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Objective:To explore the effect of augmented renal clearance(ARC)on 24-hour area under the concentration-time curve to minimum inhibitory concentration ratio(AUC 24/MIC)of vancomycin and prognosis in critical children, thus to provide proposal for individual dosage regimen. Methods:Sixty-five critical children treated with vancomycin, who suffered from sepsis/septic shock, were brought into this retrospective cohort study.According to estimate glomerular filtration rate, these children were divided into ARC group ( n=27) and normal group ( n=38). The influencing factor of AUC 24/MIC of vancomycin and therapy prognosis for two groups were detected and analyzed. Results:There were no significant differences between two groups in basic setting (age, sex, weight), scores of pediatric sequential organ failure assessment and pediatric risk of mortality Ⅲ, infection markers (C-reactive protein and procalcitonin), glutamic-pyruvic transaminase, hypoproteinemia, usage of diuretic and vasoactive agent( P>0.05). The patients from ARC group showed lower levels than those from normal group in AUC 24/MIC of vancomycin[375.2(300.8, 489.4) vs. 443.6(412.3, 593.2), Z=2.263, P=0.024] and it′s target achievement ratio (TAR)(40.7% vs. 76.3%, χ2=8.440, P=0.005). When usage of diuretic and vasoactive agent, the AUC 24/MIC of ARC group was lower than that of normal group( P<0.05). But there was no significant difference between ARC group and normal group regarding hypoproteinemia( P>0.05). The days of body temperature steady at least 48 hours[7.0(5.5, 9.0)d vs. 6.0(5.0, 8.0)d], the length of hospital stay[39.0(21.0, 58.0)d vs. 20.5(16.0, 28.0)d], the length of PICU stay[14.0(9.0, 31.5)d vs. 10.0(5.0, 15.0)d] were longer than those in normal group( P<0.05). There were no significant differences between ARC group and normal group regarding days of ventilation and infectious markers decreased at least 50%, as well as 28-days mortality( P>0.05). The multivariable analysis showed that the presence of ARC, hypoproteinemia, use of diuretics and vasoactive agent were significantly associated with AUC 24/MIC of vancomycin( P<0.05). Conclusion:ARC may down regulate levels of AUC 24/MIC and TAR of vancomycin.During ARC period, the usage of diuretic and vasoactive agent could affect the AUC 24/MIC of vancomycin.Individual dosage regimen should be employed for critical children suffered with ARC.
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Objective:To analyze the early clinical features of children with coronavirus disease 2019 (COVID-19) in order to further improve the understanding of the disease.Methods:A total of 312 children with COVID-19 under 16 years old who were first diagnosed in the children′s fever clinic at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March to May 2022 were retrospectively analyzed.The epidemiology, early clinical features and blood routine results of children were described, and the blood routine results among different age groups were compared.Results:The median age of 312 children was 3.15(1.47, 6.51) years.The proportion of infection rate of children with different ages from high to low were 1~3 years old, > 6 years old, 3~6 years old and ≤ 1 year old.Only 17 (5.4%) cases had underlying diseases.Additionally, 70.2% patients had definite positive case reports in their residential communities, and 65.1% showed a familial cluster.Moreover, 96.2% patients had fever and 52.9% patients had respiratory symptoms.The main symptoms are fever (96.2%), cough (38.1%), runny nose (20.2%), vomiting (14.7%), sore throat (11.5%), poor appetite (6.7%), nasal congestion (4.5%), expectoration (4.5%), convulsion (4.2%), diarrhea (3.8%), etc.Among 309 children, 11.3% patients had increased white blood cell count, especially in children over 6 years old ( P=0.006); 31.7% patients had decreased lymphocyte count and 32.4% had increased C-reactive protein.The positive rate of point-of-care testing was as high as 99%. Conclusion:Children with COVID-19 in Shanghai had the characteristics of familial cluster.The main symptoms are fever and respiratory symptoms.Most of the blood routine leukocytes have no obvious changes, and a few have lymphopenia and C-reactive protein elevation.Point-of-care testing detection can help the children′s fever clinic to early screen COVID-19.
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Objective:To investigate the acute kidney injury(AKI) after cardiopulmonary bypass surgery for cyanotic congenital heart diseases(C-CHD) as well as and acyanotic congenital heart diseases(A-CHD)and its possible influencing factors.Methods:One hundred and three patients with CHD admitted to PICU of Xinhua Hospital Affiliated to Shanghai Jiaotong University were enrolled from July 1, 2017 to September 30, 2019.The patients were divided into C-CHD group( n=36)and A-CHD group( n=67). The preoperative general data and information related to the operation of two groups were recorded.Hemodynamic data, oxygen metabolism index, dose of vasoactive drugs during or after operation and liquid equilibrium were assessed after surgery.The incidence and stage of AKI were calculated.Multivariate Logistic regression was used to analyze the relationship between hemodynamic index and oxygen metabolism index and AKI.The predictive value of hemodynamics and oxygen metabolism for AKI after cardiac surgery was analyzed by receiver operating characteristic curve (ROC). Results:A total of one hundred and three patients were enrolled including sixty-two males and forty-one females, the median age was 7(4, 24) months old.The preoperative hemoglobin and hematocrit in the C-CHD group were higher than those in the A-CHD group( P<0.05). Compared with the A-CHD group, the C-CHD group had higher American Society of Anesthesiologists Grades and Risk Adjustment for Congenital Heart Surgery Grades, longer operation time and cardiopulmonary bypass time( P<0.05). Central venous pressure in C-CHD group was higher than that in A-CHD group, and C-CHD group had higher dose of vasoactive drugs after surgery( P<0.05). Compared with the C-CHD group, blood lactic acid was lower and arterial oxygen partial pressure was higher in the A-CHD group( P<0.05). Fifty patients developed AKI in the PICU, and the incidence of AKI in the A-CHD group was higher than that in the C-CHD, but there was no statistical significance(53.7% vs.38.9%, P>0.05). Multivariate Logistic regression analysis showed that partial arterial oxygen pressure and arterial oxygen satiety were independent risk factors for AKI( P<0.05). The large circulation index could not directly reflect the renal perfusion.Compared with using hemodynamic index or oxygen metabolism index alone to predict the occurrence of AKI 48 h after the operation, the combined application of the two methods had higher predictive value for AKI. Conclusion:Compared with patient with A-CHD, patients with C-CHD have higher tolerance to renal damage caused by surgery, and the kidney of patient with C-CHD have higher tolerance to postoperative fluid load and demand lower oxygen consumption.It is of great clinical significance to evaluate the changes of hemodynamics and oxygen metabolism after cardiac surgery for the prevention and treatment of renal injury.
ABSTRACT
Central venous pressure (CVP) is one of the most commonly used parameters in hemodynamic monitoring, and monitoring CVP to guide the treatment of acute circulatory failure is a relatively common clinical method.However, many studies have pointed out that CVP is affected by many factors and has great limitations, which cannot provide help for the treatment of acute circulatory failure.This review summarized the analysis of the working principle of CVP, its value in treatment and influencing factors.The main purpose is to get a better understanding of CVP.
ABSTRACT
Central venous pressure (CVP) is one of the most commonly used parameters in hemody-namic monitoring,and monitoring CVP to guide the treatment of acute circulatory failure is a relatively com-mon clinical method. However,many studies have pointed out that CVP is affected by many factors and has great limitations,which cannot provide help for the treatment of acute circulatory failure. This review summa-rized the analysis of the working principle of CVP,its value in treatment and influencing factors. The main purpose is to get a better understanding of CVP.