Special problems during endort acheal intubation / 中国小儿急救医学

Critically ill patients often undergo endotracheal intubation to facilitate mechanical ventila-tion in in tensiv e cra e unit.As these patients er coev r,r espiratory support is gradually reduced until the patient can breathe unadi ed and the endotracheal tube can be removed.There are some complications during the en-dotracheal intubation.Some of them are life-threatening.Such complications might lead to a prlo onged stay in intensive care unit,additional costs,potential morbidity,and mortality.In this article,we wi ll talk abotu two special rp oblems during endotracheal inut bation.

Clinical evaluation of continuous renal replacement therapy without anticoagulation for critically ill children with high risk of bleeding / 中国小儿急救医学

Objective To explore the safety and therapeutic efficiency of continuous renal replacement therapy(CRRT) without anticoagulation for critically ill children with high risk of bleeding.Methods We retrospectively analyzed 51 patients undergoing bedside CRRT in the PICU of our hospital from December 2007 to July 2015.Patients were divided into two groups induding CRRT with anticoagulation(n=33) or without anticoagulation (n=18).The therapeutic efficiency and complications were compared between two grous.Results Totally 168 CRRT circuits were performed in these 51 patients including 62 (36.9％)circuits without anticoagulation in 18 patients with high risk of bleeding and 106(63.1％) with anticoagulation by heparin.The circuits life of CRRT without anticoagulation was (12.31±6.64) h,which was shorter than that of CRRT with anticoagulation [(17.43±9.97)h] (P＜0.001).The levels of blood creatinine,blood urea nitrogen,C-reactive protein,and lactate significantly improved after both therapies (P＜0.05).PT and APTT did not change in CRRT without anticoagulation for hemorrhagic complications(P＞0.05).APTT[(52.36±5.00)s vs.(76.48±9.02)s,P=0.013] and PLT[(127.3±20.85)×109/L vs.(95.52±15.46)×109/L,P=0.041]were significantly longer in CRRT with anticoagulation by heparin compared with those before treatment.Conclusion CRRT without anticoagulation reduces bleeding risks and achieves an acceptable circuit life.The strategy can be applied as an alternative to critically ill children at high risks of bleeding who need continuous blood purification.

Early goal-directed therapy in pediatric severe sepsis and septic shock / 中国小儿急救医学

Pediatric severe sepsis and septic shock is one of leading causes of death in PICU.Although antibiotics and comprehensive treatments have continuous improvements,its mortality rate is still high.Present study confirms early goal-directed therapy can significantly reduce the mortality of severe sepsis and septic shock.The purpose is to introduce the early goal-directed therapy protocol and to guide Chinese pediatrician to improve outcome of pediatric severe sepsis and septic shock and increase the survival rate in clinical practice.

Macrophage migration inhibitory factor in children with hematologic malignancy complicated with sepsis / 中国小儿急救医学

ObjectiveTo assess the relationship between serum macrophage migration inhibitory factor (MIF) and sepsis in children with hematologic malignancy.Methods( 1 ) An observational study was performed in a university pediatric intensive care unit.Forty-one children were enrolled in our study,and were divided into two groups:sepsis group (27 cases) and non sepsis group ( 14 cases).(2) Serum samples were taken in the both two groups in 24 h after they were admitted in hospital.Clinical and laboratory parameters,including the levels of serum MIF,cortisol,corticotropin releasing hormone ( CRH),and ferritin were measured and compared between the two groups.Multiple linear regression analysis was used to assess the relationship between MIF and CRH,cortisol and pediatric critical illness score (PCIS).ResultsThe level of MIF was significantly elevated in the sepsis group[ (5 022.71 ± 3 915.82) pg/ml] than that of non sepsis group[ ( 1 722.81 ± 1 738.53) pg/ml] (P =0.001 ).Multiple linear regression analysis showed that CRH as well as PCIS were the correlative factors of MIF( t =- 2.830,P =0.009; t =2.852,P =0.009 ).The higher CRH concentration,the lower PCIS score,and the higher MIF was.ConclusionThe level of serum MIF could reflect the severity of children with hematologic malignancy complicated with sepsis.The higher MIF concentration,the lower PCIS score,then the disease is more serious.To some extent,serum MIF is related with the adrenocortical function of sepsis children.

Macrophage migration inhibitory factor and hypothalamo-pituitary-adrenal function during sepsis inchildren / 国际儿科学杂志

The hypothalamo-pituitary-adrenal (HPA) axis modulates the inflammatory response during sepsis.Macrophage migration inhibitory factor (MIF) is a unique cytokine and critical mediator of host defenses in sepsis and septic shock.MIF counteracts the anti-inflammatory activity of glucocorticoid (GC).The interaction of GC and MIF might cause adrenal insufficiency.MIF could be a valuable clinical marker of adrenal insufficiency in sepsis.