RESUMEN
Objective:To analyze the difference of clinical characteristics and outcomes of infants with moderate and severe pediatric acute respiratory distress syndrome(PARDS)diagnosed according to baseline oxygenation index(OI) in pediatric intensive care unit(PICU).Methods:Second analysis of the data collected from the "Efficacy of pulmonary surfactant (PS) in the treatment of children with moderate and severe ARDS" program.Retrospectively compare of the differences in clinical data such as general condition, underlying diseases, OI, mechanical ventilation, PS administration and outcomes among infants with moderate and severe PARDS divided by baseline OI who admitted to PICUs at 14 participating tertiary hospitals from 2016 to December 2021.Results:Among the 101 cases, 55 cases (54.5%) were moderate and 46 cases (45.5%) were severe PARDS.The proportion of male in the severe group (50.0% vs.72.7%, P=0.019) and the pediatric critical illness score(PCIS)[72 (68, 78) vs.76 (70, 80), P=0.019] were significantly lower than those in the moderate group, while there was no significant difference regarding age, body weight, etiology of PARDS and underlying diseases.The utilization rate of high-frequency ventilator in the severe group was significantly higher than that in the moderate group (34.8% vs.10.9%, P=0.004), but there was no significant difference in PS use, fluid load and pulmonary complications.The 24 h OI improvement (0.26±0.33 vs.0.04±0.34, P=0.001) and the 72 h OI improvement[0.34 (-0.04, 0.62) vs.0.15 (-0.14, 0.42), P=0.029)]in the severe group were significantly better than those in the moderate group, but there was no significant difference regarding mortality, length of hospital stay and intubation duration after diagnosis of PARDS between the two groups. Conclusion:In moderate and severe(divided by baseline OI) PARDS infants with invasive mechanical ventilation, children in severe group have better oxygenation improvement in the early stage after PARDS identified and are more likely to receive high frequency ventilation compared to those in moderate group.Baseline OI can not sensitively distinguish the outcomes and is not an ideal index for PARDS grading of this kind of patient.
RESUMEN
Objective:To explore more clinical characteristics and outcomes of children with severe pneumonia induced by adenovirus type 7(Adv-7).Methods:Seventy children with severe pneumonia induced by Adv-7 admitted to the pediatric intensive care unit of Guangzhou Women and Children′s Medical Center from January 2016 to October 2019 were enrolled.The clinical features, treatments and outcomes of these children were recorded.Results:(1)There were 43 males(61.4%)and 27 females(38.6%). Thirty(42.9%)patients were 0-12 months old, 28(40.0%)patients were 13-36 months old, and 12(17.1%)patients were over 36 months old.(2)The average onset time of severe pneumonia induced by Adv-7 was(11.87±7.10)days before being admitted to PICU.The average sequential organ failure assessment score was 6.80±3.13.The average Murray lung injury score was 2.49±1.15.The average P/F value was(150.57±86.25)mmHg(1 mmHg=0.133 kPa). Sixty-four cases(91.4%)were involved in two or more area of lung on X-rays.All cases were diagnosed with sepsis.(3)Laboratory examination: white blood cell count was(7.6±5.5) ×10 9/L, platelet count was(238.8±164.2)×10 9/L, and C-reactive protein was(39.4±37.2)mg/L.(4)Treatments: intravenous gamma globulin was used in 65 cases(92.9%). Intravenous glucocorticoid was used in 45 cases(64.3%). Fiberoptic bronchoscopy was performed in 43 cases(61.4%). Blood purification treatment was performed in 21 cases(30%). Sixty-three patients(90.0%)were treated with non-invasive or invasive ventilator, high frequency ventilator-assisted ventilation was used in 20 cases(28.6%). Surfactant was used in six cases(8.6%). Extracorporeal membrane oxygenation was used in 19 cases(27.1%). (5)The average treatment time for ventilation was(13.10±11.58)days.The average time for temperature recover was(4.69±4.01)days in PICU.The average PICU stay time was(15.76±12.20)days.The average length of stay was(27.04±13.10)days.There were 16 patients died and the mortality was 22.9%. Conclusion:The children with severe pneumonia induced by Adv-7 were critical and had significant lung injuries.Suffering from active clinical treatment such as extracorporeal membrane oxygenation, some of these patients still had poor prognosis.
