Clinical application of plasma exchange combined with continuous veno-venous hemofiltration dialysis in children with refractory Kawasaki disease shock syndrome / 中国当代儿科杂志

OBJECTIVES@#To study the role of plasma exchange combined with continuous blood purification in the treatment of refractory Kawasaki disease shock syndrome (KDSS).@*METHODS@#A total of 35 children with KDSS who were hospitalized in the Department of Pediatric Intensive Care Unit, Hunan Children's Hospital, from January 2019 to August 2022 were included as subjects. According to whether plasma exchange combined with continuous veno-venous hemofiltration dialysis was performed, they were divided into a purification group with 12 patients and a conventional group with 23 patients. The two groups were compared in terms of clinical data, laboratory markers, and prognosis.@*RESULTS@#Compared with the conventional group, the purification group had significantly shorter time to recovery from shock and length of hospital stay in the pediatric intensive care unit, as well as a significantly lower number of organs involved during the course of the disease (P<0.05). After treatment, the purification group had significant reductions in the levels of interleukin-6, tumor necrosis factor-α, heparin-binding protein, and brain natriuretic peptide (P<0.05), while the conventional group had significant increases in these indices after treatment (P<0.05). After treatment, the children in the purification group tended to have reductions in stroke volume variation, thoracic fluid content, and systemic vascular resistance and an increase in cardiac output over the time of treatment.@*CONCLUSIONS@#Plasma exchange combined with continuous veno-venous hemofiltration dialysis for the treatment of KDSS can alleviate inflammation, maintain fluid balance inside and outside blood vessels, and shorten the course of disease, the duration of shock and the length of hospital stay in the pediatric intensive care unit.

Application of transport ventilator in the inter-hospital transport of critically ill children / 中国当代儿科杂志

OBJECTIVES@#To study the application value of transport ventilator in the inter-hospital transport of critically ill children.@*METHODS@#The critically ill children in Hunan Children's Hospital who were transported with or without a transport ventilator were included as the observation group (from January 2019 to January 2020; n=122) and the control group (from January 2018 to January 2019; n=120), respectively. The two groups were compared in terms of general data, the changes in heart rate, respiratory rate, and blood oxygen saturation during transport, the incidence rates of adverse events, and outcomes.@*RESULTS@#There were no significant differences between the two groups in sex, age, oxygenation index, pediatric critical illness score, course of disease, primary disease, heart rate, respiratory rate, and transcutaneous oxygen saturation before transport (P>0.05). During transport, there were no significant differences between the two groups in the changes in heart rate, respiratory rate, and transcutaneous oxygen saturation (P>0.05). The incidence rates of tracheal catheter detachment, indwelling needle detachment, and sudden cardiac arrest in the observation group were lower than those in the control group during transport, but the difference was not statistically significant (P>0.05). Compared with the control group, the observation group had significantly shorter duration of mechanical ventilation and length of stay in the pediatric intensive care unit and significantly higher transport success rate and cure/improvement rate (P<0.05).@*CONCLUSIONS@#The application of transport ventilator in the inter-hospital transport can improve the success rate of inter-hospital transport and the prognosis in critically ill children, and therefore, it holds promise for clinical application in the inter-hospital transport of critically ill children.

Efficacy of plasma exchange in children with severe hemophagocytic syndrome: a prospective randomized controlled trial / 中国当代儿科杂志

