Intestinal microecology and sepsis / 中国小儿急救医学

Sepsis is a common critical illness in PICU, with high morbidity and mortality.As the pathogenesis is still not well defined, the clinical management of sepsis can be tricky.The gastrointestinal tract is currently considered as one of the most susceptible organs in the early stages of sepsis, and intestinal microecology plays important roles in the development, progression and prognosis of this disease.There is a closely relationship between intestinal flora dysbiosis/translocation and sepsis.They interact with each other, and ultimately leading to multi-organ dysfunction.In this review, we provided a brief summary of intestinal microecological changes and its pathogenesis in sepsis, as well as the progress of treatment.

Analysis of clinical features of neonatal and infantile pertussis / 国际儿科学杂志

Objective:To analyse the clinical features and prognosis of pertussis in neonates and infants.Methods:The clinical data of neonates and infants with pertussis hospitalized in Children′s Hospital of Soochow University from September 2021 to September 2022 were retrospectively analyzed and grouped in terms of age, the severity of the disease, and whether a mixed infection, respectively.Results:A total of 40 infants with pertussis were analyzed.All cases showed improvement and were discharged after receiving active anti-infective treatment.In the neonatal group, higher rates of apnea and hyponatremia were observed compared to the non-neonatal group(all P<0.05).Additionally, peripheral blood leukocyte counts[20.9(15.0, 28.7)×10 9/L vs.16.6(11.3, 21.2)×10 9/L], neutrophil counts[4.6(3.7, 7.9)×10 9/L vs.3.2(2.1, 5.3)×10 9/L], γ-glutamyltransferase levels[78.0( 50.2, 109.4)U/L vs.22.5(15.1, 38.9)U/L], duration of hospitalization[21.5(16.8, 25.0)d vs.11.5(9.0, 19.8)d], and duration of oxygen use[7.0(0, 21.0)d vs.0(0, 2.3)d]were higher in the neonatal group than in the non-neonatal group(all P<0.05).However, the IgA level[0.02(0.02, 0.04)g/L vs.0.05(0.03, 0.09)g/L]was significantly lower in the neonatal group than in the non-neonatal group( P<0.05).In the severe group, the proportion of onset age of less than 3 months, fever, wheezing, shortness of breath, cyanosis after rough cough, apnea, decreased heart rate, wet rales on lung auscultation, respiratory failure, cardiac insufficiency, hyponatremia, CRP>8 mg/L, spotty/patchy shadows in the lungs, as well as the use of gammaglobulin, cardioactive drug and invasive ventilation, were higher than those in the non-severe group(all P<0.05).Furthermore, peripheral blood leukocyte counts[21.0(15.4, 37.4)×10 9/L vs.17.5(11.8, 21.2)×10 9/L], neutrophil counts[5.6(4.0, 10.7)×10 9/L vs.3.2(2.3, 4.6)×10 9/L], neutrophil to lymphocyte ratio[(0.6±0.4) vs.( 0.3±0.2)], systemic immune-inflammation index[237.5(109.5, 424.9) vs.135.9(75.4, 190.5)], γ-glutamyltransferase level[53.2(31.6, 87.4)U/L vs.29.5(15.2, 65.0)U/L], duration of oxygen use[18.0(12.8, 22.5)d vs.0(0, 0)d], and duration of hospitalization[24.5(21.8, 31.2)d vs.12.0(9.0, 16.8)d]were higher in the severe group than those in the non-severe group(all P<0.05).However, the IgA level[0.03(0.02, 0.04)g/L vs.0.05(0.03, 0.09)g/L]was significantly lower in the severe group than in the non-severe group( P<0.05).The mixed infection group had a longer duration of hospitalization and a higher proportion of fever than the single infection group(all P<0.05). Conclusion:Early detection of infantile pertussis can be challenging.Neonates with pertussis tend to experience severe symptoms, such as apnea, hyponatremia, elevated white blood cell count, and longer duration of oxygen use.Symptoms such as fever, wheezing, shortness of breath, decreased heart rate, wet lung rales, and spotty/patchy shadows in the lungs, as well as early elevated CRP, neutrophil to lymphocyte ratio, systemic immune-inflammation index, and decreased IgA levels are indicators of disease exacerbation.In mixed infections group, there is a higher proportion of fever.