RESUMEN
Objective:To explore the clinical effect of high-titer plasma in the treatment of severe viral pneumonia in children.Methods:A total of 80 eligible children with severe viral pneumonia in intensive care unit of Guangzhou Women and Children Medical Center were enrolled in this retrospective study from January 2016 to June 2019, According to whether high-titer plasma was used or not, patients were divided into the high-titer plasma group (40 cases) and non-high-titer plasma group (40 cases). Chi-square test, Fisher's exact probability test and Mann-Whitney U test were used to compare the basic data, infection indicators, blood gas and ventilator parameters related indicators, treatment and prognosis of the two groups. Results:There were no significant differences in age, sex, admission weight, onset days and fever days between the high-titer plasma group and non-high- titer plasma group before entering the study (all P>0.05); There were no significant differences in the worst SOFA score, Murray lung injury score, chest X-ray involvement and sepsis within 3 days (all P>0.05). There were no significant differences in white blood cells, neutrophils and c-reactive protein between the two groups before and after entering the study (day 3 and 7) (all P> 0.05). There were no significant differences in arterial partial pressure of oxygen (PaO 2), partial pressure of carbon dioxide (PaCO 2), lactic acid (Lac), mean airway pressure (MAP), oxygenation index (P/F) and oxygen index (OI) between the two groups before and after entering the study (day 1, 3 and 7) (all P>0.05). There were no significant differences in the use of immunoglobulin, hormone, fiberoptic bronchoscope, blood purification, high frequency ventilator, pulmonary surfactant and extracorporeal membrane between the two groups (all P>0.05). There were no statistical differences in the number of days using invasive ventilator, the number of days staying in PICU and the total length of hospital stay between the two groups (all P>0.05). There was shorter time of the body temperature decreased to normal time in the high-titer plasma group than in the non-high-titer plasma group ( Z=-2.10, P=0.04). The survival rate of the high-titer plasma group was higher than that of the non-high-titer plasma group (85% vs 65%, χ2=4.27, P=0.04). The average daily cost of the high-titer plasma group was less than that of the non-high-titer plasma group, 3 688.38 yuan (2 335.49, 5 741.51) yuan vs 3 979.24 yuan (2 670.68, 9 992.62) yuan, but the difference was not statistically significant (Z=-1.35, P=0.18). No serious adverse reactions were observed during the treatment with high-titer plasma. Conclusions:The treatment of severe viral pneumonia with high-titer plasma can shorten fever time and improve survival rate. High-titer plasma can be used as a safe and effective treatment for severe viral pneumonia.
RESUMEN
The heterogeneity and diversity of sepsis,evaluation for the role of definitions and related guidelines,and the key evidence for the diagnosis and therapies of sepsis are being paid close attention to.Here are the discussions for the heterogeneity or diversity of sepsis effected from etiology,personality,gut-derived problem,predisposing factors or premorbid conditions,co-intervention,with comparing the positive and negative changes on some of the recommendations,suggestions,techniques,medicine,and therapies amongst different editions of International Consensus Definition for Sepsis and Septic Shock,and International Guidelines for Management of Sepsis and Septic Shock in Surviving Sepsis Campaign or other related special procedures.
