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Corresponding author:Tao Shaohua,Email:tsh1987﹫sina. com [Abstract] Continuous renal replacement therapy(CRRT)has become the standard treatment for acute kidney injury or severe metabolic derangement in the pediatric intensive care unit. Anticoagulation for circuit patency is the prerequisite during CRRT operation. Regional citrate anticoagulation for CRRT is more effective and safe than systemic or regional heparin. Regional citrate anticoagulation can decrease the risk of circuit loss and filter failure;furthermore,it is safer than systemic heparin anticoagulation for the reduction of bleeding risk. Complications of citrate anticoagulation ( such as acid－base imbalance and electrolyte disturbances)can be avoided by using an appropriate protocol and regu﹣lar monitoring. Therefore,citrate should be considered as the first choice for anticoagulation during CRRT in critically ill pediatric patients,and further studies are needed to evaluate the safety and efficacy of citrate anticoagulation in the pediatric population.
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Objective To preliminarily investigate the role of Vitamin C in cecal ligation and puncture-induced septic brain injury.Methods Male specific pathogen free (SPF) Sprague-Dawley male rats were randomly assigned into control group,sham operation group,sepsis group and sepsis therapy group.The rats in sepsis group were prepared by cecal ligation and puncture.The rats in sepsis therapy group were injected sodium ascorbate through the tail vein 3 h after the cecal ligation and punature procedure.The animals in other groups were subjected only to subcutaneous bolus injection of 9 g/L saline only.Animals were evaluated by neurologic reflex scores before sacrifice and brain tissues were quickly removed at the indicated time points.Reactive oxygen species (ROS),superoxide dismutase (SOD),malondialdehyde (MDA),nitric oxide (NO),inducible nitric oxide synthase (iNOS) and catalase (CAT) were determined by using enzyme assay kits.Hematoxylin-eosin (HE) staining was used to observe morphological changes in brain tissues.Results The survival rate of the sepsis group (30％ at 7th day) was significantly lower than that of the control group (100％ at 7th day)and sham operation group(100％ at 7th day).The survival rate of the sepsis therapy group (45％ at 7th day)was significantly higher than that of the sepsis group(P ＜ O.05).The neurological reflex assessment began to decrease at 6 h in sepsis group and reached the lowest at 24 h (6.00 ± 0.53).The sepsis therapy group (7.62 ± 0.52) was significantly higher (P ＜ 0.05) than the sepsis group and began to recover at 72 h (8.63 ±0.52).ROS,SOD,MDA,NO and iNOS in the sepsis group and the sepsis therapy group reached a peak at 24 h,which decreased at 72 h.The value in sepsis therapy group was significantly decreased than that in the sepsis group,and the difference was statistically significant(P ＜0.05).CAT changed in the opposition.The SOD/CAT in sepsis group was the highest 24 h after the operation,while the ratio in sepsis therapy group was significantly improved.SOD/CAT and MDA were positively correlated(r =0.968,P ＜ 0.05).HE staining showed significant damage to the brain tissue structure in the sepsis group,however some improvement was observed in the sepsis therapy group.Conclusion Vitamin C can significantly improve the survival rate and encephalopathy prognosis in the cecal ligation and puncture SD rat models.The mechanism may be related to the reduction of oxidative stress.
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Therapeutic plasma exchange can quickly remove the pathogenic macromolecular sub-stance in vivo,and its application is gradually expanded. With the maturity and development of plasma ex-change technology,the effect of high volume plasma exchange in liver failure,thrombotic thrombocytopenic purpura,sepsis and other diseases is obvious. But there is still controversy about the wide use of high volume plasma exchange in ICU. This review aimed to discuss the use of high volume plasma exchange in patients with critical diseases.