A multi-center survey of medical staffs′ cognition and management of prolonged mechanical ventilation in pediatric intensive care unit / 中国小儿急救医学

Objective:To investigate the status of cognition and clinical management of prolonged mechanical ventilation(PMV) among medical staffs in pediatric intensive care unit(PICU) in China, and in order to improve the awareness of PICU medical staffs on PMV and standardize the management of PMV.Methods:The cross-sectional study was conducted with doctors and nurses in PICUs of the collaborative group as the survey objects from July 12 to September 12, 2020.The questionnaire was issued, collected and checked by the Children′s Hospital of Fudan University.Results:(1) PMV related settings: Nine out of eleven hospitals had established PMV multidisciplinary teams, respiratory techniques such as diaphragm ultrasound and airway peak flow monitoring could be respectively executed in 72.7% and 36.4% of PICU.Pulmonary rehabilitation techniques such as airway clearance techniques, induced spirometer exercise, external diaphragm pacemaker stimulation, transfer bed exercise, balloon blowing, hyperbaric oxygen therapy could be respectively executed in 100.0%, 9.1%, 9.1%, 9.1%, 27.3% and 27.3% of PICU, respectively.(2) The cognitive status quo of children′s PMV: The most medical staffs agreed with the view that PMV referred to the children′s continuous mechanical ventilation for more than two weeks.Sixty percent of medical staffs believed that children with PMV had basic central nervous system diseases, and 62.7% of medical staffs believed that the most common causes of difficulty in PMV weaning was abnormal brain function.(3) The cognitive status quo of the children′s PMV management in PICU: Respondents believed that the most commonly used mechanical ventilation mode was synchronized intermittent mandatory ventilation+ pressure support ventilation in children′s PMV during stable disease.Ninety-two percent of medical staffs performed the spontaneous breathing test when weaning.And 58.7% of the respondents agreed to perform tracheotomy for the children during 3 to 4 weeks of mechanical ventilation.More than half of medical staffs would execute diaphragm function assessment, bedside rehabilitation training, nutritional assessment, analgesia and sedation assessment for children with PMV.(4) The cognitive status quo of the children′s PMV management of transition from hospital to family: 54.5% of PICU provided family care training to the family members before the children were discharged from the hospital.One center established the PMV specialized outpatient clinic.45.5% of PICU would follow up these discharged children one month later.Conclusion:At present, PICU medical staffs have different awareness of children′s PMV related problems in China.And children′s PMV lacks a systematic plan regarding diagnosis, treatment and management.

Chronic injury of hematopoietic stem and progenitor cells induced by different doses of radiation / 环境与职业医学

Background The chronic injury of the hematopoietic system caused by ionizing radiation (IR) is often ignored. The essential cause of this injury is the damage of hematopoietic stem and progenitor cells (HSPCs). Objective To explore the long-term effects of IR at different radiation doses and at different radiation fractions of the same radiation dose on HSPCs in the bone marrow of mice, and to provide a scientific basis for reducing the chronic damage to the hematopoietic system caused by IR. Methods A total of 16 male C57BL/6 mice aged 8-10 weeks were randomly divided into four groups that received different doses or fractions of total body X-ray irradiation, including 1.5 Gy×4 irradiation group (n=5), 3 Gy irradiation group (n=4), 6 Gy irradiation group (n=4), and non-irradiation group (n=3). Two months after irradiation, bone marrow cells from each mouse were collected and counted. The clone forming ability of bone marrow cells was analyzed by cobblestone area-forming cell (CAFC) assay. The proportion of HSPCs was measured by flow cytometry. The cell cycle of HSPCs was assessed by antigen identified by monoclonal antibody Ki 67 (Ki-67) and 7-amino-actinomycin D (7-AAD) double staining. The reactive oxygen species (ROS) levels of HSPCs were estimated with a 2,7-dichlorodihydrofluorescein diacetate (DCFDA) probe. The cellular senescence of HSPCs was evaluated with a 5-dodecanoylaminofluorescein di-β-D-galactopyranoside (C12FDG) probe. The expression of senescence related genes such as P16, P19, P21, and P27 was measured by real-time fluorescence quantitative PCR. Results There was no significant change in the numbers of bone marrow cells 2 months after different doses and fractions of radiation (P>0.05). The clone forming ability of bone marrow cells was significantly decreased after 3 Gy and 6 Gy irradiation when compared to non-irradiated mice (P<0.01). HSPCs responded inconsistently to different doses and fractions of irradiation. Overall, there was no significant change in long-term hematopoietic stem cells (LT-HSCs) proportion after irradiation (P>0.05), the proportions of hematopoietic progenitor cells (HPCs), hematopoietic stem cells (HSCs), short-term hematopoietic stem cells (ST-HSCs), and multipotent progenitors 2 (MPP2) increased after irradiation (P<0.05), and the proportions of LSK, MPP1, MPP3, and MPP4 cells decreased after irradiation (P<0.05); except for HPCs and MPP2, the proportion of HSPCs in G0 phase was decreased (P<0.05). The ROS production in HSPCs was increased significantly after 6 Gy irradiation (P<0.05), while the ROS levels after 3 Gy and 1.5 Gy×4 irradiation were similar to that of the non-radiation group (P>0.05). The cellular senescent proportion of HPCs, LSK, and HSCs increased after irradiation (P<0.05). The expression levels of senescence related genes P16, P19, and P21 in HSCs were significantly increased (P<0.05). Conclusion The responses of HSPCs in bone marrow to IR vary depending on doses and fractions of irradiation. Increased ROS production and cellular senescence may be involved in the damage process of HSPCs under radiation settings.