RESUMEN
Objective To investigate the status of clinical nutrition management in patients in PICU,and to provide data for promoting the improvement and development of clinical nutrition of pediatric critically ill patients.Methods A questionnaire survey was conducted on PICU specialists.The nutrition assessment,nutrition intervention and nutrition management of critically ill children in PICU were investigated.The results were summarized and analyzed.Results A total of 39 PICU specialists were involved in this survey.The nutritional assessment methods and guidelines in domestic PICU were not unified.Twenty-five respondents (64.1%) believed that both clinical performance and the scales as the basis can decide whether the patients should be fed or not;all respondents believed that nutritional assessment and intervention time need to be determined by the needs of the patients;23 respondents(58.9%) used weight only as their nutritional monitoring indicators.Twenty-eight respondents(71.8%) considered that gastric tube was the first choice way to feeding for the critically ill children;20 respondents(51.3%) believed that critically ill children should be fed within 24 hours.Twelve respondents (33.3%) believed that critically ill children should be fed between 24 to 48 hours.Thirty-three respondents(84.6%) advocated early enteral nutrition;36 respondents (92.3%) considered that the main reasons of fasting in critically ill children were vomiting or abdominal distension or gastrointestinal bleeding.Twenty-eight respondents(71.8%) believed that according to the results of gastrointestinal function evaluation,they made decisions whether the patient to fast or not.Twenty-three respondents(59.0%) considered that specialists in PICU were the decision maker of the clinical nutrition in critically ill children.Twenty-four (61.5%) of the respondents believed that we needed to establish our own routines in management of nutrition in PICU.Conclusion At present in China,a lot of achievements have been made in the nutritional assessment,monitoring,early enteral nutrition intervention and management in critically ill children,but it is not enough.We need to make more effort to enhance the critically nutrition level in PICU,and we have a lot of research to do about nutrition assessment and nutrition intervention mode.It is recommended to establish Chinese guidelines or consensus to enhance the level of nutritional treatment of critically ill children.
RESUMEN
Objective To investigate the effects of epinephrine in sepsis-associated lung injury in rats. Methods Thirty SD rats were randomly divided into three groups(n =10 per group):control group received intravenous 0. 9% saline 2. 4 ml/( kg·h ); LPS group received intravenous LPS ( 6 mg/kg ); epi-nephrine treatment group received an infusion of epinephrine 0. 6μg/( kg·min) after LPS intravenous injec-tion . Blood samples were taken at 2 h and 6 h after LPS injection and the levels of serum tumor necrosis factor ( TNF)-α,interleukin( IL)-6 and IL-10 were detected. The rats were sacrificed at 6 h. The lung tissues and bronchoalveolar lavage fluid( BALF) were collected. Pathological changes of the lung tissues were observed under light microscope. Water content of lung,expression of TNF-α,IL-6 and IL-10 in BALF and in serum were detected. Results (1) The water content of lung in LPS group significantly increased compared with that in control group(85. 24% ± 5. 87% vs. 70. 19% ± 5. 87%) and epinephrine group(78. 00% ± 6. 41%) (P<0. 05). (2)Pathological examination showed that LPS could cause pulmonary capillary hyperemia,ede-ma,inflammatory cells infiltration. Atelectasis and alveolar edema were found in small number of lung tissue. Compared with LPS group, epinephrine ameliorated the lung pathological injury. ( 3 ) Compared with LPS group,serum levels of TNF-α and IL-6 significantly decreased ( P <0. 05 ) , whereas IL-10 increased ( P <0. 05) in epinephrine group. (4)Compared with LPS group,BALF levels of TNF-α[(78 ± 9)ng/L vs. (102 ±16)ng/L]andIL-6[(268±42)ng/Lvs.(347±50)ng/L]significantlydepressed(P<0.05),whereas BALFlevelsofIL-10[(210±23)ng/Lvs.(146±34) ng/L]elevated(P <0.05) inepinephrinegroup. Conclusion Epinephrine could reduce the acute lung injury caused by LPS. Its protective effect may be re-lated to decreasing the levels of TNF-α and IL-6,elevating IL-10 level.
