Significance of serum insulin combined with cardiac markers in evaluating sepsis associated encephalopathy / 中华急诊医学杂志

Objective:To explore the clinical value of serum insulin combined with cardiac-related markers in evaluating the severity of sepsis associated encephalopathy (SAE).Methods:The clinical data of 130 children with sepsis who admitted to the Pediatric Intensive Care Unit of Hunan Children's Hospital from January 2018 to December 2021 were analyzed retrospectively, and the differences of serum insulin and cardiac-related markers in children with sepsis and SAE were compared.Results:The levels of serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide in the SAE group were significantly higher than those in the non-SAE group ( P<0.05), but there was no significant difference in heart rate and lactic acid ( P>0.05). The levels of serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, N-terminal cerebral urine peptide and lactic acid in the death group were significantly higher than those in the survival group ( P<0.05), while the heart rate was not significantly different ( P>0.05). The area under ROC curve of serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide in predicting SAE were 0.841, 0.599, 0.700, and 0.667, respectively; in terms of judging the prognosis of sepsis, the area under ROC curve were 0.647, 0.669, 0.645, and 0.683, respectively; and in terms of judging the prognosis of children with SAE, the areas under the ROC curve were 0.509, 0.682, 0.666 and 0.555, respectively. Binary logistic regression equation was established with serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide: Y=8.153×NT-proBNP+1.704×CTnT-hs+27.121×insulin+0.946×CK-MB+1.573. The area under the ROC curve of the new variable Y in predicting sepsis SAE, evaluating the prognosis of sepsis, and predicting the prognosis of children with sepsis and SAE was 0.890, 0.756, and 0.729, respectively. Conclusions:Serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide can be used alone to determine the severity of sepsis and sepsis in children with SAE. The combined value of the four indicators is obviously better than that of the single indicator. The combined application of the four indicators may better evaluate the severity of sepsis and SAE.

The predicted performance of cTnⅠ for outcome or severity in children with sepsis / 国际检验医学杂志

Objective To explore the predicted performance of cTnI for outcome or severity in children with sepsis.Methods 374cases of children with sepsis were collected in pediatric intensive care unit (PICU) in our hospital from August 2012to June 2015.The patients were dividided into the common sepsis group, severe sepsis group and sepsis shock group according to the sepsis severity, and improved group, uncured group and death group according to outcome, and the cTnI>0.01μg/mL group and the cTnI≤0.01μg/mL group according to the levels of cTnI.Data on cTnI, PCT, CRP, Cr, Lac, PaO2/FiO2, BUN, PT, INR, WBC and PLT were collected in this study.Results The level of cTnI was significantly higher in children with septic shock (P<0.05) .The level of cTnI in improved group was significantly lower than those of uncured group and death group (P<0.05) .The incidence of severe sepsis and septic shock in the cTnI>0.01μg/mL group was significantly significantly higher than that of the cTnI≤0.01μg/mL group.The levels of Lac, PT and INR in the cTnI>0.01μg/mL group were significantly higher than that of the cTnI≤0.01μg/mL group (P<0.05) .A positive correlation between the level of cTnI and Lac (r=0.324) , or PT (r=0.291) , or INR (r=0.340) were found in the study (P<0.05) .Conclusion Sepsis is prone to be associated with myocardial injury, which is related to the severity and prognosis of sepsis.Insufficient circulatory perfusion, metabolic imbalance and abnormal coagulation function may be the reasons for the rise of cTnI and myocardial injury in children with sepsis.

Effect of bronchialveolar lavage on mechanical ventilation in children with severe pneumonia / 中国小儿急救医学

