospital, in accordance with the specialty characteristics of PICU, cooperated with the hospital′s department of infection and medical department to jointly construct a precise ward management strategy for the outbreak of the omicron mutants infection.Precise prevention and control management strategies were formulated from four aspects: the admission process of critically ill children, the division of PICU ward areas and nosocomial infection protection, the reception management system for children′s family members, and the " bubble management" system for PICU staff, and run them for 3 months.During the epidemic, there was no nosocomial infection of novel coronavirus infection in children or medical staff.During the period, a total of 140 critically ill children were admitted, including 87 cases transferred from the general ward in the hospital, 48 cases from the emergency department(non-febrile, 3 cases transferred by the transfer team), four cases from fever clinic, and one case from control ward.Four of the critically ill children had no emergency nucleic acid test report when they were admitted to the PICU.Among the 140 critically ill children, 54 patients received mechanical ventilation, 18 patients received blood purification, and two patients were monitored after liver transplantation.Seventy-eight (55.7%) children had underlying diseases.Conclusion:During the current round of novel coronavirus epidemic in Shanghai, PICU in our hospital formulated the admission and ward management procedures for critically ill children, which ensured the prevention and control of nosocomial infection of novel coronavirus, and at the same time ensured the treatment of critically ill children to the greatest extent.
ABSTRACT
Objective:To investigate the clinical epidemiological data of children with prolonged mechanical ventilation (PMV) in pediatric intensive care unit(PICU), and analyze the primary disease of children with PMV as well as the disease characteristics and prognosis of children with PMV under different kinds of primary disease.Methods:The clinical data of hospitalized children with PMV in PICU at Children′s Hospital of Fudan University from January 2019 to December 2020 were retrospectively collected.Results:A total of 46 children with PMV were collected.There were 18 males (39.1%) and 28 females (60.9%). The median age was 37 (8, 86) months and the median body weight was 15 (7, 20) kg.The average pediatric critical illness score at admission was 84.2±7.7, PaO 2/FiO 2 was (245.5±99.8)mmHg.The primary diseases leading to PMV were as follows: there were 14 cases of severe pneumonia, eight cases of severe encephalitis, five cases of bronchopulmonary dysplasia, three cases of upper airway obstruction/craniofacial deformity, three cases of myasthenia, three cases of brain stem tumor, three cases of mitochondrial encephalomyopathy, two cases of spinal muscular atrophy, two cases of Prader-Willi syndrome, one case of dermatomyositis, one case of severe brain injury, and one case of central hypoventilation.The causes of unable to withdraw ventilator were respiratory dysfunction in 24 cases, brain dysfunction in 16 cases, and diaphragm dysfunction in six cases.Compared with neuromuscular diseases, children with PMV caused by respiratory diseases had lower month age, higher preterm birth rate, lower PaO 2/FiO 2 ratio, higher parameters for ventilator treatment, and the differences were statistically significant ( P<0.05). Children with PMV caused by neuromuscular diseases had lower Glasgow coma score and higher coma rate, and the differences were statistically significant ( P<0.05). A total of nine (19.6%) cases underwent tracheotomy.A total of 23 (50.0%) cases were successfully extubated from ventilator, six (13.0%) cases were dependent on invasive ventilator, and six (13.0%) cases were breathing with tracheotomy tube.The median mechanical ventilation time was 33 (28, 40) days, the median PICU hospital stay was 42 (34, 56) days, and the median hospital stay was 51 (41, 65) days.A total of 27 (58.7%) cases were improved and discharged, four (8.7%) cases were transferred to rehabilitation hospital, four (8.7%) cases were transferred to local hospital, and 11 (23.9%) cases died in hospital or at home after giving up. Conclusion:The main causes of PMV in PICU children are respiratory dysfunction, brain dysfunction and diaphragm dysfunction.50.0% of the children with PMV could be discharged from the ventilator, and 23.9% died or died after giving up.
