Sepsis-induced thrombocytopenia-associated multiple organ failure / 中国小儿急救医学

Sepsis-induced thrombocytopenia-associated multiple organ failure（TAMOF）is a severe subtype of sepsis-related organ dysfunctions，which has high mortality and poor prognosis.The main clinical characteristics are thrombocytopenia caused by infection and multiple organ dysfunction.However，the exact molecular mechanism of TAMOF remains unclear.The current studies have shown ADAMTS-13，which is a von Willebrand factor lyase，plays an important role during the disease.Plasma exchange could be a treatment method，but still need more large-scale randomized controlled trials to verify.In the future，von Willebrand factor and ADAMTS-13 could become the therapeutic targets for new drug development.

Advances on the long-term prognosis of septic shock in children / 中国小儿急救医学

The mortality rate of septic shock in children is high，and the number of cases has been increasing year by year.In recent years，the number of deaths has decreased with the development of medical technology.With the increasing number of surviving children with septic shock，the prognosis regarding these patients is gaining more attention of PICU physicians than before.The long-term sequelae of patients with septic shock，which often leads to multiple organ dysfunction and complications，severely affects the quality of children life after discharge from the hospital.Notably，the meaningful outcomes mainly include physical，mental，emotional，and social functioning.Currently，few studies focusing on quality of life in children surviving from septic shock have been reported in China.Herein，this review summarized the progress of research on the long-term prognosis of patients with septic shock.

Functional status of pediatric patients after extracorporeal membrane oxygenation: A five-year single-center study.

Objective: Extracorporeal membrane oxygenation (ECMO) is a widely used treatment for circulatory and pulmonary support in newborns and young children. Over the past decade, the number of children successfully treated with ECMO has gradually increased. However, despite an increasing number of survivors, new morbidity and long-term health issues are becoming more prevalent. A better understanding of the pediatric ECMO prognosis contributes to improved treatment and care programs and minimizes the risk of sequelae and dysfunctions. We aimed to determine the incidence of new morbidity, prognoses, and follow-up data of survivors treated with ECMO in pediatric intensive care units (PICU) using the Functional Status Scale (FSS). Methods: We retrospectively collected and analyzed clinical data of patients in the PICU who received ECMO from January 2016 to January 2020. Clinical and functional outcomes were assessed at admission and discharge using the FSS. Twenty-seven patients aged between 1 month and 14 years who received ECMO in the PICU were included. Fifty-two percent were male, and the median age was 36 months (interquartile range, 21-114 months). The patients were admitted for fulminant myocarditis (n = 13), acute respiratory distress syndrome (ARDS) (n = 11), and septic shock (n = 3). Results: This study reviewed a single-center experience using the FSS for ECMO treatment in a PICU. The patients' original conditions included fulminant myocarditis, ARDS, and septic shock. Of the 27 patients who received ECMO, 9 (33%) died, 12 (67%) showed improved condition, and 6 (33%) discontinued treatment and left the hospital. Furthermore, the following adverse events were observed in the survivors who were discharged: nine (50%) cases of lower extremity deep vein thrombosis, seven (39%) jugular vein thrombosis, six (33%) acute kidney injury, five (27%) intracranial hemorrhage and cerebral infarction, and one each of (6% each) pulmonary embolism and peripheral nerve injury. Of the 12 patients who survived through 1 year after discharge, five (42%) recovered completely, whereas seven (58%) showed mild to moderate communication and motor dysfunction. The short-term survival rate and 1-year survival rate of ECMO patients were 67% (18/27) and 44% (12/27), respectively. Additionally, approximately one-third of the patients developed a new morbidity after ECMO treatment (6/18). Conclusions: High mortality and new morbidity were common in patients who received ECMO treatment. New morbidity increased the risk of death and exacerbated the functional state. Follow-up and rehabilitation after discharge are essential to achieve positive outcomes.

