Application of airway clearance technique in critically ill children / 中国小儿急救医学

Airway management is a crucial loop in the care and treatment of critically ill children.There are many kinds of airway clearance techniques, which can assist in the treatment of a variety of severe diseases in children, reduce airway obstruction caused by mucus deposition, and reduce the damage of airway and lung parenchyma caused by infection and inflammation.This review described the pathophysiological mechanism, drug application and non-drug application of airway clearance technology in different kinds of diseases.

Development and evaluation of a mortality risk prediction model for severe bacterial infections in children / 中华急诊医学杂志

Objective:To establish a mortality risk prediction model of severe bacterial infection in children and compare it with the pediatric early warning score (PEWS), pediatric critical illness score (PCIS) and pediatric risk of mortality score Ⅲ (PRISM Ⅲ).Methods:A total of 178 critically ill children were selected from the PICU of the Children's Hospital of Nanjing Medical University from May 2017 to June 2022. After obtaining the informed consent of the parents/guardians, basic information such as sex, age, height and weight, as well as indicators such as heart rate, systolic blood pressure and respiratory rate were collected from all children. A standard questionnaire was used to score the child 24 h after admission to the PICU. The children were divided into the survival and death groups according to their survival status at 28 d after admission. A mortality risk prediction model was constructed and nomogram was drawn. The value of the mortality risk prediction model, PEWS, PCIS and PRISM in predicting the risk of death was assessed and compared using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC).Results:Among the 178 critically ill children, 11 cases were excluded due to severe data deficiencies and hospitalization not exceeding 24 h. A total of 167 children were included in the analysis, including 134 in the survival group and 33 in the death group. A mortality risk prediction model for children with severe bacterial infection was constructed using pupillary changes, state of consciousness, skin color, mechanical ventilation, total cholesterol and prothrombin time. ROC curve analysis showed that the AUCs of mortality risk prediction model was 0.888 ( P<0.05). The AUCs of PEWS, PCIS and PRISM Ⅲ in predicting death in children with severe bacterial infection were 0.769 ( P< 0.05), 0.575 ( P< 0.05) and 0.759 ( P< 0.05), respectively. Hosmer-Lemeshow goodness-of-fit test showed the best agreement between risk of death and PEWS predicted morbidity and mortality and actual morbidity and mortality (χ 2 = 5.180, P = 0.738; χ 2 = 4.939, P = 0.764), and the PCIS and PRISM Ⅲ predicted mortality rates fitted reasonably well with actual mortality rates (χ 2= 9.110, P= 0333; χ 2 = 8.943, P= 0.347). Conclusions:The mortality risk prediction model for predicting the death risk has better prognostic value than PEWS, PCIS and PRISM Ⅲ for children with severe bacterial infection.

Risk factors for progression to severe pneumonia in children visiting the emergency department with pneumonia / 中华危重病急救医学

OBJECTIVE@#To determine the risk factors for developing severe pneumonia in children under 5 years old with pneumonia.@*METHODS@#A case-control study was conducted 246 children with pneumonia between 2 and 59 months old who were admitted to the department of emergency of the Children's Hospital of Nanjing Medical University from May 2019 to May 2021 were enrolled. The children with pneumonia were screened according to the diagnostic criteria of the World Health Organization (WHO). Case information of the children was reviewed to obtain relevant socio-demographic, nutritional status and potential risk factors. The independent risk factors for severe pneumonia were analyzed by univariate analysis and multivariate Logistic regression respectively.@*RESULTS@#Among the 246 patients with pneumonia, 125 were male and 121 were female. The average age was (21.0±2.9) months, 184 children with severe pneumonia. The results of population epidemiological characteristics showed that there were no significant differences in gender, age and place of residence between the severe pneumonia group and the pneumonia group. Prematurity, low birth weight, congenital malformation, anemia, length of intensive care unit (ICU) stay, nutritional support, treatment delay, malnutrition, invasive treatment, history of respiratory infection were all related factors affecting the occurrence of severe pneumonia (severe pneumonia group vs. pneumonia group: the proportion of premature infants was 9.52% vs. 1.23%, low birth weight was 19.05% vs. 6.79%, congenital malformation was 22.62% vs. 9.26%, anemia was 27.38% vs. 16.05%, length of ICU stay < 48 hours was 63.10% vs. 38.89%, enteral nutritional support was 34.52% vs. 20.99%, treatment delay was 42.86% vs. 29.63%, malnutrition was 27.38% vs. 8.64%, invasive treatment was 9.52% vs. 1.85%, respiratory tract infection history was 67.86% vs. 40.74%, all P > 0.05). However, breastfeeding, type of infection, nebulization, use of hormones, use of antibiotics, etc. were not risk factors affecting severe pneumonia. Multivariate Logistic regression analysis showed that history of premature birth, low birth weight, congenital malformation, treatment delay, malnutrition, invasive treatment, and history of respiratory infection were independent risk factors for severe pneumonia [history of premature birth: odds ratio (OR) = 2.346, 95% confidence interval (95%CI) was 1.452-3.785; low birth weight: OR = 15.784, 95%CI was 5.201-47.946; congenital malformation: OR = 7.135, 95%CI was 1.519-33.681; treatment delay: OR = 11.541, 95%CI was 2.734-48.742; malnutrition: OR = 14.453, 95%CI was 4.264-49.018; invasive treatment: OR = 6.373, 95%CI was 1.542-26.343; history of respiratory infection: OR = 5.512, 95%CI was 1.891-16.101, all P < 0.05].@*CONCLUSIONS@#Premature birth history, low birth weight, congenital malformation, delayed treatment, malnutrition, invasive treatment, and history of respiratory infection are independent risk factors for severe pneumonia in children under 5 years old.

