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Wang LJ, Li KC, Qian SY, Gao HM, Liu J, Li Z, Jia XL, Fan CN, Wang Q. [Clinical characteristics and prognosis of 8 cases of severe infant botulism]. Zhonghua Er Ke Za Zhi 2024; 62:218-222. [PMID: 38378282 DOI: 10.3760/cma.j.cn112140-20230908-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Objective: To summarize the clinical characteristics and prognosis of severe infant botulism and evaluate the therapeutic effect of botulinum antitoxin in the pediatric intensive care unit (PICU). Methods: The clinical data of 8 cases diagnosed with infantile botulism were retrospectively analyzed in the PICU of Beijing Children's Hospital from October 2019 to August 2023. Data of basic demographic information, clinical manifestations, laboratory tests, treatment and prognosis of each child were collected and analyzed using descriptive statistical methods. Results: Eight laboratory-confirmed cases of infant botulism were included in this study, all of which were male infants with an age of 6.0 (3.3,6.8) months. Three of the children were from Inner Mongolia Autonomous Region, 2 of them were from Hebei, and the other 3 were from Beijing, Shandong and Xinjiang Uyghur Autonomous Region, respectively. All the patients were previously healthy. In 4 of these cases, the possible cause was the ingestion of either honey and its products or sealed pickled food by the mother or child before the onset of the disease. The first symptom was poor milk intake (4 cases), followed by shallow shortness of breath (7 cases), limb weakness (7 cases) and so on. The typical signs were bilateral dilated pupils (8 cases) and decreased limb muscle strength (8 cases). The main subtype was type B (7 cases), and only 1 case was classified as type A. Six of the children were treated with antitoxin therapy for a duration of 24 (19, 49) d. Seven of them had invasive mechanical ventilation. All the patients survived upon discharge with a follow-up period of 29 d to 3 years and 8 months. Six patients had fully recovered, and 2 recently discharged patients were gradually recovering. Conclusions: For infants with suspected contact or ingestion of botulinum and presented with bilateral pupillary paralysis, muscle weakness and clear consciousness, the stool should be collected for diagnostic testing using a mouse bioassay as soon as possible. Type B was the most common type. The antitoxin treatment was effectiveness and the prognosis was well.
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Affiliation(s)
- L J Wang
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - K C Li
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - H M Gao
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - J Liu
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Z Li
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - X L Jia
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - C N Fan
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Q Wang
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Liu G, Zhang CM, Li Y, Sun JY, Cheng YB, Chen YP, Wang ZH, Ren H, Liu CF, Jin YP, Chen S, Wang XM, Xu F, Xu XZ, Zhu QJ, Wang XD, Liu XH, Liu Y, Hu Y, Wang W, Ai Q, Dang HX, Gao HM, Fan CN, Qian SY. [Respiratory virus infection and its influence on outcome in children with septic shock]. Zhonghua Er Ke Za Zhi 2024; 62:211-217. [PMID: 38378281 DOI: 10.3760/cma.j.cn112140-20231014-00286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Objective: To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes. Methods: The clinical data of children with septic shock in children's PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results: A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs (OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions: The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.
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Affiliation(s)
- G Liu
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - C M Zhang
- Department of Pediatric Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Y Li
- Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Soochow University, Suzhou 215025, China
| | - J Y Sun
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - Y B Cheng
- Department of Pediatric Intensive Care Unit, Henan Children's Hospital, Zhengzhou 450018, China
| | - Y P Chen
- Department of Pediatric Intensive Care Unit, Baoding Children's Hospital, Baoding 071051, China
| | - Z H Wang
- Department of Pediatric Intensive Care Unit, Baoding Children's Hospital, Baoding 071051, China
| | - H Ren
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - C F Liu
- Department of Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Y P Jin
- Department of Pediatric Intensive Care Unit, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - S Chen
- Department of Pediatric Intensive Care Unit, Tianjin Children's Hospital, Tianjin 300074, China
| | - X M Wang
- Department of Hematology, Tianjin Children's Hospital, Tianjin 300074, China
| | - F Xu
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - X Z Xu
- Department of Pediatric Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Q J Zhu
- Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Soochow University, Suzhou 215025, China
| | - X D Wang
- Department of Pediatric Intensive Care Unit, Henan Children's Hospital, Zhengzhou 450018, China
| | - X H Liu
- Department of Pediatric Intensive Care Unit, Baoding Children's Hospital, Baoding 071051, China
| | - Y Liu
- Department of Pediatric Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Y Hu
- Department of Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - W Wang
- Department of Pediatric Intensive Care Unit, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Q Ai