Diagnosis and treatment recommendation for pediatric COVID-19 (the second edition) / 浙江大学学报·医学版

The coronavirus disease 2019 (COVID-19) has caused a global pandemic. All people including children are generally susceptible to COVID-19, but the condition is relatively mild for children. The diagnosis of COVID-19 is largely based on the epidemiological evidence and clinical manifestations, and confirmed by positive detection of virus nucleic acid in respiratory samples. The main symptoms of COVID-19 in children are fever and cough; the total number of white blood cell count is usually normal or decreased; the chest imaging is characterized by interstitial pneumonia, which is similar to other respiratory virus infections and infections. Early identification, early isolation, early diagnosis and early treatment are important for clinical management. The treatment of mild or moderate type of child COVID-19 is mainly symptomatic. For severe and critical ill cases, the oxygen therapy, antiviral drugs, antibacterial drugs, glucocorticoids, mechanical ventilation or even extracorporeal membrane oxygenation (ECMO) may be adopted, and the treatment plan should be adjusted timely through multi-disciplinary cooperation.

Comprehensive rehabilitation intervention strategy for children with difficulty withdrawing from ventilator / 中国小儿急救医学

Mechanical ventilation is an important rescue method for critically ill children, and timely evacuation is crucial for children with invasive mechanical ventilation.Difficult or delayed evacuation can prolong the hospitalization time of children and increase the complications and mortality of mechanical ventilation.The pathological mechanism of withdrawal difficulty is complex and affected by many factors.Early rehabilitation intervention is very important to improve the prognosis of children with withdrawal difficulty.This study briefly introduced the definition, etiology and comprehensive rehabilitation intervention of difficult withdrawal.

Application of ECMO in the treatment of severe adenovirus pneumonia / 中国小儿急救医学

Adenovirus is one of the common pathogens causing respiratory tract infection in children, which can cause severe pneumonia.Severe adenovirus pneumonia has an acute onset, rapid progress, and many complications, but there is no specific treatment and the mortality rate is high.Mechanical ventilation is an important means of respiratory support for the treatment of severe adenoviral pneumonia, and ventilator-associated lung injury is an inevitable drawback of mechanical ventilation.ECMO can replace and support cardiopulmonary function for a long time, reduce the occurrence of such damage, and improve oxygenation.When patients with severe adenovirus pneumonia develop respiratory failure or ARDS, and conventional treatment fails to improve hypoxemia, or accompanied by air leakage and other complications, ECMO treatment should be considered.However, there are few relevant studies in China, and further experience needs to be accumulated in the selection of respiratory support modes, intervention opportunities and management points of ECMO respiratory support for severe adenovirus pneumonia.

Application of ECMO in the treatment of severe adenovirus pneumonia / 中国小儿急救医学

Adenovirus is one of the common pathogens causing respiratory tract infection in chil﹣dren,which can cause severe pneumonia. Severe adenovirus pneumonia has an acute onset,rapid progress,and many complications,but there is no specific treatment and the mortality rate is high. Mechanical ventilation is an important means of respiratory support for the treatment of severe adenoviral pneumonia,and ventilator﹣associated lung injury is an inevitable drawback of mechanical ventilation. ECMO can replace and support cardiopulmonary function for a long time,reduce the occurrence of such damage,and improve oxygenation. When patients with severe adenovirus pneumonia develop respiratory failure or ARDS,and conventional treat﹣ment fails to improve hypoxemia,or accompanied by air leakage and other complications,ECMO treatment should be considered. However,there are few relevant studies in China,and further experience needs to be ac﹣cumulated in the selection of respiratory support modes,intervention opportunities and management points of ECMO respiratory support for severe adenovirus pneumonia.