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.

Progress on the roles of adipokines in sepsis organ injury / 中国小儿急救医学

Sepsis is a serious life-threatening organ dysfunction disease caused by the body′s response to infection, which is the main cause of death in patients admitted to ICU.The occurrence, development and prognosis of sepsis are closely related to metabolism and regulation of inflammatory response.Adipose tissue not only participates in energy storage and metabolism, but also, as an important endocrine organ, secretes a variety of adipokines with pro-inflammatory or anti-inflammatory activities, and thus participates in the occurrence and development of sepsis.There are many kinds of adipokines, and different adipokines play different roles in sepsis and sepsis-related organ damage.Some adipokines such as adiponectin, adipokine complement Clq/tumor necrosis factor-associated protein 3, vaspin, irisin and Apelin are closely related with the pathogenesis and prognosis of organ injury in sepsis.

Progress on drug treatment of acute respiratory distress syndrome / 中国小儿急救医学

Acute respiratory distress syndrome(ARDS) refers to non-cardiac respiratory failure caused by various internal and external factors in the lung, and is a common clinical critical illness.As in adults, lung-protective ventilation strategies combined with pharmacological support remain the mainstay of treatment for children with ARDS.A large number of clinical studies have been carried out on drug therapy, and some progress has been made.This article reviewed alveolar surfactants, hormones, nitric oxide, angiotensin converting enzyme 2, immune nutrition, etc., in order to provide references for subsequent treatment.

Oxidative phosphorylation in septic organ injury / 国际儿科学杂志

Sepsis is a systemic inflammatory response syndrome caused by pathogenic microorganisms that infect the host.If treated improperly, it can progress to severe sepsis or even septic shock.As such, it′s one of the main reasons for the death of children in PICU.The inflammatory response of sepsis exerts great influence on a series of basic physiological functions of cells, including the oxidative phosphorylation of the mitochondria.Oxidative phosphorylation is a process during which oxygen is reduced to generate high-energy phosphate bonds in the form of adenosine triphosphate(ATP), which supplies energy for cells and produces a series of functional by-products.During sepsis, the process of oxidative phosphorylation in mitochondria undergoes a series of complex alterations, which in turn can further promote the development of septic organ injury.The present review aims to clarify the relationship between changes in oxidative phosphorylation and the impairment of various organs in sepsis.

Sepsis-related mortality and family socioeconomic features of septic patients in pediatric intensive care unit in the Yangtze River Delta / 中国小儿急救医学