Objective To investigate the efficacy and application of bronchoalveolar lavage in chil-dren with severe pneumonia undergoing mechanical ventilation. Methods Using a prospective randomized controlled clinical study, 202 children with severe pneumonia received mechanical ventilation in Hunan Children′s Hospital from January 2016 to January 2018 were selected as the subjects. According to the digital method,all cases were divided into treatment group (101 cases) and control group (101 cases) randomly. The patients in the control group were given conventional treatment ( anti-infection and symptomatic thera-py) . The treatment group was treated with bronchoalveolar lavage on the basis of conventional treatment. The basic situation,the respiratory function before and after the treatment,the inflammation index,the curative effect and the prognosis of two groups were analyzed. Results There were no significant differences between the two groups in gender,age,course pre-admission,pediatric critical illness score,respiratory function and in-flammation index ( P>0. 05 ) . The respiratory function indexes of the treatment group were obviously im-proved 2 hours after the treatment and the PaO2 ,PaO2/FiO2 and SaO2 were significantly higher than those of the control group[PaO2:(82. 4 ± 6. 4) mmHg(1 mmHg=0. 133 kPa) vs. (74. 0 ± 5. 5) mmHg, PaO2/FiO2:(360. 2 ± 21. 3) mmHg vs. (332. 6 ± 23. 5) mmHg,SaO2:(94. 9 ± 8. 2)％ vs. (88. 6 ± 10. 3)％], while the PaCO2 were significantly lower than the control group [ ( 37. 3 ± 10. 3 ) mmHg vs. ( 45. 8 ± 5. 5 ) mmHg],and the differences were statistically significant (P<0. 05). Five days after treatment,the WBC, PCT and CRP of treatment group were significantly lower than those in the control group[WBC:(8. 5 ± 2. 4) × 109/L vs. (11. 7 ± 3. 5) × 109/L,PCT:(1. 2 ± 0. 7) μg/L vs. (2. 3 ± 0. 9) μg/L,CRP:(9. 1 ± 3. 2) mg/L vs. (16. 5 ± 4. 7) mg/L,P<0. 05,respectively]. The total effective rate in the treatment group was significantly higher than that in the control group[93. 1％(94/101)vs. 81. 2％(82/101)]. Mechanical venti-lation duration and PICU stay in treatment group were significantly shorter than those in the control group [(148. 5 ±30. 6)h vs. (159. 6 ±47. 3)h,(220. 8 ±49. 7)h vs. (330. 7 ±94. 6)h]. The positive rate of patho-genic bacteria was significantly higher than that in the control group [79. 2％(80/101)vs. 62. 4％(63/101), P<0. 05],but there was no significant difference in the 28 days mortality of the two groups[5. 0％(5/101) vs. 5. 9％(6/101),P>0. 05]. Conclusion The bronchoalveolar lavage can improve the respiratory func-tion,reduce the inflammatory reaction,shorten mechanical ventilation duration and PICU stay in children with severe pneumonia undergoing mechanical ventilation obviously. It is worth popularizing in the PICU because of the improvement of curative effect in these children.

Clinical analysis and drug resistance research of pulmonary fungal infection among children with severe diseases in pediatric intensive care unit / 中国小儿急救医学

Objective To investigate the prevalence of pulmonary fungal infection and drug resist-ance of the pathogenic fungi among children with severe diseases in pediatric intensive care unit(PICU). Methods From July 2013 to June 2017,the complete clinical data,results of fungal culture and drug sensi-tivity of bronchoalveolar lavage fluid in 112 critically ill children with pulmonary fungus infection of PICU hospitalization in our hospital were collected. Samples of peripheral venous blood were collected meantime, including blood routine examination,C reactive protein,G test and GM test. Results One hundred and twen-ty-six fungi were isolated from sputum samples in 112 critically ill children. Severe pulmonary infection (30. 36%,34/112) was the most common form of the primary diseases, the next were severe sepsis (16. 07%,18/112)and severe malnutrition(15. 18%,17/112). Classified based on age difference,the first one was ＜1 year old (43. 75%,49/112),the second one was 1 to 3 years old(29. 46%,33/112). The fun-gal strains were predominantly Candida albicans (61. 90%) and Candida tropicalis (16. 67%),among the infectious cases 14 were diagnosed as mixed infection. Two cases of 3 cryptococcal infectious children were HIV infection,another one was malignant tumor,Cryptococcus was cultured in both sputum,pleural effusion and cerebrospinal fluid. The drug resistance rate of fluconazol in 126 strains of fungi was 12. 70%,the rate of itraconazole was 7. 14%. Generally,the fungi cultured were with very low resistance to 5-fluorocytosine,vori-conazole and amphotericin B. However,the strains of Aspergillus fumigates,Candida kruse,Candida parapsi-losis and Cryptococcus were highly resistant to fluconazol and itraconazole,but with very low resistance to 5-fluorocytosine and amphotericin B. Conclusion Candida albicans is the main pathogenic fungus of pulmo-nary fungal infection among children in PICU,and we could choose voriconazole and amphotericin B as treat-ment of critically ill children with pulmonaty fungal infection.

Application of flexible fiberoptic bronchoscopy in critically ill children with continuous invasive respirato-ry support / 中国小儿急救医学

Objective To explore the role and effectiveness of flexible fiberoptic brochoscopy ( FFB) in critically ill children with continuous invasive respiratory support. Methods From July 2014 to June 2017,135 critically ill children with severe pneumonia had received continuous invasive respiratory sup-port and undergone FFB in the pediatric intensive care unit( PICU) of our hospital. These patients were en-rolled into the therapy group. Another 104 severe pneumonia patients who had not received FFB were enrolled into the control group. Clinical characteristics of both groups were collected and compared. Results No sig-nificant differences were detected in patients′gender, age, PCIS, usage of antibiotics, and the levels of CRP and PCT assayed at the time of admission to PICU between the therapy group and control group(P>0. 05). The positive rate of bacteria culture of the bronchoscopic lavage was 78. 52％( 106 cases ) in the therapy group,and it was significantly higher than that in the control group(60. 58％,63 cases) (χ2 =5. 681,P <0. 005). For 106 cases in the therapy group,117 bacteria strains were identified,while there were 72 bacteria strains found in 63 cases with positive bacteria culture in the control group. Gram negative bacteria were the most common type,followed by Gram positive bacteria. The third most common pathogenic microbes were fungi,with a significantly higher frequency in the therapy group. No significant differences were found in PaO2 and oxygenation index between both groups before FFB. However,in a half hour after FFB,the PaO2 and oxygenation index significantly increased in the therapy group,and higher than those in the control group (P<0. 005). The levels of CRP and PCT assayed before and the first day after FFB were not significantly changed(P>0. 05). But the levels of CRP and PCT in the therapy group significantly decreased in the third day after FFB,and more than those in the control group. Furthermore,duration of invasive respiratory sup-port,and the stay of PICU were significantly shorter in the therapy group(P<0. 005). Conclusion FFB can play an important role in the collection of pathogenic microbes. It also achieves better results in the treatment of severe pneumonia for children in PICU. Therefore,it is worthwhile to be recommended as a safe and feasi-ble intervention in PICU.