Acute generalized exanthematous pustulosis/exfoliative dermatitis eruption / 中国小儿急救医学

Severe drug eruption is the most common skin drug adverse reaction in clinic. Immune‐mediated adverse drug reactions occur commonly in clinical practice and include mild,self‐limited cutaneous eruptions, IgE‐mediated hypersensitivity, and severe cutaneous adverse drug reactions. Severe cutaneous adverse drug reactions represent an uncommon but potentially life‐threatening form of delayed T cell‐mediated reaction. The spectrum of illness ranges from acute generalized exanthematous pustulosis to drug reaction with eosinophilia with systemic symptoms,to the most severe form of illness,Stevens‐Johnson syndrome and toxic epidermal necrolysis. Drug‐induced exfoliative dermatitis may be one of the manifestations of eosinophilia with systemic symptoms. Typical clinical manifestations,medication history,relevant physical examinations and related auxiliary examinations of patients are helpful to the early diagnosis of the disease. This article introduced in detail the research progress of acute generalized eruptive pustulosis and exfoliative dermatitis eruption.

Multicenter investigation of extracorporeal membrane oxygenation application in pediatric intensive care unit in China / 中华儿科杂志

Objective@#To survey the conduction and evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in pediatric intensive care unit (PICU) in China mainland.@*Methods@#In a questionnaire-based survey, we retrospectively reviewed the application of ECMO in children's hospital and general hospital in China mainland to summarize and analyze the categories of diseases and prognosis of children treated with ECMO therapy.@*Results@#By December 31, 2017, a total of 23 hospitals using ECMO, including 22 tertiary referral hospitals and 1 secondary hospital, among which 16 were children′s hospitals and 7 were general hospitals. Thirty-seven ECMO equipment was available. A total of 518 patients treated with ECMO, within whom 323 (62.4%) successfully weaned from ECMO and 262 (50.6%) survived to discharge. Among 375 pediatric patients, 233 (62.1%) were successfully weaned from ECMO and 186 (49.6%) survived to discharge. Among 143 newborn patients, 90 (62.9%) successfully weaned from ECMO, 76 (53.1%) survived to discharge. ECMO was applied in veno-arterial (VA) mode to 501 (96.7%) patients, veno-venous (VV) mode to 14 (2.7%) patients, and VV-VA conversion mode to 3 (0.6%) patients. Sixty-nine patients required extracorporeal cardiopulmonary resuscitation (ECPR), including 20 newborn patients (29.0%) and 38 pediatric patients (71.0%), who were all with cardiovascular disease. Neonatal respiratory distress syndrome (26/61), persistent pulmonary hypertension of the newborn (PPHN) (12/61), and meconium aspiration syndrome (MAS) (11/61) are the most common pulmonary diseases in newborn patients; among whom, infants with PPHN had highest survival rate (10/12), followed by MAS (9/11). Among newborn patients with cardiovascular diseases, those who admitted were after surgery for congenital cardiac disease were the most common (54/82), while those with septic shock had the highest survival rate (2/3). In pediatric pulmonary diseases, acute respiratory distress syndrome was the most common (42/93), while plastic bronchitis was with the highest survival rate (4/4), followed by viral pneumonia (13/16). Among pediatric cardiovascular diseases, congenital cardiac defect was the most common (124/282), while fulminant myocarditis had the highest survival rate (54/77).@*Conclusion@#The application of ECMO as a rescue therapy for children with severe cardiopulmonary failure has dramatically developed in China mainland.

The role of extracorporeal membrane oxygenation in assisting and replacing cardiac function / 中国小儿急救医学

As one of the cyclical substitution technologies, extracorporeal membrane oxygenation (ECMO) has rapidly developed in recent years. This technology can provide effective circulation function support and win valuable time for heart restoration or heart transplantation. It is an effective measure to treat refractory heart failure. In recent years,ECMO has been widely used in the pediatric critical illness area to save the lives of a large number of critically ill children. In order to enable pediatric intensive care physicians to further understand the role of ECMO in assisting and replacing cardiac function,the paper will provide a brief introduction to this aspect.

