[Pathogenic analysis of ventilator-associated pneumonia in the pediatric intensive care unit in high-altitude areas].

OBJECTIVE: To investigate the pathogens of ventilator-associated pneumonia (VAP) and their drug resistance in the pediatric intensive care unit (PICU) in high-altitude areas and to provide a clinical basis for the prevention and treatment of VAP. METHODS: A total of 94 children with VAP hospitalized in the PICU in high-altitude areas between June 2011 and June 2013 were recruited. Their lower respiratory tract secretions were collected for bacterial culture and drug sensitivity test. RESULTS: Of the 94 children with VAP, 22 (23%) had a single bacterial infection, and 72 (77%) had mixed infections, mostly with Klebsiella pneumoniae and Acinetobacter baumannii (17 cases, 27%). Of the 178 isolated strains of pathogens, 139 (78%) were Gram-negative bacteria (G⁻ bacteria), mainly including Klebsiella pneumoniae, Stenotrophomonas maltophilia, Acinetobacter baumannii, and Pseudomonas aeruginosa, 26 (15%) were Gram-positive bacteria (G⁺ bacteria), mainly including Staphylococcus aureus, and 13 (7%) were fungi, mainly including Candida albicans. Most G⁻ bacteria had a high drug resistance. Pseudomonas aeruginosa was extensively drug-resistant. Acinetobacter baumannii was only highly sensitive to cefoperazone/sulbactam and imipenem. Multidrug resistance (methicillin resistance) was found in G⁺ bacteria, for which vancomycin was effective. CONCLUSIONS: The pathogens of VAP in high-altitude areas are mostly G- bacteria, which may cause mixed infections and develop drug resistance. This provides guidance for the rational use of antimicrobial drugs and the development of key prevention and control measures for VAP.

[Efficacy and safety of sildenafil in the treatment of high altitude heart disease associated with severe pulmonary arterial hypertension in children: a preliminary evaluation].

OBJECTIVE: To observe the clinical efficacy and safety of sildenafil in the treatment of high altitude heart disease associated with severe pulmonary arterial hypertension (PAH) in children. METHODS: Fifty children (aged 2 months to 2 years) with high altitude heart disease associated with severe PAH, who were continuously transferred to the Intensive Care Unit between January 2011 and October 2013, were randomly assigned to observation and control groups. The control group was given conventional treatment, while the observation group received oral sildenafil [1 mg/(kg . d)] three times daily for 7-10 days in addition to the conventional treatment. Before and after treatment, hemodynamics, blood gas, routine blood parameters, and blood biochemical parameters were recorded. RESULTS: After treatment, the observation group had a significantly higher decrease in mean pulmonary artery pressure and significantly higher increases in arterial partial pressure of oxygen, cardiac output, cardiac index, and oxygenation index compared with the control group (P<0.05). In the observation group, there were no significant changes in mean arterial pressure, routine blood parameters and blood biochemical parameters (P>0.05), and no obvious adverse reactions were found. CONCLUSIONS: For children with high altitude heart disease associated with severe PAH, sildenafil can effectively reduce pulmonary artery pressure and improve cardiac function and does not cause adverse reactions. This therapy has good safety according to the preliminary evaluation.