ABSTRACT
Objective:To investigate the correlation and consistency between the parameters of the thromboelastography(TEG) and of routine coagulation tests and platelet count(PLT) in critically ill children in the pediatric intensive care unit.Methods:We conducted a retrospective analysis on the results of the simultaneous TEGs, coagulation tests and PLT of 231 children in pediatric intensive care unit at Children′s Hospital Affiliated to Fudan University from March 2019 to July 2019, including the correlation analysis, the chi-square test and Kappa consistency analysis.Results:The reaction time(R) was linearly dependent on activated partial thromboplastin time(APTT), prothrombin time(PT) and thrombin time(TT), respectively.The maximal amplitude(MA), clot time formation(K) and alpha-angle(α) were linearly dependent on fibrinogen.The MA, K and α were linearly dependent on PLT, too.And the correlation between MA and PLT was the best( R=0.656). There were significant differences( P<0.001) and poor consistency(Kappa value: 0.112, 0.047, 0.124) between R and APTT, PT, TT.There was no significant difference( P>0.05) and there was moderate consistency(Kappa value: 0528, 0.518, 0.408) between Ma, K, α and PLT.There were significant differences( P<0.001) and the consistency was poor or fair(Kappa value: 0.324, 0.188, 0.170) between Ma, K, α and fibrinogen. Conclusion:TEG is significantly correlated with PLT in evaluating platelet function and the consistency is good.The TEG parameters are linearly correlated with the relevant results of routine coagulation tests in evaluating the coagulation factor and fibrinogen function, but consistency is weak.Therefore, it is concluded that these two methods are irreplaceable.
ABSTRACT
Objective:To explore the value of body temperature, pediatric clinical illness score(PCIS), white blood cell count (WBC), plasma C-reactive protein (CRP), procalcitonin (PCT) and pro-adrenomedullin (pro-ADM) in predicting nosocomial infection in PICU.Methods:From June 2016 to March 2017, the critically ill children in PICU of Children′s Hospital of Fudan University were selected and divided into nosocomial infection group and non nosocomial infection group according to the diagnostic criteria of nosocomial infection.The body temperature, PCIS, WBC, CRP, PCT and pro-ADM were recorded at 4 hours (T1), (48±1) hours (T2), (120±1) hours (T3) and (192±1) hours (T4) after admission, and their predictive value of each index, which was the closest time point (Th) to nosocomial infection was analyzed.Receiver-operating characteristic (ROC) curves were performed to calculate the areas under the curves (AUC), sensitivity and specificity, and multivariate Logistic regression analysis was used to study the risk factors of nosocomial infection.Results:A total of 85 cases were included, including 27 cases in nosocomial infection group and 58 cases in non nosocomial infection group.There was no significant difference in age, weight, body temperature, WBC, PCT, pro-ADM, primary disease and invasive operation between two groups (all P>0.05). There were significant differences in gender, PCIS, CRP, intubation rate and central venous catheterization rate ( P<0.05), when patients were admitted to PICU.At Th, the differences of body temperature, PCIS, CRP, PCT and pro-ADM between two groups were statistically significant ( P<0.05), as well as the AUC were 0.787, 0.755, 0.709, 0.704 and 0.809, respectively, as well as the best cut-off values for predicting nosocomial infection were 38.0 ℃, 87 points, 14.5 mg/L, 0.28 ng/mL and 0.67 nmol/L, respectively.There was no significant difference regarding WBC between two groups ( P>0.05). PCIS may be an independent risk factor for nosocomial infection( OR=0.978, 95% CI 95.9-99.9, P<0.05). Conclusion:Pro-ADM has high sensitivity and specificity in predicting nosocomial infection, and PCIS is an independent risk factor for nosocomial infection.