Rerecognition of pulmonary edema of drowning / 中国小儿急救医学

Drowning is one of the main causes of accidental injuries common in children.Hypoxia and pulmonary edema occur due to inhalation of fluids after drowning.How to identify and deal with pulmo-nary edema of drowning early is related to the improvement of survival rate and reduction of complications. Timely and effectively mechanical ventilation,reasonable parameter selection of ventilator and other compre-hensive treatments are the key to control pulmonary edema.

Acute abdomen pain in children / 中华实用儿科临床杂志

Acute abdomen pain is one of the most common emergency in pediatrics.It mainly refers to abdomi-nal symptoms and signs,always accompanied by systemic inflammatory response,which caused by the rapid pathological changes of tissues or organs in abdominal,pelvic and retroperitoneal.Since acute progression of onset and a variety of diseases caused by acute abdomen pain in children,furthermore,infants and young children will not accurately use words to express,generally do not cooperate with the physical examination and a variety of laboratory tests,other factors and so on,which causes early diagnosis is difficult.If without timely diagnosis and treatment,the consequences will be often serious.This article briefly introduces the diagnosis and emergency treatment of acute abdomen pain in children.

Investigation on extracorporeal membrane oxygenation application in pediatric acute fulminant myocarditis in China / 中国小儿急救医学

Objective To review multi-center experience on rescue use of extracorporeal membrane oxygenation(ECMO) in pediatric patients with acute fulminant myocarditis and to investigate its short-term outcome in China.Methods The survey was conducted in 28 tertiary hospitals in China mainland.All children<18 years who had been supported with non-open chest ECMO to rescue acute fulminant myocarditis in PICU were reviewed.Results Twenty-three of 63 patients with ECMO support were diagnosed acute fulminant myocarditis.Their mean age was(86.3±48.8)months,mean weight was(25.8±12.1)kg,and mean left ventricular ejection fraction was(39.5±15.6)%.Eighteen patients(78.3%) survived to discharge and 5 cases(21.7%) died.The average length of ECMO was(119.1±57.3)h,(110.6±42.7)h for survival,(150.0±93.8)h for nonsurvival.There was no statistically difference between survival and death in ECMO support time(P=0.41).The mean arterial pressure increased from(60.7±23.7)mmHg(1mmHg=0.113kPa) of the beginning to(72.1±9.8)mmHg at 24h after ECMO treatment,and increase of mean arterial pressure was higher in the survival compared with the nonsurvival(P=0.04).The mean serum lactate decreased from(6.8±5.1)mmol/L at ECMO initiation to(2.9±2.6)mmol/L at 24h after ECMO treatment,and decrease of serum lactate was higher in survival group compared to nonsurvival group(P<0.001).Twenty-one patients(91.3%) were decanulated from ECMO successfully.Three patients died within 30 days after ECMO support,and eighteen patients survived to hospital discharge.The overall survival rate was 78.3%.There were no significant difference between the death and the survival in ECMO support time(P=0.41) and medical cost(P=0.24).The most common complications during ECMO were bleeding and disfunction of oxygenator.Of the 18 survivors,15 were followed up,4 experienced obvious sequelae,and 2 had neurologic issues.Conclusion ECMO is an effective hemodynamic support treatment that confers better clinical outcome for pediatric patients with acute fulminant myocarditis.

Effect and mechanism of aspirin to inhibit metastasis of colorectal cancer in mice / 局解手术学杂志

Objective To investigate the inhibitory effect of aspirin on liver metastasis of colon cancer in mice and the possible mechanism.Methods A total of 32 BALB/C mice were injected with CT26 colorectal cancer cells to establish colon cancer liver metastatic model,with 3 mice dead,15 mice in control group and 14 mice in experimental group.The control group was given saline 0.2 mL/d,the experimental group were given aspirin 30 mg/kg.The liver weight and the number of metastatic tumors were calculated after 30 days of intervention.HE and CD31 staining was performed by immunohistochemistry to observe the metastasis and angiogenesis.The protein expression of VEGF and cox-2 were analyzed by Western blot.Results The average liver weight and number of liver metastases nodules in the experimental group were significantly lower than those in the control group(P<0.05).Pathological examination showed that the experimental group of mice the number of liver cells and liver tumor angiogenesis were significantly less than the control group(P<0.05).Western blot showed that the expression of VEGF and cox-2 of CT26 cells were down-regulated after treated with aspirin.Conclusion Aspirin can down regulate the protein expression of VEGF and cox-2 protein to inhibit liver metastasis of colon tumor proliferation and angiogenesis,thereby inhibiting metastasis of colon cancer cells,for therapeutic purposes.