OBJECTIVES@#To investigate the efficacy and application value of plasma exchange as an adjuvant therapy in children with hemophagocytic syndrome (HPS).@*METHODS@#A prospective randomized controlled trial was designed. Forty children with severe HPS were enrolled, who were treated in the pediatric intensive care unit (PICU) of Hunan Children's Hospital from October 2018 to October 2020. The children were randomly divided into a plasma exchange group and a conventional treatment group using a random number table, with 20 children in each group. The children in the conventional treatment group received etiological treatment and conventional symptomatic supportive treatment, and those in the plasma exchange group received plasma exchange in addition to the treatment in the conventional treatment group. The two groups were compared in terms of general information, clinical symptoms and signs before and after treatment, main laboratory markers, treatment outcome, and prognosis.@*RESULTS@#Before treatment, there were no significant differences between the two groups in gender, age, course of the disease before admission, etiological composition, pediatric critical illness score, involvement of organ or system functions, and laboratory markers (P>0.05). After 7 days of treatment, both groups had remission and improvement in clinical symptoms and signs. After treatment, the plasma exchange group had significantly lower levels of C-reactive protein, procalcitonin, and serum protein levels than the conventional treatment group (P<0.05). The plasma exchange group also had significantly lower levels of alanine aminotransferase and total bilirubin than the conventional treatment group (P<0.05). The length of stay in the PICU in the plasma exchange group was significantly shorter than that in the conventional treatment group (P<0.05). The plasma exchange group had a significantly higher treatment response rate than the conventional treatment group (P<0.05). There were no significant differences between the two groups in the total length of hospital stay and 3-month mortality rate (P>0.05).@*CONCLUSIONS@#Plasma exchange as an adjuvant therapy is effective for children with severe HPS. It can improve clinical symptoms and signs and some laboratory markers and shorten the length of stay in the PICU, and therefore, it may become an optional adjuvant therapy for children with severe HPS.

Application of dexmedetomidine in children with agitation during ventilator weaning / 中国当代儿科杂志

OBJECTIVE@#To study the clinical effect and safety of dexmedetomidine in children with agitation during ventilator weaning.@*METHODS@#A prospective open observational study was performed for children who were admitted to the intensive care unit and experienced mechanical ventilation between March 2017 and August 2018. They were given dexmedetomidine due to the failure in the spontaneous breathing test (SBT) caused by agitation. A sedation-agitation scale score of ≥5 was defined as agitation. The children were observed in terms of the sedation state at 0.5, 1, 2, 6, and 12 hours after the administration of dexmedetomidine, blood gas parameters before extubation and at 1, 24, and 48 hours after extubation, vital signs (heart rate, respiratory rate and mean arterial pressure) before SBT, before extubation, and at 10, 60, and 120 minutes and 24 hours after extubation, and incidence rates of adverse events related to the use of dexmedetomidine.@*RESULTS@#A total of 19 children were enrolled in this study. All the children were in a state of agitation at the time of enrollment. At 0.5, 1, 2, 6, and 12 hours after the administration of dexmedetomidine, 12, 17, 17, 18, and 18 children respectively reached the sedation state. There were no significant differences in the oxygenation index, arterial partial pressure of carbon dioxide, heart rate, respiratory rate, and mean arterial pressure at each time point before and after extubation (P>0.05). No adverse events were observed, such as severe hypotension and respiratory depression, and only one child experienced reversible bradycardia.@*CONCLUSIONS@#Dexmedetomidine is safe and effective in children with agitation during ventilator weaning, but prospective randomized controlled trials are needed for verification.

Dynamic change in vitamin D level in infants/toddlers with severe pneumonia and a correlation analysis / 中国当代儿科杂志