- Department of Hematology, Tianjin Children's Hospital, Tianjin 300074, China
| | - H X Dang
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - H M Gao
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - C N Fan
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Xu F, Liu CF, Qian SY. [Analgesia and sedation from comfort to protection of organ function]. Zhonghua Er Ke Za Zhi 2024; 62:193-195. [PMID: 38378278 DOI: 10.3760/cma.j.cn112140-20231130-00401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- F Xu
- Department of Pediatric Critical Care, Children's Hospital of Chongqing Medical University, Chongqing 400014,China
| | - C F Liu
- Department of Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004,China
| | - S Y Qian
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Wang Q, Qian SY. [Neuromonitoring in critically ill children]. Zhonghua Er Ke Za Zhi 2024; 62:286-288. [PMID: 38378295 DOI: 10.3760/cma.j.cn112140-20231221-00448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Q Wang
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Tan N, Li KC, Qian SY. [Application of systemic glucocorticoids in preventing upper airway obstruction after extubation in children]. Zhonghua Er Ke Za Zhi 2023; 61:1136-1139. [PMID: 38018053 DOI: 10.3760/cma.j.cn112140-20230814-00103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Affiliation(s)
- N Tan
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - K C Li
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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6
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Hon KL, Leung KKY, Chan KL, Hui WF, Chau KT, Qian SY. Survival of out-of-hospital cardiac arrest following a return of spontaneous circulation beyond 30 minutes. Hong Kong Med J 2023; 29:564-565. [PMID: 37607868 DOI: 10.12809/hkmj219365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Affiliation(s)
- K L Hon
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - K K Y Leung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - K L Chan
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - W F Hui
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - K T Chau
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing, China
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7
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Hon KL, Fung GPG, Chen RH, Leung KKY, Hui WF, Cheung WL, Chung FS, Qian SY. Extracorporeal membrane oxygenation for pulmonary hypoplasia and prematurity: any chance of survival? Hong Kong Med J 2023; 29:561-562. [PMID: 38016921 DOI: 10.12809/hkmj219831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Affiliation(s)
- K L Hon
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - G P G Fung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - R H Chen
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - K K Y Leung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - W F Hui
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - W L Cheung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - F S Chung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Fang BL, Liu G, Qian SY, Zeng JS. [Interpretation of the second edition of pediatric acute respiratory distress syndrome consensus]. Zhonghua Er Ke Za Zhi 2023; 61:978-982. [PMID: 37899336 DOI: 10.3760/cma.j.cn112140-20230712-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- B L Fang
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - G Liu
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - J S Zeng
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Liu G, Qian SY, Liu J. [Progress in the application of targeted monoclonal antibodies in children with hemophagocytic syndrome]. Zhonghua Er Ke Za Zhi 2023; 61:945-948. [PMID: 37803867 DOI: 10.3760/cma.j.cn112140-20230515-00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Affiliation(s)
- G Liu
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - J Liu
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Yue G, Cao YL, Ying D, Hongchang Z, Qian SY, De Long Z, Qiang CG, Bei J, Ting WW, Mingke L. Transcriptome Profiling of Male Adult Angiostrongylus cantonensis. Iran J Parasitol 2023; 18:382-389. [PMID: 37886258 PMCID: PMC10597880 DOI: 10.18502/ijpa.v18i3.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/09/2023] [Indexed: 10/28/2023]
Abstract
Background The pathogen of angiostrongyliasis is the parasite Angiostrongylus cantonensis, and the transcriptome profiling of the male adult was unclear. We aimed to understand how the male adults adapt, so the expression profile of A. cantonensis adult males was analyzed. Methods In order to improve the understanding of the transcriptome of adult males, RNA from three groups of male adult A. cantonensis was extracted and reverse transcribed to construct cDNA libraries. After sequencing, annotation of unigenes and transcripts was performed by querying the NR (Non-Redundant Protein Sequence Database), GO (Gene Ontology) and COG/KOG (Clusters of Orthologous Groups of proteins/euKaryotic Ortholog Groups) databases. Results For each group of adults, 43,260,894 raw reads and 43,200,341 clean reads were obtained. After successful assembly, 87,649 unigenes and 146,895 transcripts were obtained. Annotation of the unigenes and transcripts was identical and male adults expressed a series of genes encoding proteins specific to the male gender at the adult stage, such as proteins involved in energy metabolism, energy synthesis and transport. Expression of the ribosome pathway suggests a relationship with the physical activities during the adult male stage. Conclusion The transcriptome analysis is a good reference to understand further the expression profile of male adult A. cantonensis.