RESUMEN
Objective To study the clinical outcomes and safety of immunoadsorption therapy for refractory autoimmune disease in children.Methods Three boys who suffered of severe autoimmune disease-one boy suffered of severe dermatomyositis and pulmonary infection; one suffered of severe anaphylactoid purpura with alimentary tract hemorrhage and entero ablation for intestinal perforation ; other one suffered of systemic juvenile idiopathic arthritis and severe prosopo-cellular tissue infection,macrophage active syndrome,were treated with blood immunoadsorption by resin immunoadsorbent of HA280.Then evaluated the clinical outcome of 3 cases,including symptom improvement,change of serum immune globulin,complement,enzyme of liver and heart,autoantibody.Results After the treatment of immunoadsorption,the symptom of 3 cases improved obviously; the sensitivity of the corticosteroids increased; autoantibody of antinuclear antibody (ANA) and anti-cyclic citrullinated peptide antibody (CCP) changed to negative; C-reactive protein (CRP) dropped (P ＜ 0.05) ; descending scale of IgM,IgA,C3,C4 increased (P ＜ 0.05) ; the normal scale of immunoglobulin didn't changed (P ＞ 0.05) ; besides aspartate aminotransferase (AST) dropped in the case of dermatomyositis,the other enzyme of liver and heart didn't changed.Conclusions The body could be restored quickly by the treatment of immunoadsorption together with the drug; CRP in the blood could be removed by immunoadsorbent of resin; 1 or 2 times blood immunoadsorption could not change the level of enzyme,but it need to do more on severe cases,especially those with poor organ function; for the safe of the treatment of immunoadsorption for the young age,low weigh and severe cases,the operative procedure should be critical care.
RESUMEN
Objective To explore the application of the ultrasonic cardiac output monitor(USCOM) in the children with pneumonia complicated with heart failure.Methods Fourteen children with pneumonia complicated with heart failure were enrolled in the experimental group and thirty-two children with common pneumonia were enrolled in the control group.We used the USCOM to measure the cardiac output indicators,including the aortic peak velocity,heart rate,stroke volume index,cardiac index,ejection time and correcting ejection time.Results The heart rate in the experimental group was faster than that of control group[(174 ±10) beats/min vs (133 ± 14) beats/min,P ＜0.05],the aortic peak velocity in the experimental group was lower than that of control group [(1.246 ±0.234) m/s vs (1.449 ±0.300) m/s,P ＜0.05],the stroke volume index in the experimental group was lower than that of control group [(29.357 ± 6.500) ml/m2 vs (40.188 ±5.337) ml/m2,P ＜0.05],and the correcting ejection time in the experimental group was shorter than that of control group [(342.560 ± 8.219) ms vs (354.430 ± 16.500) ms,P ＜ 0.05].Conclusion The cardiac function monitoring by USCOM is accurate and convenient,and USCOM can provide the accurate evidence for the clinical application.
RESUMEN
Objective To discuss pathogens findings in children with severe pneumonia.Methods Bacteria was detected by using sputum culture and blood culture in sterile culture media.Viruses and atypical pathogenic antibodies were detected by using indirect immunofluorescence.Influenza A (H1N1) virus RNA were tested using RT-PCR.According to the results of bacterial culture and drug sensitive test,we can guide the use of antibiotics,and individualize treatment was carried out,including anti-inflammatory,organ function support.Results Bacteria was found in 69 children by using sputum culture.Gram negative bacteria accounted for 57.47％.Gram positive bacteria accounted for 42.53％.Escherichia coli(14.94％),Haemophilus influenzae (20.96％) and klebsiella pneumoniae(13.79％) were the main strains of Gram negative bacteria,Staphylococcus aureus (21.84％)and Streptococcus pneumonia(16.1％)were the main strains of Gram positive bacteria.Bacteria was found in 7 (8.00％) children by using blood culture.Virus were identified in 11 out of 123 patients,including 2 cases of respiratory syncytial virus antibody positive,2 cases of adenovirus antibodies positive,4 cases of influenza B virus antibody positive,2 cases of parainfluenza virus antibody positive and influenza A(H1N1) virus from only one case,Mycoplasma pneumonia agents were identified in 8 patients.Eighty-nine children (72.36％) complicated with sepsis,85 children (69.11％) with respiratory failure,48 children (39.02％) with gastrointestinal dysfunction,32 children (26.02％) with heart failure,18 children(14.63％) with septic shock,13 cases (10.57％) with toxic encephalopathy,5 children (4.07％) with disseminated intravascular coagulation.Among them,17 children (13.82％) complicated with multiple organ dysfunction syndrome.In the 123 children with severe pneumonia,46 cases (37.4％) were cured,73 cases (59.35％) improved,and 4 cases died (3.25％) with critical multiple organ dysfunction syndrome.Conclusion The detection rate of pathogen is high in this study.We should pay more attention to individualize therapy for complication,so that the cure rate could be increased.
