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Individualized treatment refers to the clinician's optimal clinical practice for individual patient which directed under modern medical theory and guideline in view of evidence-based medicine,and applied by combined rational and experiential thinking.The medical treatment with combined standardization and individualization is an ideal situation in medical practice.The article explained dialectical relationship between guideline and individualization,and discussed on individualized application of fluid resuscitation in patient with septic shock and on the thinking about how improving the guideline to sepsis.
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Objective To investigate the application of continuous blood purification in the children with critical diseases. Methods Eighteen critical patients aged 1 ～ 15 years in PICU underwent continuous blood purification(CBP). Fourteen with acute renal failure (ARF) were treated with continuous veno-venous hemmofiltration(CVVH) ,2 with Guillain-Barre syndrome and 2 with Raye's syndrome were treated with plasma exchange(PE). The changes of clinical symptoms, blood biochemistry , blood gas, and oxygenation were analyzed before and after CBP. Results After CVVH treatment, the BUN and creatinine of 14 patients with ARF were decreased from (48.6 ± 14. 8) mmol/L to(28. 9 ±5.4) mmol/L and (634. 3 ±258. 2) μ mol/L to (318.4 ± 143.5) μmol/L,K+ and pH of serum were maintained in the normal range,oxygenation was significantly improved. Breathing difficulties and muscle strength in 2 patients with GBS were ameliorated and successfully weaned from ventilator after PE. Serum ALT,AST and ammonia of 2 cases with Raye's syndrome decreased significantly and they discharged after comprehensive treatment including PE. Bleeding in puncture region were found in 3 patients, hypothermia in 2 patients. During the treatment, vital signs of patients were stable,blood pressure and pulse were not fluctuated. Conclusion CBP is an effective and safe method in the treatment of critical diseases in children.
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The venenums which lead to acute poisoning are frequent, such as drug and intoxicant poisoning,and the therapeutic means are not the same. This text only introduces blood purification for goals of treatment which remove etiological factors and recover function of impair organ, including principle, main types and indication.
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Objective To investigate the application of blood purification for critical disease with non-renal indications in PICU. Methods We retrospectively analyzed the clinical data of 10 critical disease cases with non-renal indications in PICU admitted from Jan to Dec 2009. Five cases were with acute liver failure,2 with autoimmune disease (1 with Guillaln-Barre syndrome, 1 with systemic juvenile rheumatoid arthritis with macrophage activation syndrome) ,2 with severe sepsis,one with metabolic diseases. Results Four cases were treated with plasma exchange combined with continuous veno-venous hemmofiltration. Three cases were treated with continuous veno-venous hemmofiltration. Three cases were treated with plasma exchange.Conclusion CBP is an effective and safe method in the treatment of critical diseases with non-renal indications in PICU.
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Objective To find out the morbidity and main pathogens of ventilator-associated pneumonia(VAP) in PICU.Methods 44 VAP cases were reviewed.Results 44 VAP cases were diagnosed and analyzed from 1998, 2 to 2001,1,the morbidity of VAP was 69.8%.The predominant pathogen was Pseudomonas aeruginosa.Conclusion It has reference value in consideri ng the possible pathogens of pneumonia.