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Affiliation(s)
- Guo Yue
- School of Medicine, Huzhou University & Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou, Zhejiang, China
| | - Yu Liang Cao
- Emergency Department, South Taihu Hospital, Gangnan Road 1566, Huzhou, Zhejiang, China
| | - Dong Ying
- School of Medicine, Huzhou University & Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou, Zhejiang, China
| | - Zhou Hongchang
- School of Medicine, Huzhou University & Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou, Zhejiang, China
| | - Shang Ya Qian
- School of Medicine, Huzhou University & Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou, Zhejiang, China
| | - Zhang De Long
- School of Medicine, Huzhou University & Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou, Zhejiang, China
| | - Chen Gao Qiang
- School of Medicine, Huzhou University & Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou, Zhejiang, China
| | - Jiang Bei
- School of Medicine, Huzhou University & Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou, Zhejiang, China
| | - Wu Wan Ting
- School of Medicine, Huzhou University & Key Laboratory of Vector Biology and Pathogen Control of Zhejiang Province, Huzhou, Zhejiang, China
| | - Lu Mingke
- School of Life Sciences, Xiamen University, Fujian, China
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Fang BL, Xu F, Lu GP, Ren XX, Zhang YC, Jin YP, Wang Y, Liu CF, Cheng YB, Yang QZ, Xiao SF, Yang YY, Huo XM, Lei ZX, Dang HX, Liu S, Wu ZY, Li KC, Qian SY, Zeng JS. [Analysis of risk factors of mortality in infants and toddlers with moderate to severe pediatric acute respiratory distress syndrome]. Zhonghua Er Ke Za Zhi 2023; 61:216-221. [PMID: 36849347 DOI: 10.3760/cma.j.cn112140-20221108-00947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Objective: To identify the risk factors in mortality of pediatric acute respiratory distress syndrome (PARDS) in pediatric intensive care unit (PICU). Methods: Second analysis of the data collected in the "efficacy of pulmonary surfactant (PS) in the treatment of children with moderate to severe PARDS" program. Retrospective case summary of the risk factors of mortality of children with moderate to severe PARDS who admitted in 14 participating tertiary PICU between December 2016 to December 2021. Differences in general condition, underlying diseases, oxygenation index, and mechanical ventilation were compared after the group was divided by survival at PICU discharge. When comparing between groups, the Mann-Whitney U test was used for measurement data, and the chi-square test was used for counting data. Receiver Operating Characteristic (ROC) curves were used to assess the accuracy of oxygen index (OI) in predicting mortality. Multivariate Logistic regression analysis was used to identify the risk factors for mortality. Results: Among 101 children with moderate to severe PARDS, 63 (62.4%) were males, 38 (37.6%) were females, aged (12±8) months. There were 23 cases in the non-survival group and 78 cases in the survival group. The combined rates of underlying diseases (52.2% (12/23) vs. 29.5% (23/78), χ2=4.04, P=0.045) and immune deficiency (30.4% (7/23) vs. 11.5% (9/78), χ2=4.76, P=0.029) in non-survival patients were significantly higher than those in survival patients, while the use of pulmonary surfactant (PS) was significantly lower (8.7% (2/23) vs. 41.0% (32/78), χ2=8.31, P=0.004). No significant differences existed in age, sex, pediatric critical illness score, etiology of PARDS, mechanical ventilation mode and fluid balance within 72 h (all P>0.05). OI on the first day (11.9(8.3, 17.1) vs.15.5(11.7, 23.0)), the second day (10.1(7.6, 16.6) vs.14.8(9.3, 26.2)) and the third day (9.2(6.6, 16.6) vs. 16.7(11.2, 31.4)) after PARDS identified were all higher in non-survival group compared to survival group (Z=-2.70, -2.52, -3.79 respectively, all P<0.05), and the improvement of OI in non-survival group was worse (0.03(-0.32, 0.31) vs. 0.32(-0.02, 0.56), Z=-2.49, P=0.013). ROC curve analysis showed that the OI on the thind day was more appropriate in predicting in-hospital mortality (area under the curve= 0.76, standard error 0.05,95%CI 0.65-0.87,P<0.001). When OI was set at 11.1, the sensitivity was 78.3% (95%CI 58.1%-90.3%), and the specificity was 60.3% (95%CI 49.2%-70.4%). Multivariate Logistic regression analysis showed that after adjusting for age, sex, pediatric critical illness score and fluid load within 72 h, no use of PS (OR=11.26, 95%CI 2.19-57.95, P=0.004), OI value on the third day (OR=7.93, 95%CI 1.51-41.69, P=0.014), and companied with immunodeficiency (OR=4.72, 95%CI 1.17-19.02, P=0.029) were independent risk factors for mortality in children with PARDS. Conclusions: The mortality of patients with moderate to severe PARDS is high, and immunodeficiency, no use of PS and OI on the third day after PARDS identified are the independent risk factors related to mortality. The OI on the third day after PARDS identified could be used to predict mortality.