The application of fiber bronchoscope in children with severe pneumonia:a review / 中国小儿急救医学

Fiber bronchoscopy has been used in pediatric for decades,and has became the important diagnostic tools in pediatric respiratory diseases.with the improvement of fiber bronchoscope equipment and the advancement of operation technology,fiber bronchoscope has been expanded unceasingly in pediatric, especially in the critically ill children.As a common critical disease in pediatric,severe pneumonia is urgent, serious and high rate of mortality.As the effect of conventional antibiotic treatment is not ideal in current, while fiber bronchoscopy with the dual function of examination and treatment makes it use more and more widely in children with severe pneumonia.Fiber bronchoscopy can improve the effect of treatment in children with severe pneumonia,short the course of the disease,improve the prognosis of children,reduce the rate of mortality.

Application and safety of bed side flexible fiberoptic bronchoscopy in PICU / 中国小儿急救医学

Objective To id scuss the role and safety of fiberoptic bronchoscopy for diagnosing and treating respiratory dsi ease in PICU.Methods A total of 95 eil gible children with respri atory diseases admi-tted ni PICU of Hu′nan Prvo inec Children′s Hospital were enroll ed in this retrospectvi e study from January 2013t o December 2013, and the efficacy and complications of fiberoptic bronchoscopy were assessed.Results A total of 95 children underwented bronchoscopy 112 timest, he most common of microscopic examination resutl s was tracheal bronchitis ( 62.1%) , followed by congenital airway abnormality ( 21.1%); 58 times (56.9%) showed becteria positive in 102 times lavage and sputum culture results, including 16 times (27.6%) of Klebsiella pneumoniae bacteria,12 times(20.7%) of Acinetobacter baumannii.After under-wenting bronchoscopy and lavage wash,blood gas analysis of pH value,PaO2 ,PaCO2 ,SaO2 had significant improvement than before( P0.05).The inrt aopear tive and postoperative transient comlp ications were obserev d in 38 times (33.9%).Conclusion The appil cation of fiberoptic bronchoscopy for diagnosing and ter ating disease in PICU has a cetr ia n value, its vo erall safety is reliable.

Changes of albumin levels in children with sepsis / 临床儿科杂志

Objective To discuss the signiifcance of serum albumin level in assessing severity, progress and prognosis of sepsis in children. Methods The clinical data of 212 patients diagnosed with sepsis admitted to PICU from February 2010 to July 2010 were retrospectively analyzed, and 52 patients had severe sepsis and 31 patients had septic shock. Meanwhile, 110 non-sepsis patients were selected as controls. The relationships of hypoalbuminemia with pediatric critical illness score (PCIS), pediatric risk of mortality III (PRISM III) and prognosis were evaluated, and the change of albumin level in patients with dif-ferent severity of sepsis was observed. Relative factors analysis of albumin level ≤25 g/L was performed. Results As the serum albumin level was decreased, the PCIS was signiifcantly decreased while the PRISM III was increased (P<0.01). The se-rum albumin level was signiifcantly different among children with septic shock, severe sepsis and sepsis and controls (F=13.938, P=0.000). The results of relative factors analysis showed that sepsis children with an albumin level≤25 g/L had more organ failures, higher mortality, longer hospital and PICU stay and more likelihood for ventilator support (P<0.01). Lower albumin levels were accompanied with lower rates of recovery and improvement but higher mortality (rs=-0.161, P=0.000). Conclusions Hypoalbuminemia can be used as indirect indicator for severity of infection. The albumin level≤25 g/L indicated the severity of illness and prognosis in children with sepsis.

Pathogenesis of acute kidney injury induced by sepsis / 中国小儿急救医学

Acute kidney injury(AKI) induced by sepsis is one symptom of sepsis-induced multiple organ dysfunction,which indicates critical illness.The current study have found that many factors involved in AKI,including hemodynamic changes in renal,ischemia-reperfusion injury,direct inflammatory injury,coagulation and endothelial cell dysfunction,apoptosis and so on.