A meta-analysis of the prognostic value of pentraxin 3 for the patients with sepsis / 中国小儿急救医学

Objective:To investigate the prognostic value of pentraxin 3(PTX3)levels in patients with sepsis through meta-analysis.Methods:Databases including PubMed, The Cochrane Library, Embase, Web of Science, China Science and Technology Journal Database(VIP), China National Knowledge Infrastructure(CNKI), Wanfang Data and China Biology Medicine disc(CBM)from inception to April 2020 were searched for clinical studies that reported the relationship between PTX3 levels and the prognosis of patients with sepsis.Literature selection was based on inclusion and exclusion criteria.The quality of the included studies was evaluated with Newcastal-Ottawa scale and the Meta-analysis was conducted with Review Manager 5.3 software.Results:Ten studies with 1 710 cases were included.Meta-analysis results showed that compared with survivors, PTX3 levels of non-survivors significantly increased(in the random effects model, I2=95%, P<0.001), the combined standard mean difference between non-survivors and survivors was 1.31(95% CI 0.73-1.90). A combined analysis of six studies on the predictive value of PTX3 for 28-day mortality in patients with sepsis was carried out, and the pooled sensitivity was 0.799(95% CI 0.730-0.854), the pooled specificity was 0.735(95% CI 0.649-0.807), the pooled odds ratio was 11.02(95% CI 6.60-18.40), the pooled positive likelihood ratio was 3.02(95% CI 2.24-4.06), the pooled negative likelihood ratio was 0.27(95% CI 0.20-0.37), and the area under summary receiver operator characteristic was 0.83(95% CI 0.79-0.86). Conclusion:PTX3 has a good prognostic value for sepsis.

Surviving Sepsis Guidelines 2016:continuous changes in sepsis managements / 中国小儿急救医学

The Surviving Sepsis Guidelines were first published in 2004,with revisions in 2008 and 2012.In January 2017,the fourth revision of the Surviving Sepsis Guidelines was presented at the 46th annual SCCM meeting and published online in Critical Care Medicine.The updated guideline was generated by 55 international experts and providing 93 recommendations on early management of sepsis and septic shock.There are numerous major advances in the revision of the guidelines.Among the various topics covered,initial resuscitation and antibiotic therapy are the domains in which the most important changes and advances were made.

The evaluation of clinical studies published in Chinese Pediatric Emergency Medicine during 2011 to 2015 according to CONSORT statement / 中国小儿急救医学

Objective To search and evaluate the quality of reports of clinical trial studies published in Chinese Pediatric Emergency Medicine according to CONSORT statement.Methods We collected all articles published in Chinese Pediatric Emergency Medicine from January 1,2011 to November 31,2015 through searching the WanFang Database,then evaluated and analyzed clinical trial studies.Results Among all 1317 articles we retrieved,62 (4.7％)of them belong to clinical trial study.According to CONSORT statement,all the articles satisfied items from 1b to 6b (including abstract,introduction,trial design,participants,interventions and outcomes),only 30(48.4％) and 4(6.5％) articles mentioned item 8a (method used to generate the random allocation sequence)and 8b(type of randomization;details of any restriction),respectively.None of the editors reported item 9(mechanism used to implement the random allocation sequence,describing any steps taken to conceal the sequence until interventions were assigned)and 10(who generated the random allocation sequence,who enrolled participants,and who assigned participants to interventions).Among 62 included studies,33(53.2％)studies concentrated on respiratory system diseases.However,studies about nervous system,circulatory system and digestive system were 5(8.1％),4(6.5％)and 4 (6.5％) respectively.Although all the results had statistical significance,only 38(61.3％),7(11.3％) and 5 (8.1％)mentioned randomization,follow-up and blinding respectively.Flow diagram was only included in one (1.6％) article.Conclusion The articles of clinical trial studies published in Chinese Pediatric Emergency Medicine did not take CONSORT statement as reference completely.