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Affiliation(s)
- B L Fang
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045,China
| | - F Xu
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing 400014,China
| | - G P Lu
- Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai 201102,China
| | - X X Ren
- Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020,China
| | - Y C Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200062,China
| | - Y P Jin
- Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021,China
| | - Y Wang
- Department of Pediatric Critical Care Medicine Unit, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127,China
| | - C F Liu
- Department of Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004,China
| | - Y B Cheng
- Department of Pediatric Intensive Care Unit, Henan Children's Hospital, Zhengzhou 450000,China
| | - Q Z Yang
- Department of Pediatric Intensive Care Unit, Liaocheng People's Hospital, Liaocheng 252000,China
| | - S F Xiao
- Department of Pediatric Intensive Care Unit, Kunming Children's Hospital, Kunming 650034,China
| | - Y Y Yang
- Department of Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou 510623,China
| | - X M Huo
- Department of Pediatric Intensive Care Unit, Hebei Children's Hospital, Shijiazhuang 050031,China
| | - Z X Lei
- Department of Pediatric Intensive Care Unit, Hainan Women and Children's Medical Center, Haikou 570206, China
| | - H X Dang
- Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing 400014,China
| | - S Liu
- Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020,China
| | - Z Y Wu
- Department of Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou 510623,China
| | - K C Li
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045,China
| | - S Y Qian
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045,China
| | - J S Zeng
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045,China
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Qian SY, Ellis JL. [Paying attention to the identification and prevention of severe respiratory syncytial virus infections in children]. Zhonghua Er Ke Za Zhi 2023; 61:193-195. [PMID: 36849342 DOI: 10.3760/cma.j.cn112140-20221103-00931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- S Y Qian
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - J L Ellis
- Department of Pediatrics and Adolescent Medicine, the Hong Kong Children's Hospital, Hong Kong SAR 999077, China
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13
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Wang ZH, Liu G, Fan CN, Wang XD, Liu XH, Su J, Gao HM, Qian SY, Li Z, Cheng YB. [Diagnosis and treatment of pediatric septic shock in pediatric intensive care units from hospitals of different levels]. Zhonghua Er Ke Za Zhi 2023; 61:209-215. [PMID: 36849346 DOI: 10.3760/cma.j.cn112140-20221028-00916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Objective: To investigate the differences in clinical characteristics, diagnosis, and treatment of pediatric septic shock in pediatric intensive care unit (PICU) among hospitals of different levels. Methods: This retrospective study enrolled 368 children with septic shock treated in the PICU of Beijing Children's Hospital, Henan Children's Hospital, and Baoding Children's Hospital from January 2018 to December 2021. Their clinical data were collected, including the general information, location of onset (community or hospital-acquired), severity, pathogen positivity, consistence of guideline (the rate of standard attainment at 6 h after resuscitation and the rate of anti-infective drug administration within 1 h after diagnosis), treatment, and in-hospital mortality. The 3 hospitals were national, provincial, and municipal, respectively. Furthermore, the patients were divided into the tumor group and the non-tumor group, and into the in-hospital referral group and the outpatient or emergency admission group. Chi-square test and Mann-Whitney U test were used to analyze the data. Results: The 368 patients aged 32 (11, 98) months, of whom 223 were males and 145 females. There were 215, 107, and 46 patients with septic shock, with males of 141, 51, and 31 cases, from the national, provincial, and municipal hospitals, respectively. The difference in pediatric risk of mortality Ⅲ (PRISM Ⅲ) scores among the national,provincial and municipal group was statistically significant (26(19, 32) vs.19(12, 26) vs. 12(6, 19), Z=60.25,P<0.001). The difference in community acquired septic shock among the national,provincial and municipal group was statistically significant (31.6%(68/215) vs. 84.1%(90/107) vs. 91.3%(42/46), χ2=108.26,P<0.001). There were no significant differences in compliance with guidelines among the 3 groups (P>0.05). The main bacteria detected in the national group were Klebsiella pneumoniae (15.4% (12/78)) and Staphylococcus aureus (15.4% (12/78)); in the provincial group were Staphylococcus aureus (19.0% (12/63)) and Pseudomonas aeruginosa (12.7% (8/63)), and in the municipal group were Streptococcus pneumoniae (40.0% (10/25)) and Enteric bacilli (16.0% (4/25)). The difference in the proportion of virus and the proportion of 3 or more initial antimicrobials used among the national,provincial and municipal group was statistically significant (27.7% (43/155) vs. 14.9% (13/87) vs. 9.1% (3/33), 22.8%(49/215) vs. 11.2%(12/107) vs. 6.5%(3/46), χ2=8.82, 10.99, both P<0.05). There was no difference in the in-hospital mortality among the 3 groups (P>0.05). Regarding the subgroups of tumor and non-tumor, the national group had higher PRISM Ⅲ (31(24, 38) vs. 22 (21, 28) vs.16 (9, 22), 24 (18, 30) vs. 17(8, 24) vs. 10 (5, 16), Z=30.34, 10.45, both P<0.001), and it was the same for the subgroups of in-hospital referral and out-patient or emergency admission (29 (21, 39) vs. 23 (17, 30) vs. 15 (10, 29), 23 (17, 29) vs. 18 (10, 24) vs. 11 (5, 16), Z=20.33, 14.25, both P<0.001) as compared to the provincial and municipal group. There was no significant difference in the in-hospital mortality among the 2 pairs of subgroups (all P>0.05). Conclusion: There are differences in the severity, location of onset, pathogen composition, and initial antibiotics of pediatric septic shock in children's hospitals of different levels, but no differences in compliance with guidelines and in-hospital survival rate.