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Objective To explore the distribution of pathogens, bacterial drug resistance, clinical features and prognosis of bacterial meningitis (BM) in children.MethodsThe clinical data of children diagnosed with BM during January 2011 to July 2015 were retrospectively analyzed. Children were divided into good outcome group and poor outcome group by the outcome at discharge. The distribution of pathogens, bacterial drug resistance, clinical features, and prognosis were analyzed among different groups.ResultsThere were included 95 children diagnosed with BM,. among whom 69 (72.6%) children had Gram-positive bacterial infections with predominantStreptococcus pneumonia (43 cases, 45.3%) and 26 (27.4%) children had Gram-negative bacterial infections with predominantEscherichia coli (13 cases, 13.7%). More than 50%Streptococcus pneumonia andEscherichia coli were resisted to penicillin. The neurological complications in children with BM included subdural effusions, hydrocephalus, cerebral parenchyma injury, and hearing and visual impairment, et.al. Multivariate logistic regression analysis showed that consciousness, coma, and low level of glucose in cerebrospinal lfuid were the independent risk factors for adverse outcome at discharge.ConclusionStreptococcus pneumonia andEscherichia coli were the predominant pathogens in children with BM with high resistance rate to penicillin. BM children may have varying degrees of neurological sequelae. The unconsciousness and low level of glucose in cerebrospinal lfuid were associated with unfavorable outcomes at discharge.
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Objective To study the reasonable doses, efficacy and safety of regional citrate anticoagulation (RCA) for continuous veno-venous hemofiltration(CVVH) in children. Methods There were 66 patients hospi-ta-lized in Pediatric Intensive Care Unit of Zhujiang Hospital,Southern Medical University treated with RCA-CVVH that were recruited in the study from October 2012 to July 2014. The patients were divided into 4 groups according to their weight:≤10 kg( group Ⅰ) ,20 kg≥weight>10 kg( group Ⅱ) ,30 kg≥weight>20 kg( group Ⅲ) ,>30 kg( groupⅣ),and each group randomly received 2 different doses of anticoagulant acid citrate dextrose formula A(ACD-A):ACD-A(mL/h)=0. 75×blood flow rate(BFR)(mL/min)(A dose) and ACD-A=1. 5×BFR(B dose). Data of hemo-filter duration, activated partial thromboplastin time( APTT) ( systemic and circuit) , ionized calcium( Ca2+) ( systemic and circuit), blood urea nitrogen(BUN), serum creatinine(Cr), alanine aminotransferase(ALT), aspartate amin-otransferase(AST), blood pH, sodium ion(Na+), bicarbonate ion(HCO3-) were collected and analyzed. Results There was no significant difference in BUN,Cr,ALT,AST and APTT of 2 different doses of ACD-A among the groups (all P>0.05);pH of B dose of ACD-A in group Ⅰwas significantly higher than that in A dose(F=7.384,P=0. 015);pH of B dose of ACD-A in groupⅡwas significantly higher than that in A dose(F=4. 492,P=0. 046),HCO3-of B dose of ACD-A in groupⅠwas significantly higher than that in A dose(F=7. 735,P=0. 013);HCO3-of B dose of ACD-A in groupⅡwas significantly higher than that in A dose(F=4. 644,P=0. 042);hemofilter duration of B dose of ACD-A in group Ⅲ was significantly higher than that in A dose(t=-3. 147,P=0. 016);hemofilter duration of B dose of ACD-A in groupⅣwas significantly higher than that in A dose(t=-6. 342,P=0. 000). Conclusions RCA-CVVH is effective and safe for critical children,and different doses of ACD-A for children with different weight can re-duce metabolic alkalosis and enhance regional anticoagulation.
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Continuous blood purification is continuous, slow removal of water and solute molecules in the blood.So,it is a treatnent modality of organ supports.With the development of blood purification in children,application of continuous blood purification in children is beyond the field of renal replacement therapy.Treatment indications include systemic inflammatory response syndrome,sepsis,multiple organ dysfunction syndrome,acute respiratory distress syndrome,bums,etc.Continuous blood purification has become the most important treatment in pediatric intensive care unit.Because of the children's physiological features,blood purification equipment and the disease spectrum, continuous blood purification requires higher technology and presents more difficultits.