ABSTRACT
Objective@#To develop the early respiratory rehabilitation techniques in pediatric intensive care unit(PICU) for children with mechanical ventilation.@*Methods@#A respiratory rehabilitation team was established, and early respiratory rehabilitation intervention methods for critically ill children were also developed.Early bedside rehabilitation were implemented after the vital signs of mechanical ventilation children were stable for 24 hours, and the rehabilitation effect and adverse events were observed.@*Results@#According to the patient′s condition, 23 patients in PICU received early respiratory rehabilitation after incubations, including 10 males and 13 females, aged 57.0(17.5, 91.5) months.There was no adverse event in 729 rehabilitation practices.The average consulting time was 8.0(4.0, 18.0) days after incubations.The average incubation time was 693.5(345.2, 1 027.1)hours of all the patients.As to 16 patients who were weaned before charged out, the average incubation time was 566.2(243.4, 928.7)hours, and the average incubation time from respiratory rehabilitation performance to weaning was 168.0(6.0, 564.0) hours.In 19 patients who only received limbs massage and passive movements, the average incubation time was 381.7(309.6, 541.4) hours and the average incubation time from respiratory rehabilitation performance to weaning was 187.2(81.5, 382.9) hours.However the difference between these who received respiratory rehabilitation and only received limbs massage and passive movements was not statistically significant.@*Conclusion@#It′s safe and feasible to perform the early respiratory rehabilitation in PICU for critically ill children with mechanical ventilation.
ABSTRACT
Objective To report the treatment effects of open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision on closed calcaneal fractures.Methods A retrospective study was done of the 20 patients (25 feet) who had been treated at Ward One,Department of Orthopaedics,People's Hospital of Yunfu from February 2016 to February of 2019 for closed calcaneal frac-tures by open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision.They were 16 males and 4 females,aged from 16 to 60 years.According to the Sanders classification,there were 3 cases of type Ⅱ,15 cases of type Ⅲ and 2 cases of type Ⅳ.Their fractures were reduced by traction,extruding,prying and direct visualization through the tarsal canal window;the bone plates were inserted through a small incision at the back of the heel and fixated by screws.Postoperative observation was done to address fracture healing,and length,width,height,B(o)hler angle and Gissane angle of the affected calcaneus,as well as functional recovery of the ankle-hindfoot by the American Orthopaedic Foot and Ankle Society (AOFAS) evaluation.Results The operation time for a single foot ranged from 45 min to 70 min,averaging 64.5 min;the intraoperative fluoroscopy for a single foot ranged from 3 times to 6 times,averaging 4.5 times.Local skin necrosis of about 0.5 cm x 0.3 cm appeared in one foot after operation but responded to dressing change.No other wound complications occurred.Their follow up was carried out for 6 to 36 months (average,17.3 months).The fractures healed well with well-shaped bony callus and flat articular surface after 4 to 6 months.The length (80.5 mm ±4.2 mm),width (44.8 mm ±5.2 mm),height (44.4 mm ±3.0 mm),B(o)hler angle (25.0° ± 5.1 °) and Gissane angle (113.8 ° ± 8.6°) of the calcaneus at the last follow up were significantly improved than the preoperative values (79.4 mm ± 4.5 mm,50.5 mm ± 6.3 mm,40.0 mm ±4.4 mm,12.0°± 13.8° and 107.0°± 13.3°) (all P ＜ 0.05).By the AOFAS ankle-hindfoot scale,functional recovery of the foot was excellent in 20,good in 3 and fair in 2 cases,giving an excellent to good rate of 92％.Conclusion In the treatment of closed calcaneal fractures,open reduction and internal fixation with bone plate through a small posterior heel plus tarsal canal incision may lead to fine outeomes due to its advantages of small incision and fine fracture reduction.
ABSTRACT
Children with prolonged mechanical ventilation often have complex conditions, such as long hospital stay of PICU.They have many complications and high mortality.In addition, these patients have low quality of life, lack of psychological care, family emotional communication, and heavy burden of disease.The long-term management and rehabilitation of these children should be strengthened.This study summarized the researches of prolonged mechanical ventilation in adults at home and abroad, in order to provide experience for prolonged mechanical ventilation management in children.