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Affiliation(s)
- Z H Wang
- Baoding Research Laboratory of Pediatric Severe Infectious Diseases, Department of Pediatric Intensive Care Medicine, Baoding Children's Hospital, Baoding 071051, China
| | - G Liu
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - C N Fan
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - X D Wang
- Department of Pediatric Intensive Care Unit, Henan Children's Hospital, Zhengzhou 450000, China
| | - X H Liu
- Baoding Research Laboratory of Pediatric Severe Infectious Diseases, Department of Pediatric Intensive Care Medicine, Baoding Children's Hospital, Baoding 071051, China
| | - J Su
- Department of Pediatric Intensive Care Unit, Henan Children's Hospital, Zhengzhou 450000, China
| | - H M Gao
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Z Li
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Y B Cheng
- Department of Pediatric Intensive Care Unit, Henan Children's Hospital, Zhengzhou 450000, China
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14
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Hon KL, Leung KKY, Wong JCP, Qian SY, Ip P. Ethical dilemmas in critically ill children in Hong Kong. Hong Kong Med J 2023; 29:84-85. [PMID: 36810245 DOI: 10.12809/hkmj208875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Affiliation(s)
- K L Hon
- Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - K K Y Leung
- Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - J C P Wong
- Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - P Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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15
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Liu G, Zheng YLC, Tan N, Wang LJ, Liu YC, Gao HM, Qian SY. [Application of initial anti-infectives and trends in children with septic shock]. Zhonghua Er Ke Za Zhi 2022; 60:1288-1294. [PMID: 36444432 DOI: 10.3760/cma.j.cn112140-20220511-00443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective: To investigate the pathogen composition, initial anti-infectives and pathogen coverage, and trends over the last 5 years in children with septic shock in pediatric intensive care unit (PICU). Methods: The single-center retrospective study included 257 children with septic shock who were admitted to PICU of Beijing Children's Hospital, Capital Medical University from 2017 to 2021. The causitive pathogen composition, initial use of anti-infective drugs, pathogen coverage, and changes in recent years were analyzed. The children were divided into sufficient and insufficient coverage groups according to whether the pathogen were sufficiently covered by initial anti-infectives; community-and hospital-acquired groups; and with and without underlying disease groups. T test, rank-sum test and Chi-square test were used for comparison between the groups to investigate the differences in pathogen, treatment and prognosis. Results: A total of 257 septic shock children were included, with 162 males and 95 females, aged 36 (12, 117) months. The pathogen positive rate was 64.6% (166/257) and the in-hospital mortality was 27.6% (71/257). In the 208 pathogen-positive samples, bacteria was the most common (57.7%, 120/208) with G-negative bacteria predominating (55.8%, 67/120), followed by viruses (26.0%, 54/208). Nearly 99.2% (255/257) of the children were treated with antibacterial at the beginning, of whom 47.1% (121/257) were treated with carbapenems combined with vancomycin or linezolid. The proportion of 3 or more antibacterial combinations was higher in children with underlying diseases and hospital-acquired septic shock than in those without underlying disease or community-acquired septic shock (27.4% (49/179) vs. 14.1% (11/78), 29.4% (52/177) vs. 10.0% (8/80), χ2=5.35,11.56,all P<0.05). The proportion of initial combination of carbapenem and vancomycin or linezolid reduced from 52.5% (21/40) to 41.3% (19/46), and of adequate pathogen coverage increased from 40.0% (16/40) to 58.7% (27/46) in the last five years. Conclusions: The initial use of antibacterial drugs is common in children with septic shock in PICU, especially in those with hospital-acquired septic shock and underlying diseases. In recent years, antimicrobial combinations have decreased, but the pathogen coverage has improved, indicating that drug selection is more reasonable and accurate.