RESUMEN
<p><b>OBJECTIVE</b>To analyze the diagnosis and treatment characteristics of patients with severe Influenza A.</p><p><b>METHOD</b>A retrospective investigation on the clinical manifestation, chest radiography, electronic fiber bronchoscopy and the histology of the cast, rescue course and outcome was conducted in 15 children with severe influenza A during January to May of 2013.</p><p><b>RESULT</b>Eleven cases were male, the range of age was 2 to 6 years; 5 cases were female, the range of age was 1 month to 6 years, accouting for 4.2% of hospitalized children with influenza. Three patients had an underlying chronic disease, two had nephrotic syndrome, and one had congenital heart disease. All the 15 cases were diagnosed as severe influenza A virus infection complicated with pneumonia and respiratory failure, of whom 10 cases were infected with H1N1 virus , the other 5 cases could not be identified as H1N1 virus by using H1N1 kit, but none of the 15 cases were infected with H7N9 virus. Of 15 cases, 8 had atelectasis, 4 had pneumothorax, 3 had pneumomediastinum, 4 had pleural effusion, 1 had pneumorrhagia; 12 patients required mechanical ventilation. 1 only required noninvasive mask CPAP, 2 did not require assisted ventilation, they were just given mask oxygen. Seven cases' sputum culture showed combined infection with bacteria and fungi, sputum smear examination detected: G(+) cocci in 2 cases, and G(-) bacilli in the other 2. By using electronic fiber bronchoscopy, bronchial cast was detected in 5 patiens. Histological examination of the bronchial cast revealed a fibrinous exudation containing large quantity of eosinophils, neutrophils in 1 patients, fibrinous exudation and necrotic material containing large quantity of neutrophils in 4 patients. After the bronchial casts were removed, 4 patients were improved greatly. All patients were treated with postural drainage of left and right side position, massage of electric oscillation, strengthening the sputum suction aiming to improve pulmonary ventilation function. Three patients died: 1 case was compliicated with nephrotic syndrome, another case had congenital heart disease, and 1 case hads pneumorrhagia, renal failure and multiple organ dysfunction syndrome (MODS).</p><p><b>CONCLUSION</b>The mortality of severe Influenza A is higher if it is complicated with underlying chronic diseases. In children undergoing rapid and progressive respiratory distress with lung atelectasis, consolidation or emphysema on chest X-ray, plastic bronchitis should be considered. Electronic fiber bronchoscopy should be performed early Lung physicotherapeutics still are important assistant measures for improving the pulmonary ventilation function.</p>
Asunto(s)
Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Antivirales , Usos Terapéuticos , Bronquitis , Diagnóstico , Terapéutica , Virología , Broncoscopía , Métodos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana , Diagnóstico , Mortalidad , Terapéutica , Unidades de Cuidados Intensivos , Intubación Intratraqueal , Terapia por Inhalación de Oxígeno , Neumonía Viral , Diagnóstico , Terapéutica , Atelectasia Pulmonar , Diagnóstico , Terapéutica , Virología , Enfermedades Raras , Respiración Artificial , Estudios Retrospectivos , Esputo , Microbiología , Resultado del TratamientoRESUMEN
Objective To compare the clinical effect for treatment of scapula neck or body fractures by straight incision approach and the Judet approach.Methods From July 2001 to July 2011,32 patients with scapula neck or body fractures were treated using the two different approaches:(1) the straight incision approach in 15 patients including 11 males and 4 females,the average age of 38.10 years,fractures classified by Ada-Miller including 4 ⅡA,6 ⅡB and 5 Ⅳ; (2) the Judet approach in 17 patients including 12 males and 5 females,the average age of 39.47 years,fractures classified by Ada-Miller including 5 ⅡA,4 ⅡB and 8 Ⅳ.All patients were followed up.Intraoperative data and postoperative pain of two groups were compared by visual analogue score (VAS),the efficacy were evaluated by Rowe-Zarins scores and the patient's postoperative shoulder function were assessed by Constant-Murley functional score.Results All fractures were preliminary healed after 8 weeks of surgery,there was no wound infection,no internal fixation