Objective:To investigate pediatric sepsis-related mortality of pediatric intensive care unit(PICU) and family socioeconomic status in Yangtze River Delta.Methods:A prospective, multicenter observational study was conducted to collect sepsis cases from eight PICUs in Jiangsu, Zhejiang and Shanghai from August 2016 to July 2017.Sepsis cases were divided into normal sepsis group and severe sepsis group.The primary outcome was in-hospital death.Patient data were prospectively collected including age, gender, medical insurance status, long-term residence, source of admission, first-day pediatric sequential organ failure score(pSOFA) score, underlying diseases and socioeconomic characteristics including family education level, family annual economic income.Results:A total of 4, 983 patients admitted in PICUs, of which 651 patients were diagnosed sepsis on admission.The prevalence of sepsis was 13.1% (651/4 983), and overall mortality was 11.7% (76/651). The prevalence of severe sepsis was 28.3% (184/651), and the mortality was 20.1% (37/184). The overall median age was 0.9 years old.The infant group accounted for 50.8%, including 331 cases, followed by toddler group 19.8% (129 cases), preschool group 13.0% (86 cases), school group 11.8% (77 cases), and adolescent group 4.3% (28 cases). The median pSOFA score was 4.Logistic regression analysis showed that the OR value was 1.4(95% CI 1.3-1.5) of pSOFA score corresponding to the death of sepsis in hospital.There were 14.6% patients left hospital in medical insurance group, while 27.4% in non-medical insurance group, and there was significant difference between these two groups.The median of daily cost was 5, 446 RMB, among which the median of daily cost of sever sepsis was 6, 678 RMB.The median of total cost for sepsis was 36, 109 RMB, and that for severe sepsis was 41, 433 RMB. Conclusion:The sepsis-related mortality was high in PICU.The pSOFA score has a certain predictive value for the prognosis of sepsis.The burden of sepsis is still heavy.Compared with medical insurance families, non-medical insurance families have a higher proportion of choosing left hospital.

Advances on mechanical ventilation strategy of acute respiratory distress syndrome patients guided by drving pressure / 中国小儿急救医学

Acute respiratory distress syndrome (ARDS) is an acute diffuse inflammatory lung injury.Mechanical ventilation is the cornerstone of the treatment from ARDS, which aims to minimize ventilator-induced lung injury while maintaining effective oxygenation.The level of driving pressure affects the volume injury, pressure injury, biological injury and shearing injury during mechanical ventilation of ARDS patients.This study reviewed the mechanical ventilation strategy with driving pressure as guidance in ARDS patients.

Pulmonary mechanical characteristics of children with acute respiratory distress syndrome / 中国小儿急救医学

The etiology and pathogenesis of acute respiratory distress syndrome (ARDS) are different.There are individual differences in the changes of pulmonary mechanics during the progress of the disease.The changes of compliance, pressure and volume are closely related to the etiology, severity and age.Correct use of lung protective ventilation strategy, reasonable adjustment of ventilator parameters and reduction of ventilator-associated lung injury are the key to improve the success rate of ARDS treatment.Therefore, we must pay more attention to the characteristics and changes of pulmonary mechanics in ARDS.

Advances in the pathogenesis of severe adenovirus pneumonia in children / 中国小儿急救医学

Human adenovirus is one of the most important pathogen causing acute respiratory infections in infants and young children, and is easy to cause severe adenovirus pneumonia and respiratory distress syndrome, which can cause death and varying degrees of sequelae.The pathogenesis of human adenovirus-induced severe adenovirus pneumonia remains unclear.It is currently believed that the main predisposing &factors for the occurrence and development of adenovirus pneumonia are immune dysfunction and immune dysfunction after viral infection.This article reviewed the research progress on the pathogenesis of adenovirus pneumonia induced by human adenovirus.

Influence of Resolvin D1 on the inflammatory response and expression of NLRP3 in mice with acute lung injury / 中华实用儿科临床杂志

Objective:To investigate the effects of Resolvin D1 (RvD1) on the inflammatory response and the expression of Nod-like receptor protein 3(NLRP3) inflammasomes in mice with acute lung injury.Methods:The 30 male BALB/c mice weighing 25-30 g were divided into 3 groups(each group with 10 mice). Mice in the normal control group were given normal saline by tail vein injection.Mice in the lipopolysaccharide (LPS) group were given the same volume of LPS (10 mg/kg) via tail vein injection.Mice in the RvD1 group were injected with RvD1 (5 μg/kg) through the tail vein 30 minutes prior to LPS administration.Mice were humanely sacrificed after 6 hours.Histopatholo-gical changes of lung tissue, the levels of pro-inflammatory cytokines interleukin(IL)-18 and IL-1β, and the expression of NLRP3 inflammasomes in lung tissue were measured.Results:After LPS administration, the lung of mice showed pathological damage.The levels of pro-inflammatory factors IL-18 and IL-1β as well as the expression of NLRP3, apoptosis-associated speck-like protein containing a card(ASC)and Caspase-1 in the LPS group were significantly higher than those in the normal control group (all P<0.05). After pretreatment with RvD1, the pathological damage of lung tissue was alleviated.The levels of pro-inflammatory factors IL-18 and IL-1β as well as the expression of NLRP3, ASC and Caspase-1 in the RvD1 group were significantly lower than those in the LPS group (all P<0.05). Conclusions:RvD1 can attenuate the pulmonary inflammation in acute lung injury and inhibit the release of pro-inflammatory factors, which is possibly related to the suppression of NLRP3.

