[Effect of continuous hemofiltration on inflammatory mediators and hemodynamics in children with severe hand, foot and mouth disease].

OBJECTIVE: To investigate the effect of continuous veno-venous hemofiltration (CVVH) on inflammatory mediators in children with severe hand, foot and mouth disease (HFMD), and to investigate its clinical efficacy. METHODS: A total of 36 children with stage IV HFMD were enrolled and randomly divided into conventional treatment group and CVVH group (n=18 each). The children in the CVVH group were given CVVH for 48 hours in addition to the conventional treatment. The levels of interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) and lactic acid in peripheral venous blood, heart rate, blood pressure, and left ventricular ejection fraction were measured before treatment and after 24 and 48 hours of treatment. RESULTS: After 24 hours of treatment, the conventional treatment group had a significantly reduced serum IL-2 level (P<0.01), and the CVVH treatment group had significantly reduced serum levels of IL-2, IL-6, IL-10, and TNF-α (P<0.05). After 48 hours of treatment, both groups had significantly reduced serum levels of IL-2, IL-6, IL-10, and TNF-α (P<0.01), and the CVVH group had significantly lower levels of these inflammatory factors than the conventional treatment group (P<0.01). After 48 hours of treatment, heart rate, systolic pressure, and blood lactic acid level were significantly reduced, and left ventricular ejection fraction was significantly increased in both groups, and the CVVH group had significantly greater changes in these indices except systolic pressure than the conventional treatment group (P<0.01). CONCLUSIONS: CVVH can effectively eliminate inflammatory factors, reduce heart rate and venous blood lactic acid, and improve heart function in children with severe HFMD.

Epidemiology of Cardiopulmonary Arrest and Outcome of Resuscitation in PICU Across China: A Prospective Multicenter Cohort Study.

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.

[Clinical study of volume resuscitation in children with septic shock].

OBJECTIVE: To compare the effect of crystalloid and crystalloid plus albumin in the treatment of pediatric septic shock. METHODS: Data of 63 pediatric patients with septic shock admitted to Department of Critical Care Medicine of Hebei Provincial Children's Hospital were collected and retrospectively analyzed. The patients were divided into two groups according to whether they received albumin for volume resuscitation within 1 day after admission or not. The patients in observation group (crystalloid + albumin group, n=33) received normal saline (20 mL/kg) followed by 1 g/kg albumin 30 minutes after admission, and those in control group (crystalloid group, n=30) received only normal saline (20 mL/kg) 30 minutes after admission, and normal saline resuscitation was continued according to the effect of fluid therapy. Anti-infection and vasoactive drugs strategies were the same in both groups. The first-hour infusion volume, time showing stable hemodynamics, the incidence of pulmonary edema, and blood lactate levels at 0, 6, 12 hours after achieving the goals were compared, and blood lactate clearance rates were calculated. RESULTS: The first-hour infusion volume time in the observation group was lower than that in control group (41.56 ±10.50 mL vs. 57.24±7.54 mL, t=4.596, P=0.000), and time showing stable hemodynamics was shorter than that in control group but without statistically significant difference (219.87±70.23 minutes vs. 287.10±67.00 minutes, t=2.047, P=0.360). The incidence of pulmonary edema in observation group was slightly lower than that in control group [6.1% (2/33) vs. 10.0% (3/30), χ2=2.272, P=0.259]. The lactic acid levels were decreased gradually along with rehabilitation time, while lactate clearance rate was increased in both groups. At 0 hour and 6 hours after resuscitation, the lactate level in the observation group was significantly lower than that in control group (0 hour: 3.65±2.84 mmol/L vs. 5.72±2.11 mmol/L, t=1.940, P=0.046; 6 hours: 2.12±1.21 mmol/L vs. 4.09±1.45 mmol/L, t=2.892, P=0.005), while the lactate clearance rate was significantly increased compared with control group [0 hour: (0.38±0.15)% vs. (0.18±0.09)%, t=1.447, P=0.018; 6 hours: (0.62±0.14)% vs. (0.51±0.11)%, t=1.920, P=0.047]. However, at 12 hours after resuscitation, there were no statistically significant differences in the lactic acid level (1.46±0.39 mmol/L vs. 1.54±1.90 mmol/L, t=0.450, P=0.072) and the lactate clearance rate [(0.78±0.19)% vs. (0.77±0.18)%, t=0.091, P=0.928] between observation group and control group. CONCLUSIONS: Albumin resuscitation in children with septic shock can stabilize hemodynamics earlier, reduce the incidence of pulmonary edema, and improve the successful rescue rate of refractory septic shock.

[Clinical research of timing of application of antibiotics in septic shock of pediatric patients].

OBJECTIVE: To investigate the value of timing of antibiotics in pediatric septic shock. METHODS: Eighty children with septic shock treated with bundle treatment in Department of Critical Care Medicine were retrospectively analyzed. Eighty children with septic shock were divided into observation group (n=40, anti-infection therapy within 1 hour after admission) and control group (n=40, anti-infection therapy 1-6 hours after admission). The contents of lactate, C-reaction protein (CRP) and procalcitonin (PCT) were compared between two groups at admission and 24 hours and 72 hours after admission. RESULTS: Lactate in the observation group was significantly lower than that of the control group within the first 24 hours after admission (8.65 ± 2.84 mmol/L vs. 11.75 ± 3.20 mmol/L, P<0.01). CRP in the observation group was significantly lower than that of the control group 24 hours and 72 hours after admission (66.25 ± 8.55 mg/L vs. 91.77 ± 7.71 mg/L, 22.03 ± 7.46 mg/L vs. 50.11 ± 7.30 mg/L, both P<0.01). PCT in the observation group was significantly lower than that of the control group 72 hours after admission (0.67 ± 0.31 µg/L vs. 1.16 ± 0.25 µg/L, P<0.01). Time for shock recovery in the observation group was significantly shorter than that of the control group (6.80 ± 3.70 hours vs. 12.80 ± 3.63 hours, P<0.05), but no statistical difference in mortality rate between groups was found [5% (2/40) vs. 10% (4/40), P>0.05]. CONCLUSION: With the early empirical anti-infection treatment in pediatric septic shocked patients, time for recovery from shock can be shortened and successful rate of resuscitation can be improved.