OBJECTIVE@#To study the correlation of dynamic change in serum 25-hydroxy vitamin D [25(OH)D] level with the disease severity and related laboratory markers in infants/toddlers with severe pneumonia.@*METHODS@#A total of 132 infants/toddlers with severe pneumonia who were hospitalized between March 2017 and March 2018 were enrolled as the severe pneumonia group. According to the disease severity on admission and after one week of treatment, they were further divided into non-critical group (41 children on admission and 78 after one week of treatment), critical group (59 children on admission and 35 after one week of treatment), and extremely critical group (32 children on admission and 19 after one week of treatment). A total of 142 infants/toddlers who underwent physical examination during the same period of time were enrolled as the healthy control group. The serum levels of 25(OH)D, procalcitonin (PCT), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured on admission and after one week of treatment for the severe pneumonia group, and the serum level of 25(OH)D was measured on admission for the healthy control group. According to the 25(OH)D level after one week of treatment, the children with severe pneumonia were divided into increased vitamin D (VD) group with 81 children and reduced VD group with 51 children, and a comparative analysis and a correlation analysis were performed.@*RESULTS@#The severe pneumonia group had a significantly lower mean 25(OH)D level than the healthy control group (P<0.05), and all the three subgroups of different severities had significantly lower 25(OH)D level than the healthy control group (P<0.05). On admission and after one week of treatment, the non-critical group had a significantly higher 25(OH)D level than the critical and extremely critical groups (P<0.01), and the critical group had a significantly higher 25(OH)D level than the extremely critical group (P<0.05). The extremely critical and critical groups had significantly higher serum levels of PCT and NT-proBNP than the non-critical group on admission and after one week of treatment (P<0.05). After one week of treatment, compared with the reduced VD group, the increased VD group had a significantly less serious condition. At discharge, the increased VD group had a significantly better outcome compared with the reduced VD group (P<0.01). In the children with severe pneumonia, the change value of serum 25(OH)D level after treatment was negatively correlated with the change values of PCT and NT-proBNP (r=-0.597 and -0.404 respectively; P<0.01).@*CONCLUSIONS@#The change in VD level is correlated with the severity of severe pneumonia in infants/toddlers and can be used as an index for disease monitoring. VD supplementation may help with disease recovery.

Impact of continuous blood purification on T cell subsets in children with severe sepsis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the impact of continuous blood purification (CBP) on T-cell subsets and prognosis in children with severe sepsis.</p><p><b>METHODS</b>A total of 42 children with severe sepsis were randomly divided into a control group (n=22) and a CBP group (n=20). The patients in the control group received conventional treatment, while those in the CBP group underwent continuous veno-venous hemofiltration daily 12-24 hours for 3 days besides conventional treatment. Changes in clinical variables and in peripheral blood regulatory T cell subsets were assessed 3 and 7 days after treatment.</p><p><b>RESULTS</b>The pediatric intensive care unit length of stay and duration of mechanical ventilation were significantly shortened and the 28-day mortality rate was significantly lower in the CPB treatment group as compared with the control group (P<0.05). In the CBP treatment group, the percentage of CD3(+), CD4(+), CD8(+) T cell populations and PCIS scores were significantly higher at 3 and 7 days after treatment than before treatment (P<0.05). At 7 days after treatment, the percentage of CD3(+), CD4(+), CD8(+) T cell populations, CD4(+)/CD8(+) ratio and PCIS scores were significantly higher in the CBP group than in the control group (P<0.05).</p><p><b>CONCLUSIONS</b>The CBP treatment may counteract the suppression of immune function and thus improve prognosis in children with severe sepsis.</p>

Changes in T cell subsets in children with sepsis, and their clinical significance / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To observe changes in T cell subsets in children with sepsis and their prognosis, and to investigate the clinical significance of these changes in the occurrence and development of sepsis.</p><p><b>METHODS</b>Fifty children with severe sepsis and 150 children with general sepsis were enrolled as subjects, and 50 age-matched healthy children were included as controls. The percentages of CD3(+), CD4(+) and CD8(+) T cells in peripheral blood and CD4(+)/CD8(+) ratio were measured by flow cytometry. The pediatric critical illness score (PCIS) was calculated within 24 hours of admission.</p><p><b>RESULTS</b>The children with severe sepsis showed significantly lower percentages of CD3(+), CD4(+) and CD8(+) T cells CD4(+)/CD8(+) ratio and PCIS than the controls and children with general sepsis (P<0.01). Among the 200 cases of sepsis, the percentages of CD3(+), CD4(+) and CD8(+) T cells, CD4(+)/CD8(+) ratio and PCIS were significantly lower in the cured group than in the deceased group.</p><p><b>CONCLUSIONS</b>Children with sepsis have different degrees of cellular immunosuppression, and the degree of cellular immunosuppression is significantly correlated with the severity of the disease. Detection of T cell subsets in peripheral blood is of great significance for evaluating immune function and judging disease severity in children with sepsis.</p>