Prognosis and rehabilitation of sepsis-associated encephalopathy / 中华实用儿科临床杂志

Sepsis-associated encephalopathy (SAE) is a serious complication of sepsis, which can greatly increase the mortality of patients with sepsis, and may result in prolonged cognitive dysfunction in SAE survivors.Therefore SAE has received more and more attention in the field of critical illness.However, there are few studies on the mechanism of poor prognosis and possible predictors of SAE, and no specific rehabilitation methods have been reported.In this article, progress in the research on the prognosis and rehabilitation of SAE is summarized, in order to provide a reference for the long-term prognosis and rehabilitation treatment of severe sepsis in children.

Diagnosis and treatment of sepsis associated disseminated intravascular coagulation in children / 国际儿科学杂志

Sepsis associated disseminated intravascular coagulation is a common complication of sepsis and one of the major causes of increased mortality in pediatric intensive care units.When sepsis occurs, the inflammatory factor storm will cause damage to various tissues and organs of the body, and its complication DIC will further aggravate the organ dysfunction.Therefore, the early detection of DIC is crucial in the treatment of sepsis in children.Since the first diagnostic criteria were proposed by the ministry of health and welfare of Japan (JMHW) in 1983, new diagnostic criteria have been proposed in recent years.At the same time, timely diagnosis is helpful for early intervention to improve the prognosis, so a variety of treatment schemes have also emerged.This article reviews the establishing history, advantages and disadvantages of the diagnostic criteria for sepsis associated DIC, as well as the research progress on various anticoagulants and anticoagulant therapies.

Energy balance and prognosis of children with mechanical ventilation in pediatric intensive care unit / 中华临床营养杂志

Objective To investigate the influencing factors for energy balance and the relationship be-tween energy balance and clinical outcome in PICU mechanical ventilation children. Methods Children with mechanical ventilation who were hospitalized in PICU for more than 3 days from June 2015 to May 2016 were collected, resting energy expenditure was measured by resting energy metabolic detector, and the nutrition bal-ance was calculated, the influencing factors on energy balance was analyzed by regression analysis. Results A total of 104 mechanical ventilation children were included with the average energy consumption of ( 265. 4 ± 63. 2) kJ/kg in the first 3 days and the average energy supply of (219. 8±82. 9) kJ/kg, and failed to reach the target value ( P<0. 05) . As the time of hospitalization was prolonged, the supply of energy increased gradu-ally, the SAPS Ⅱ ( r=-0. 609, P=0. 000) , mechanical ventilation time ( r=-0. 456, P=0. 000) , ICU stay time ( r=-0. 646, P=0. 000) , the number of organ failure ( r=-0. 568, P=0. 000) , infection complications ( r=-0. 859, P=0. 000) were negatively correlated to energy supply balance; regression analysis showed that complications of nosocomial infection ( P = 0. 000 ) , number of organ failure ( P = 0. 000 ) , mechanical ventilation time ( P=0. 000) , ICU retention time ( P=0. 001) were predictors of energy supply balance. Con-clusion Insufficient supply of energy for the first three days of mechanical ventilation is high in the critically ill children. Factors affecting energy supply balance include patient's organ failure, infection complications, me-chanical ventilation time, and ICU retention time, which suggest that the strengthening of the nutritional man-agement of the critically ill children with mechanical ventilation will benefit to the clinical outcome.

Right heart protective ventilation strategy in children with acute respiratory distress syndrome / 中国小儿急救医学

Acute respiratory distress syndrome (ARDS) can cause pulmonary vascular dysfunction, increase right ventricular afterload and lead to right ventricular failure,also known as acute cor pulmonale. Mechanical ventilation to maintain oxygenation and ventilation has a negative impact on right ventricular function,which may lead to lung-right ventricular interaction and aggravate the deterioration of right ventricu-lar failure,which may be one of the causes of right ventricular failure. Therefore,in the treatment of mechani-cal ventilation for ARDS,attention must be paid to the right ventricular function of patients.