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Affiliation(s)
- G Liu
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Y L C Zheng
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - N Tan
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - L J Wang
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Y C Liu
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - H M Gao
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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16
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Wang YQ, Su C, Qian SY, Hao RL, Guo Y, Xu Y. [Two cases of lymphatic malformation-6 caused by new variation in PIEZO1 gene]. Zhonghua Er Ke Za Zhi 2022; 60:1219-1221. [PMID: 36319164 DOI: 10.3760/cma.j.cn112140-20220401-00264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Y Q Wang
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - C Su
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - R L Hao
- Genetics and Birth Defects Control Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing 100045, China
| | - Y Guo
- Genetics and Birth Defects Control Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory for Genetics of Birth Defects, Beijing Pediatric Research Institute, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing 100045, China
| | - Yan Xu
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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17
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Li RB, He XH, Fang BL, Yang Y, Yao KH, Qian SY. [Clinical and molecular characteristics of Streptococcus pneumoniae-associated hemophagocytic lymphohistiocytosis in children]. Zhonghua Er Ke Za Zhi 2022; 60:209-214. [PMID: 35240740 DOI: 10.3760/cma.j.cn112140-20211027-00908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To summarize the clinical features of Streptococcus pneumoniae-associated hemophagocytic syndrome (SP-HLH), and the serotypes and drug-resistant characteristics of the isolated strains. Methods: There were 15 children with SP-HLH admitted to the Pediatric Intensive Care Unit (PICU) of Beijing Children's Hospital, Capital Medical University from January 2013 to December 2020 were included in this study. Clinical data including children's general characteristics, clinical features, laboratory examinations, treatments, prognosis and the outcomes of follow-up by May 2021 were analyzed retrospectively. The serotypes and drug resistance of the isolated strains were identified. All children were divided into the clinical improvement group and the death group. Mann-Whitney U test, Fisher's exact test were used to compare the data of the two groups. Results: Among the 15 children with SP-HLH, 8 were males and 7 were females. The age of these children was 1.0 (1.0, 2.5) years. Regarding the primary infection, there were 9 cases of severe pneumonia, 3 cases of meningitis and 3 cases of blood stream infection. None of these children had received pneumoniae conjugate vaccine (PCV) and all of them were admitted to the PICU. Respiratory failure was observed in 10 patients, acute renal injury in 5, and hemolytic uremic syndrome in 3 patients. All children received glucocorticoids and high-dose intravenous immunogloblin (IVIG) in addition to anti-infective treatment. Eight of the children were cured while the other 7 died. The neutrophil count in the death group was lower than that in the clinical improvement group ((5.0 (1.7, 9.3) × 109 vs. 5.2 (3.4, 10.5) ×109/L, Z =-2.43, P<0.015), and the length of hospital stay and days of PICU stay in the death group were both shorter than those in the improvement group statistically (3 (1, 11) vs. 39 (34, 48) d, 2 (1, 4) vs. 19 (12, 31) d, Z=-3.25, -3.24, both P=0.001). Ten serotypes of Streptococcus pneumoniae were identified, including 4 strains of 19F, 3 of 19A, 1 of 23F, 1 of 15A and 1 of 14, among which 9 strains (9/10) were covered by PCV13. All strains were resistant to erythromycin yet sensitive to vancomycin and linezolid. Conclusions: SP-HLH is more common in children under the age of 3, with a high mortality rate. The death cases have lower neutrophil count and rapid disease progression. The comprehensive treatment is anti-infective combined with glucocorticoids and high-dose IVIG. The predominant serotypes are 19F and 19A and all isolated strains were susceptible to vancomycin and linezolid.
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Affiliation(s)
- R B Li
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - X H He
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - B L Fang
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Y Yang
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - K H Yao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Laboratory of Drmatology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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18
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Liu G, Chu JP, Chen JL, Qian SY, Jin DQ, Lu XL, Xu MX, Cheng YB, Sun ZY, Miao HJ, Li J, Dong SY, Ding X, Wang Y, Chen Q, Duan YY, Huang JT, Guo YM, Shi XN, Su J, Yin Y, Xin XW, Zhao SD, Lou ZX, Jiang JH, Zeng JS. [Effect and influence factors of cardiopulmonary resuscitation in children with congenital heart disease in pediatric intensive care unit]. Zhonghua Er Ke Za Zhi 2022; 60:197-202. [PMID: 35240738 DOI: 10.3760/cma.j.cn112140-20211116-00962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To investigate the prognostic factors of children with congenital heart disease (CHD) who had undergone cardiopulmonary resuscitation (CPR) in pediatric intensive care unit (PICU) in China. Methods: From November 2017 to October 2018, this retrospective multi-center study was conducted in 11 hospitals in China. It contained data from 281 cases who had undergone CPR and all of the subjects were divided into CHD group and non-CHD group. The general condition, duration of CPR, epinephrine doses during resuscitation, recovery of spontaneous circulation (ROSC), discharge survival rate and pediatric cerebral performance category in viable children at discharge were compared. According to whether malignant arrhythmia is the direct cause of cardiopulmonary arrest or not, children in CHD and non-CHD groups were divided into 2 subgroups: arrhythmia and non-arrhythmia, and the ROSC and survival rate to discharge were compared. Data in both groups were analyzed by t-test, chi-square analysis or ANOVA, and logistic regression were used to analyze the prognostic factors for ROSC and survival to discharge after cardiac arrest (CA). Results: The incidence of CA in PICU was 3.2% (372/11 588), and the implementation rate of CPR was 75.5% (281/372). There were 144 males and 137 females with median age of 32.8 (5.6, 42.7) months in all 281 CPA cases who received CPR. CHD group had 56 cases while non-CHD had 225 cases, with the percentage of 19.9% (56/281) and 80.1% (225/281) respectively. The proportion of female in CHD group was 60.7% (34/56) which was higher than that in non-CHD group (45.8%, 103/225) (χ2=4.00, P=0.045). There were no differences in ROSC and rate of survival to discharge between the two groups (P>0.05). The ROSC rate of children with arthythmid in CHD group was 70.0% (28/40), higher than 6/16 for non-arrhythmic children (χ2=5.06, P=0.024). At discharge, the pediatric cerebral performance category scores (1-3 scores) of CHD and non-CHD child were 50.9% (26/51) and 44.9% (92/205) respectively. Logistic regression analysis indicated that the independent prognostic factors of ROSC and survival to discharge in children with CHD were CPR duration (odds ratio (OR)=0.95, 0.97; 95%CI: 0.92~0.97, 0.95~0.99; both P<0.05) and epinephrine dosage (OR=0.87 and 0.79, 95%CI: 0.76-1.00 and 0.69-0.89, respectively; both P<0.05). Conclusions: There is no difference between CHD and non-CHD children in ROSC and survival rate of survival to discharge was low. The epinephrine dosage and the duration of CPR are related to the ROSC and survival to discharge of children with CHD.