The survey of multi-center experience on rescue use of extracorporeal membrane oxygenation in pediatric patient with respiratory failure / 中国小儿急救医学

Objective To review multi-center experience on rescue use of extracorporeal membrane oxygenation(ECMO) in pediatric patients with respiratory failure and to investigate its short-term outcome in China.Methods The survey was conducted in 4 tertiary hospitals in China mainland.All children<18 years old who had been supported with non-open chest ECMO to rescue respiratory failure in PICU were reviewed.Results Twenty-one patients with ECMO support were diagnosed respiratory failure.Male was 14,female was 7.Twelve patients successfully weaned off ECMO, 8 patients survived to discharge and 13 died.The largest part of protopathy was severe pneumonia(33%)and acute respiratory distress syndrome(29%).Their mean age was 29.0(9.0,81.5)months, mean weight was 12.0(9.0,20.8)kg,and mean OI index was 31.5(19.2,41.0).The average length of ECMO run was 149.0(91.2,242.0)hours.The blood gas analysis showed that PO2 increased from 49.5(40.4,61.9)mmHg(1mmHg=0.133kPa) at the beginning to 65.0(42.6,120.5)mmHg at 24h after ECMO treatment,and the increase of PO2 was higher in the survival compared with the nonsurvival[52.0(1.8,89.4) mmHg vs.8.2(-15.1,33.9) mmHg,P=0.036].The SO2 increased from 80.0%(70.4%,91.8%)at ECMO initiation to 98.0%(95.6%,100%)at 24h after ECMO treatment,and increase of SO2 was higher in survival group compared to that of nonsurvival group[23.5%(11.4%,27.1%) vs.4.3%(2.4%,23.8%),P=0.039].VV mode had higher survival rate than VA mode(3/3 vs.5/18).The longer the use of ventilator before ECMO,the mortality rate increased as well.The mechanical ventilation time before ECMO was significantly longer in nonsurvival group than that in the survival group[4.5(2.5,12.0)h vs.1.6(1.0,2.2)h,P=0.015].The most common complications during ECMO run were bleeding and disfunction of oxygenator.Conclusion ECMO is an effective support treatment for the pediatric patients with respiratory failure,which significantly improves oxygenation.

The clinical application of tracheal gas insufflation / 中国小儿急救医学

Tracheal gas insufflation is a non conventional respiratory support technology. It might avoid severe CO2 retention in lung protective ventilation strategy, reduce ventilator-associated lung injury, which was recommented recently. In this article,we made a brief introduction of the principle,classification and clinical applications of tracheal gas insufflation technique.

Acquisition and interpretation of respiratory pathogens in children / 中国小儿急救医学

Respiratory tract infection is a commo n disease in hc ildren.The pathoeg ns of respiratory trract infection are very complex, includingvi ruses, bactre ia, mycoplasma pneumoniae, and fugn al, etc.The research of respiratro y pathogens is imp ortant for clinical diagnosis na d treatmento f respiratory tract infec-tions in children.In this article,we make a brife introduction to the ca qiu sition and interpretation of respirato-ry pathogens in cih ldren.

Current status and recognition of high frequency ventilation in acute respiratory distress syndrome / 中华实用儿科临床杂志

Acute respiratory distress syndrome(ARDS) is a common critical disease in pediatric patients,and mechanical ventilation is one of the most important methods for respiratory support.High frequency oscillation ventilation,which has these characteristics of low tidal volume,low airway pressure,and low alveolar injury,is a safe and effective treatment of ARDS.This article will elaborate about current status and recognition of high frequency ventilation in ARDS.

The application of extracorporeal membrane oxygenation in fulminant myocarditis / 中国小儿急救医学

Fulminant myocarditis is a myocarditis of acute hemodynamic disorder as the main per-formance,with acute onset,rapid progression and high mortality.It will lead to serious arrhythmia and cardic shock,which may be delay to the diagnosis.There is no specific medicine for this disease currently,which is treated with symptomatic and supportive therapy in general.The application of extracorporeal membrane oxy-genation is an effective measures for the treatment of acute fulminant myocarditis in recent years.In this arti-cle,we made a review on the application of extracorporeal membrane oxygenation in fulminant myocarditis at present.