Nutritional risk screening and its clinical significance of infants with severe pneumonia / 中国实用护理杂志

Objective To investigate the nutritional risk of hospitalized infants with severe pneumonia and its relationship with clinical outcome. Methods Totally 113 infants with severe pneumonia admitted to pediatric intensive care unit (PICU)were enrolled in the study. Nutritional risks were screened by STRONGkids, and the nutritional were assessment with WHO Anthro. Clinical outcomes were recorded and analyzed, including mechanical ventilation, length of PICU stay, total hospital expenses, prognosis, and biochemical test index. Results A total of 44 infants (38.9％) had high nutritional risk, 49 (43.4％) had medium nutritional risk, 20 (17.7％) had low nutritional risk when they admitted to PICU. A total of 59 (52.2％) infants were malnourished when they admitted to PICU. There was a significant correlation between the degree of malnutrition and nutritional risk (r =0.574, P<0.01).The incidence of high nutritional risk was significantly higher in 28d～1year-old group than in 1～3 year-old group (χ2=20.46, P<0.01). Nearly 42.5％(48/113) of the children had congenital disease and had higher incidence of high nutritional risk (χ2=11.375, P=0.003) and higher incidence of malnutrition (χ2=10.083, P=0.001) than those without congenital disease. The rate of mechanical ventilation (P=0.028), the duration of mechanical ventilation (P<0.01), total hospital expenses (P=0.002) and the incidence of poor prognosis(P=0.014) were significantly higher in high nutritional risk group than the low nutritional risk group. The retinol binding protein in the high nutrition risk group was significantly lower than the low nutrition risk group (χ2=6.333, P=0.021). Conclusions High nutritional risk and malnutrition are common in infants with severe pneumonia. Malnutrition and nutritional risk are increased in patients less than 1 year old or suffering from congenital disease. Patients with high nutritional risk are more likely to have worse clinical outcomes. STRONGkids is a valid tool for nutritional risk screening in hospitalized children, and early nutrition support is recommended.

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.

Reunderstanding of pulmonary edema caused by excessive fluid load / 中国小儿急救医学

Pulmonary edema with fluid overload is a common clinical syndrome.Current studies had found that the mechanism of pulmonary edema was related to capillary structure and osmotic changes in addi-tion to excessive water load.The clinical diagnosis should be combined with the medical history, the basic disease and the X-ray and ultrasound examination.The fluid overload should be reduced and the hemodynamic stability and organ function optimization should be taken into consideration.

Application value of continuous blood purification in pediatric intensive care unit: analysis of 203 cases / 中华危重病急救医学

Objective To explore the clinical application value of the continuous blood purification (CBP) technology in pediatric intensive care unit (ICU). Methods A retrospective study was conducted. All CBP patients admitted to pediatric ICU of Children's Hospital of Nanjing Medical University from 2015 to 2017 were enrolled. The disease diagnosis, CBP treatment mode, catheter placement, anticoagulation way, treatment time and adverse reactions were summarized and analyzed. Results ① A total of 203 children were included, male accounted for 59.1%; age 37 days to 14 years old, with an average of (4.52±3.60) years old; weight 3.3-68.0 kg, with an average of (21.38±13.77) kg.② There were a total of 660 CBP treatments, with an average of 3.25 times per person. The main treatment modes of CBP were plasma exchange (PE, 38.64%), and followed by continuous veno-venous hemodiafiltration (CVVHDF, 38.64%), hemoperfusion (HP, 16.51%) and continuous veno-venous hemofiltration (CVVH, 6.21%).③ Central venous catheterization was mainly placed in the right internal jugular vein (90.64%), followed by the right femoral vein (5.42%) and the left femoral vein (3.94%).④ Heparin sodium was the main anticoagulant in pipeline filters (84.73%), followed by low molecular weight heparin calcium (11.33%), sodium citrate and non-anticoagulant (both 1.97%). Mixed anticoagulants were used 21 children. ⑤ Primary diseases included poisoning (26.11%), liver failure (25.62%), sepsis (12.32%), shock after cardiopulmonary resuscitation (11.82%), acute respiratory distress syndrome (ARDS, 8.37%), central nervous system diseases (5.41%) and metabolic diseases (4.93%). The lowest efficacy of CBP was metabolic diseases, with mortality rate of 60.00%; followed by ARDS, shock after cardiopulmonary resuscitation, sepsis and liver failure, with mortality was 58.82%, 41.67%, 36.00% and 32.69%, respectively. The length of hospitalization stay of children with central nervous system diseases was (30.89±15.13) days.⑥ Adverse events of CBP treatment included uncontrollable restlessness (2.88%), hypotension (1.82%), allergic rash (1.21%), catheterization and pipeline coagulation (1.21%), filter coagulation (1.06%), decreased heart rate and oxygen saturation (0.76%); CBP was stopped in 8 children due to cardiac arrest during the treatment. Conclusion At present, the application of CBP technology in pediatric ICU is universal, and it is an important way to rescue critical illness.