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Affiliation(s)
- G Liu
- Pediatric Intensive Care Unit,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - J P Chu
- Pediatric Intensive Care Unit, Xian Children's Hospital, Xi'an 710003, China
| | - J L Chen
- Pediatric Intensive Care Unit, Guiyang Maternal and Child Health Care Hospital, Guiyang 550000, China
| | - S Y Qian
- Pediatric Intensive Care Unit,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - D Q Jin
- Pediatric Intensive Care Unit, Anhui Children's Hospital, Hefei 230000, China
| | - X L Lu
- Pediatric Intensive Care Unit, Children's Hospital of Hunan Province, Changsha 410000, China
| | - M X Xu
- Pediatric Intensive Care Unit, Hebei Children's Hospital, Shijiazhuang 050000, China
| | - Y B Cheng
- Pediatric Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, China
| | - Z Y Sun
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China
| | - H J Miao
- Emergency Ward/Pediatric Intensive Care Unit, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
| | - J Li
- Pediatric Intensive Care Unit, Jinan Children's Hospital, Jinan 250000, China
| | - S Y Dong
- Pediatric Intensive Care Unit, Liaocheng People's Hospital, Liaocheng 252000, China
| | - X Ding
- Pediatric Intensive Care Unit,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Y Wang
- Pediatric Intensive Care Unit, Xian Children's Hospital, Xi'an 710003, China
| | - Q Chen
- Pediatric Intensive Care Unit, Guiyang Maternal and Child Health Care Hospital, Guiyang 550000, China
| | - Y Y Duan
- Pediatric Intensive Care Unit, Anhui Children's Hospital, Hefei 230000, China
| | - J T Huang
- Pediatric Intensive Care Unit, Children's Hospital of Hunan Province, Changsha 410000, China
| | - Y M Guo
- Pediatric Intensive Care Unit, Hebei Children's Hospital, Shijiazhuang 050000, China
| | - X N Shi
- Pediatric Intensive Care Unit, Hebei Children's Hospital, Shijiazhuang 050000, China
| | - J Su
- Pediatric Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, China
| | - Y Yin
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China
| | - X W Xin
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, China
| | - S D Zhao
- Emergency Ward/Pediatric Intensive Care Unit, Children's Hospital of Nanjing Medical University, Nanjing 210000, China
| | - Z X Lou
- Pediatric Intensive Care Unit, Jinan Children's Hospital, Jinan 250000, China
| | - J H Jiang
- Pediatric Intensive Care Unit, Liaocheng People's Hospital, Liaocheng 252000, China
| | - J S Zeng
- Pediatric Intensive Care Unit,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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19
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Xu WM, Gao HM, Liu YC, Wang LJ, Qian SY. [Clinical analysis of 6 critically ill children with acute chlorine poisoning]. Zhonghua Er Ke Za Zhi 2022; 60:124-128. [PMID: 35090229 DOI: 10.3760/cma.j.cn112140-20210723-00622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To analyze the clinical characteristics and treatment of critically ill children with acute chlorine poisoning and explore the risk factors and effective strategies. Methods: This retrospective study collected the clinical data, including general state, clinical characteristics, treatment and follow-up(till 1 year and 6 months after discharge), of 6 critically ill children who were hospitalized in the Pediatric Intensive Care Unit of Beijing Children's Hospital due to acute chlorine poisoning in August 2019. Results: There were 6 children characterized by severe dyspnea in this accident, among whom 4 were boys and two girls, aged 4-12 years. When the accident occurred, they were within 5 m of the chlorine source. These patients underwent tracheal intubation and mechanical ventilation in 3.5-7.0 h after poisoning. The child who was the closest to the chlorine source (1.5 m) and took the longest time (5 min) to evacuate was the most severe one. He suffered hypoxia which could not be corrected by conventional mechanical ventilation and severe shock, then had veno-arterial extracorporeal membrane oxygenation(ECMO) treatment started 10 h after the accident. All the 6 children in this study survived. Following-up found no growth and developmental abnormality. The pulmonary function tests were normal except for one case with increased small airway resistance due to previous suspected asthma, and the lung CT, electhoencephalogram, and brain magnetic resonance imaging were all normal. Conclusions: Severe chlorine poisoning is mainly characterized by respiratory failure. Mechanical ventilation is often required within a few hours after poisoning. When conventional mechanical ventilation is ineffective, ECMO could save live. Timely treatment could improve prognosis.