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Sepsis associated encephalopathy (SAE)is the most common form of encephalopathy in the pediatric intensive care units and might appear before other systemic features of sepsis.The pathogenesis of SAE is complex and not clear.SAE causes increased morbidity and mortality but has limited therapeutic options.SAE has become a hot issue in critical care medicine.
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Multiple organ dysfunction syndrome(MODS),a hot topic worldwide,has made rapid progress with nigh mortality.MODS in pediatrics versus MODS in adults are similar but different.Due to special age-related physiological characteristics.It is difficult to carry out randomized controlled clinical study compared with adults.Diagnosis and treatment of pediatric MODS can only be obtained with reference to adult MODS.This study reviews on the epidemiology,clinical scoring system,pathogenesis,clinical features and treatment of MODS in pediatrics.
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Objective To explore the effect of evidence-based care on the constipation of psychiatric patients.Methods The constipations in 328 psychiatric patients admitted to our department were intervened with evidence-based nursing.Frequency for defecation,incidence of difficult defecation and incidence of dry stool before intervention were compared to those two weeks after intervention.Result Two weeks after intervention,the defecation frequency,incidence of difficult defecation and incidence of dry stool were all significantly lower than those before the intervention(P<0.001).Conclusions The evidence-based nursing used in care to psychiatric patients with constipation can reduce the incidence of constipation,and relieve their physiological and psychological pains.
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OBJECTIVE To investigate the distribution and the resistance of pathogens from the children with VAP in PICU,and to analyze the reasons of antibiotics resistance of the pathogens.METHODS The sputum obtained from the children with final diagnosis of VAP in PICU was cultured and identified from Jan 2005 to Dec 2006.The resistance of the bacteria identified to antibiotics used frequently was determined by Kirby-Bauer method.RESULTS A total of 187 strains were isolated from sputum specimens,of which Gram-negative bacilli and Gram-positive cocci accounted for 76.5% and 23.5%,respectively.Acinetobacter baumannii(17.7%),Escherichia coli(16.0%),Pseudomonas aeruginosa(15.0%) and Klebsiella pneumoniae(13.9%) were the most frequently isolates of Gram-negative bacilli.Their resistant rates to ?-lactam antibiotics were high,especially the ESBLs-producing strains in E.coli and K.pneumoniae.The Staphylococcus epidermidis(5.9%),Staphylococcus aureus(4.8%) and Enterococcus faecalis(4.3%) were the most common strains of Gram-positive cocci.No vancomycin-resistanct strains were found,but resistance rates to ?-lactam antibiotics and other antibiotics were high in S.epidermidis and S.aureus.CONCLUSIONS The main strains cultured from the sputum specimens of children with VAP in PICU are Gram-negative bacilli with high resistance rates to antibiotics,especially the ESBLs producing bacilli to ?-lactam antibiotics.Staphylococcus are the main Gram-positive cocci.
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Objective To explore a kind of modified peritoneal dialysis (PD) adapt for acute renal failure (ARF) in children. Methods After punctured many pinholes in tail end and sterilized by ethylene oxide the ID 2. 5 tracheal tube and urinary catheter were used as PD - catheter for children. The tracheal tube or urinary catheter was placed in abdomen with Seldinger's techniques Then the PD was carried out in the way that dialysis solution passing in and out of abdomen in two different pipelines Results The edema, circulation and respiration of the 21 children with ARF were improved after PD in this way and the urine quantity increased too, although 5 of them died of D1C and MOSF. No peritonitis or leakage of PD solution was taken place. The Scr.BUN,UA,K + ,CO2- CP of the chidren were decreased from(424? 133)?mol/L,(41.5? 12 6) mmol/L, (764 ? 187) ?mol/L,(6 7 ?2. 1) mmol/L, (14 5 ? 3.7) mmol/L before PD to( 166?37) ?mot/L,(8.9?3 1) mmol/L,(350?74) ?mol/L,3.7?0 4 mmol/L,(23.0? 1. 8) ?mol/L.Conclusion Tracheal tube or urinary catheter may be used as PD- catheter for ARF in children.