ABSTRACT
Objective:To develop the early respiratory rehabilitation techniques in pediatric intensive care unit(PICU) for children with mechanical ventilation.Methods:A respiratory rehabilitation team was established, and early respiratory rehabilitation intervention methods for critically ill children were also developed.Early bedside rehabilitation were implemented after the vital signs of mechanical ventilation children were stable for 24 hours, and the rehabilitation effect and adverse events were observed.Results:According to the patient′s condition, 23 patients in PICU received early respiratory rehabilitation after incubations, including 10 males and 13 females, aged 57.0(17.5, 91.5) months.There was no adverse event in 729 rehabilitation practices.The average consulting time was 8.0(4.0, 18.0) days after incubations.The average incubation time was 693.5(345.2, 1 027.1)hours of all the patients.As to 16 patients who were weaned before charged out, the average incubation time was 566.2(243.4, 928.7)hours, and the average incubation time from respiratory rehabilitation performance to weaning was 168.0(6.0, 564.0) hours.In 19 patients who only received limbs massage and passive movements, the average incubation time was 381.7(309.6, 541.4) hours and the average incubation time from respiratory rehabilitation performance to weaning was 187.2(81.5, 382.9) hours.However the difference between these who received respiratory rehabilitation and only received limbs massage and passive movements was not statistically significant.Conclusion:It′s safe and feasible to perform the early respiratory rehabilitation in PICU for critically ill children with mechanical ventilation.
ABSTRACT
Objective To evaluate the role of group Ⅱ metabotropic glutamate receptors (mGluRs) in cognitive decline caused by multiple administrations of ketamine in mice and the relationship with hippocampal glycogen synthase kinase-3 beta (GSK-3β) expression.Methods Forty-five SPF healthy female C57BL/6 mice,aged 6-8 weeks,weighing 20-30 g,were randomized into 3 groups (n=15 each) using a random number table method:control group (group C),ketamine group (group K) and mGluR agonist LY354740 group (group L+K).In K and L+K groups,ketamine 30 mg/kg was intraperitoneally injected three times a day at an 30-min interval for 14 consecutive days.LY354740 was intraperitoneally injected at 30 min before the first injection of ketamine in group L+K.The equal volume of normal saline was given instead in group C.Morris water maze test was performed the day after the last administration.The mice were then sacrificed,and hippocampi were harvested to determine the expression of GSK3β,NR2A and postsynaptic density protein 95 (PSD95) by Western blot.Results Compared with group C,the escape latency was significantly prolonged,the time of staying at the original platform quadrant was shortened,the frequency of crossing the original platform was decreased,the expression of GSK3β3 and NR2A was up-regulated,and the expression of PSD95 was down-regulated in group K (P＜0.05),and no significant change was found in the parameters mentioned above in group L+K (P＞0.05).Compared with group K,the escape latency was significantly shortened,the time of staying at the original platform quadrant was prolonged,the frequency of crossing the original platform was increased,the expression of GSK3β and NR2A was down-regulated,and the expression of PSD95 was up-regulated in group L+K (P＜0.05).Conclusion Group Ⅱ mGluRs are involved in the process of cognitive decline caused by multiple administrations of ketamine in mice,which is associated with up-regulated expression of hippocampal GSK-3β.
ABSTRACT
Drug‐induced hypersensitivity syndrome is also known as drug reaction with eosinophilia and systemic symptoms which is a rare and serious adverse drug reaction. The clinical manifestations include skin eruption,hematologic abnormalities,lymphadenopathy,and internal organ involvement ( liver,kidney, lung) . Its pathogenesis is still unclear and is considered to be related to a variety of factors,including drug‐specific immune responses,viral reactivation and inheritance. Prompt withdrawal of suspicious drugs is the key to treatment,and the use of systemic corticosteroids and intravenous immunoglobulins remains contro‐versial.