loosening,no shoulder deformity and other complication.Length of incision,operative time and blood loss of straight incision approach was 6.73±0.96 cm,58.67±4.39 min,94.25±6.14 ml and length of incision,operative time and blood loss of Judet approach was 18.88±1.41 cm,82.24±4.49 min,227.77±23.08 ml.VAS of straight incision approach and Judet approach were 2.60±1.55 and 4.65±1.93,mild and moderate postoperative pain evaluated by VAS were significant differences between two groups.The excellent rate by Rowe-Zarins scores of straight incision approach and Judet approach were 93.3％(14/15) and 88.2％(15/17),they were no significant differences.There was no significant differences in the shoulder joint mobility and muscle strength of Constant-Murley functional score between two groups.However,pain and daily life of Constant-Murley functional score were significant differences between two groups and Constant-Murley functional score of straight incision approach and Judet approach were 85.60±3.31 and 80.65±3.44.Conclusion Compared with Judet approach,straight in cision approach has many advantages,such as a short time of surgery,minor injury,light postoperative pain,good postoperative functional recovery.It is the better surgical approach for the treatment of scapular fractures.
RESUMEN
Objective To summarize the characteristics of ecthyma gangrenosum and explore its significance in early diagnosis of pseudomonas aeruginosa sepsis in children.Methods We retrospectively reviewed the medical records of 11 children with ecthyma gangrenosum who were hospitalized at Guangzhou women and children's medical center between May 2008 and Apr 2011.Results Eight cases were male and 7 were less than twelve months,the oldest was 2 years old,all of them were diagnosed as Pseudomonas aeruginosa spesis.Two patients had a single lesion,and the others had multiple lesions.Ecthyma gangrenosum located on the trunks in 7 cases,on anogenital areas in 5 cases,on extremities in 5 cases and on faces in 3.The lesions appeared on day 2 to day 10.On average,they developed on day 5.Seven patients developed ecthyma gangrenosum before admission,the course of the illness before admission was 6 days.Fever and multiple organ dysfunction occurred in all the patients and their cultures grew pseudomonas aeruginosa,blood cultures were positive in 8 cases,the others were isolated psudomonas aeruginosa from tissue of the lesion,discharge,ascites,pleural effusion,respectively.The time of ecthyma gangrenosum appeared was earlier than the time of the culture results reported.All of the patients were started empiric antibiotics therapy on admission,the initial antibiotic regimen was appropriate in 9 patients,8 needed surgical intervention,4 were treated with continuous blood purification.Ten patients survived and 2 died,the hospital stay was from 1 to 63 days,the average was 30.Conclusion Ecthyma gangrenosum is a known cutaneous manifestation of pseudomonas aeruginosa sepsis,which is helpful for early diagnosis and treatment,and then the outcome will be improved.
RESUMEN
Objective To evaluate the efficacy of percutaneous internal fixation with hollow screw for femoral neck fractures.Methods From June 2001 to June 2004,48 cases of femoral neck fractures,including 22 cases of fracture without displacement(type Garden I and II) and 26 cases of fracture displacement(type Garden III and IV),were treated by close reduction and percutaneous internal fixation with 3 hollow screws forming inverse triangle.Results The intraoperative blood loss was less than 10 ml,and the average operation time was 32.5 min(range,18-54 min).48 cases were followed up for 24-61 months(mean,38.2 months),union of fracture found in 97.9%(47/48) of cases,union time being 4-12 months(mean,6.2 months).According to Harris score of hip joint function,32 cases were excellent,11 cases good,3 cases fair,2 cases bad,the rate of excellent and good results being 89.6%(43/48).In 22 cases of fracture without displacement,there was no nonunion and ischemic necrosis of head of femur.In 26 cases of fracture displacement,the rate of nonunion and ischemic necrosis of head of femur were 3.8%(1/26) and 11.5%(3/26) respectively.Conclusions Percutaneous internal fixation with hollow screw has the advantages of ideal curative effects,simple procedure,reliable fixation and less complications.