RESUMEN
Objective: To investigate the epidemiology and the effectiveness of resuscitation from cardiopulmonary arrest (CPA) among critically ill children and adolescents during pediatric intensive care unit (PICU) stay across China. Methods: A prospective multicenter study was conducted in 11 PICUs in tertiary hospitals. Consecutively hospitalized critically ill children, from 29-day old to 18-year old, who had suffered from CPA and required cardiopulmonary resuscitation (CPR) in the PICU were enrolled (December 2017-October 2018). Data were collected and analyzed using the "in-hospital Utstein style." Neurological outcome was assessed with the Pediatric Cerebral Performance Category (PCPC) scale among children who had survived. Factors associated with the return of spontaneous circulation (ROSC) and survival at discharge were evaluated using multivariate logistic regression. Results: Among 11,599 admissions to PICU, 372 children (3.2%) had CPA during their stay; 281 (75.5%) received CPR, and 91 (24.5%) did not (due to an order of "Do Not Resuscitate" requested by their guardians). Cardiopulmonary disease was the most common reason for CPA (28.1% respiratory and 19.6% circulatory). The most frequent initial dysrhythmia was bradycardia (79%). In total, 170 (60.3%) of the total children had an ROSC, 91 had (37.4%) survived till hospital discharge, 28 (11.5%) had survived 6 months, and 19 (7.8%) had survived for 1 year after discharge. Among the 91 children who were viable at discharge, 47.2% (43/91) received a good PCPC score (1-3). The regression analysis results revealed that the duration of CPR and the dose of epinephrine were significantly associated with ROSC, while the duration of CPR, number of CPR attempts, ventricular tachycardia/ventricular fibrillation (VT/VF), and the dose of epinephrine were significantly associated with survival at discharge. Conclusion: The prevalence of CPA in critically ill children and adolescents is relatively high in China. The duration of CPR and the dose of epinephrine are associated with ROSC. The long-term prognosis of children who had survived after CPR needs further improvement.
RESUMEN
The application of nano zero-valent iron (nZVI) in water environment was limited by its easily aggregation and potential biological toxicity. In this study, biochar embedded nZVI (BC-nZVI) was prepared by carbon-thermal reduction method, and the SEM-EDX mapping results showed that nZVI was successfully embedded on biochar. Meanwhile, BC-nZVI with the optimal Fe/C of 2/1 showed a similar Se(vi) removal efficiency to pure nZVI. Effects of pH, BC-nZVI loading, and initial Se(vi) concentration were studied. Se(vi) removal rates (at 30 min) by BC-nZVI at pH 4.0 and 5.0 were 98.2% and 95.9%, respectively. But Se(vi) removal rate (at 30 min) was sharply decreased to 25.8% at pH 6.0. With the increase of BC-nZVI loading from 0.5 g L-1 to 1 g L-1, Se(vi) removal rate (at 30 min) significantly increased from 25.5% to 95.9%. And the continuous increase of BC-nZVI loading to 2 g L-1 did not improve Se(vi) removal rate. Se(vi) less than 3 mg L-1 was completely removed by BC-nZVI in 30 min, but Se(vi) more than 6 mg L-1 only was removed about 25.9% at 30 min. Optimal parameters were pH 4.0, 2 g L-1 BC-nZVI, and 1.5 mg L-1 Se(vi). Variation of calculated amount, SOD activity, and protein content of Escherichia coli with nZVI and BC-nZVI indicated that nZVI and BC-nZVI both produced negative effects on the growth of E. coli. But the amount and SOD activity of E. coli with pure nZVI was lower than that with BC-nZVI. Moreover, E. coli with nZVI released more protein than that with BC-nZVI. So modified nZVI by biochar was less harmful to E. coli than nZVI.