Critical illness related to community acquired pneumonia, its epidemiology and outcomes in a pediatric intensive care unit of Pakistan

Serum-integrated omics reveal the host response landscape for severe pediatric community-acquired pneumonia

OBJECTIVE

Community-acquired pneumonia (CAP) is the primary cause of death for children under five years of age globally. Hence, it is essential to investigate new early biomarkers and potential mechanisms involved in disease severity.

METHODS

Proteomics combined with metabolomics was performed to identify biomarkers suitable for early diagnosis of severe CAP. In the training cohort, proteomics and metabolomics were performed on serum samples obtained from 20 severe CAPs (S-CAPs), 15 non-severe CAPs (NS-CAPs) and 15 healthy controls (CONs). In the verification cohort, selected biomarkers and their combinations were validated using ELISA and metabolomics in an independent cohort of 129 subjects. Finally, a combined proteomics and metabolomics analysis was performed to understand the major pathological features and reasons for severity of CAP.

RESULTS

The proteomic and metabolic signature was markedly different between S-CAPs, NS-CAPs and CONs. A new serum biomarker panel including 2 proteins [C-reactive protein (CRP), lipopolysaccharide (LBP)] and 3 metabolites [Fasciculol C, PE (14:0/16:1(19Z)), PS (20:0/22:6(4Z, 7Z, 10Z, 13Z, 16Z, 19Z))] was developed to identify CAP and to distinguish severe pneumonia. Pathway analysis of changes revealed activation of the cell death pathway, a dysregulated complement system, coagulation cascade and platelet function, and the inflammatory responses as contributors to tissue damage in children with CAP. Additionally, activation of glycolysis and higher levels of nucleotides led to imbalanced deoxyribonucleotide pools contributing to the development of severe CAP. Finally, dysregulated lipid metabolism was also identified as a potential pathological mechanism for severe progression of CAP.

CONCLUSION

The integrated analysis of the proteome and metabolome might open up new ways in diagnosing and uncovering the complexity of severity of CAP.

Study on the Application of the Concept of Childlike Interest with Refined Nursing Intervention in the Treatment of Children with Severe Pneumonia

Objectives

To analyze the application of childlike concept with refined nursing intervention in the treatment of children with severe pneumonia.

Methods

100 cases of children with severe pneumonia admitted to our hospital from June 2019 to June 2021 were selected and divided into the control group and the observation group, in which the control group was given refined nursing care and the observation group was given the childlike concept with refined nursing intervention to compare the treatment effects of patients in both groups. The clinical indexes such as recovery time of body temperature, disappearance time of pulmonary rales, recovery time of heart rate, disappearance time of cough, and hospitalization time, were compared between the two groups.

Results

Compared with the control group, the time to recovery of body temperature, time to disappearance of pulmonary rales, time to recovery of heart rate, time to disappearance of cough, and hospitalization time were significantly lower in the observation group, and the difference was statistically significant (P < 0.05). Compared with the control group, the compliance rate of patients in the observation group was significantly lower, and the difference was statistically significant (P < 0.05). Compared with the control group, the total effective rate of patients in the observation group was significantly higher, and the difference was statistically significant (P < 0.05). Compared with the control group, the overall satisfaction rate of patients in the observation group was significantly higher, and the difference was statistically significant (P < 0.05). The results of univariate analysis showed that the differences between the two groups were statistically significant (P < 0.05) in terms of economic conditions, payment method, child's condition, child's age, comorbid underlying diseases, and nursing care method, and the results of logistic multifactor regression analysis showed that the payment method of self-payment, child's critical condition, and comorbid underlying diseases were the most important factors affecting the anxiety of the family members of children with severe pneumonia. risk factors for the occurrence of anxiety in the families of children with severe pneumonia, and the method of care was a protective factor (P < 0.05).

Conclusion

The concept of childlike fun and refined nursing interventions can effectively improve the treatment effect of children with severe pneumonia, improve patients' condition, increase patients' compliance and satisfaction, and reduce the risk of anxiety and other negative emotions of the child's family members.