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Affiliation(s)
- W M Xu
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - H M Gao
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Y C Liu
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - L J Wang
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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20
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Qian SY, Li XZ, Zhou J, Liu L, Xie JF, Huang YZ, Li XQ. [The implementation of hour-1 bundle for sepsis in medical staff]. Zhonghua Nei Ke Za Zhi 2022; 61:104-107. [PMID: 34979779 DOI: 10.3760/cma.j.cn112138-20210220-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To determine the physicians'compliance of hour-1 bundle for sepsis. A management system of hour-1 bundle for sepsis was established. The clinical data of 286 sepsis patients were collected, who were classified into 3 months before the bundle (control group), 9 months during process (observation group) and 3 months after bundle (study group). The compliance of hour-1 bundle implementation was compared in three groups. The results showed that with the application and implementation of the management system, the compliance of hour-1 bundle for sepsis in the control group, observation group and study group was 58.3%(28/48), 69.1%(105/152) and 88.4%(76/86) respectively (χ2=7.053,P=0.029). The 28 day mortality in sepsis patients was 41.7%(20/48), 34.9%(53/152) and 23.3%(20/86) respectively (χ2=5.576,P=0.062).The management system of hour-1 bundle for sepsis can effectively improve the physicians' compliance.
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Affiliation(s)
- S Y Qian
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University,Jiangsu Provincial Key Laboratory of Critical Care Medicine, Nanjing 210009, China
| | - X Z Li
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University,Jiangsu Provincial Key Laboratory of Critical Care Medicine, Nanjing 210009, China
| | - J Zhou
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University,Jiangsu Provincial Key Laboratory of Critical Care Medicine, Nanjing 210009, China
| | - L Liu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University,Jiangsu Provincial Key Laboratory of Critical Care Medicine, Nanjing 210009, China
| | - J F Xie
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University,Jiangsu Provincial Key Laboratory of Critical Care Medicine, Nanjing 210009, China
| | - Y Z Huang
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University,Jiangsu Provincial Key Laboratory of Critical Care Medicine, Nanjing 210009, China
| | - X Q Li
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University,Jiangsu Provincial Key Laboratory of Critical Care Medicine, Nanjing 210009, China
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21
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Li KC, Wang LJ, Liu G, Jin P, Wang YQ, Zhang T, Xu MX, Liu CY, Gao HM, Zhou T, Liu CF, Qian SY. [Analysis of 39 children with acute necrotizing encephalopathy]. Zhonghua Er Ke Za Zhi 2021; 59:582-587. [PMID: 34405641 DOI: 10.3760/cma.j.cn112140-20210208-00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the risk factors for death in children with acute necrotizing encephalopathy (ANE) in pediatric intensive care unit (PICU). Methods: This was a multicenter retrospective study. Thirty-nine children with ANE were from PICUs in 4 centers from December 1, 2014 to December 1, 2020. The 4 participating centers were Beijing Children's Hospital, Shengjing Hospital of China Medical University, Hebei Children's Hospital, and Bao'an Maternity & Child Health Hospital. Patients were divided into survival and non-survival groups by the outcome at discharge, and the differences in clinical data between the two groups were compared. Risk factors for death in children with ANE and the odds ratios (OR) were analyzed by univariable Logistic regression. Results: Thirty-nine children with ANE were included. There were 18 males and 21 females. The median onset age was 30 months. The mortality at discharge was 41% (16/39). The onset age of most patients (74%, 29/39) was younger than 4 years old. Influenza virus was the most common precursor infection (80%, 20/25). Patients with shock at PICU admission were more common in the non-survival group (12/16 vs. 17% (4/23), P=0.001). Glasgow coma score (GCS) at PICU admission was significantly lower in the non-survival group than survival group (3 (3, 6) vs. 6 (5, 7), Z=-2.598, P=0.009). The optimal cut-off value was 4. The proportion of patients with GCS ≤ 4 at PICU admission was higher in the non-survival group (10/16 vs. 22% (5/23), P=0.018). ANE severity score (ANE-SS) at PICU admission was significantly higher in the non-survival group (5 (2, 6) vs. 2 (1, 4), Z=-2.436, P=0.015). The proportion of patients with high risk ANE-SS was higher in non-survival group than the survival group (9/16 vs. 22% (5/23), P=0.043). The proportion of application of high-dose methylprednisolone (20 mg/(kg·d)) was significantly higher in survival group than non-survival group (43% (10/23) vs. 1/13, P=0.031). Univariable Logistic regression indicated that risk factors for death in children with ANE were shock (OR=14.250, 95%CI 2.985-68.018, P=0.001), GCS≤4 (OR=6.000, 95%CI 1.456-24.733, P=0.013) and high risk ANE-SS (OR=4.629, 95%CI 1.142-18.752, P=0.032) at PICU admission. Conclusions: ANE usually occurs in children under 4 years old after influenza infection. Shock, GCS≤4 and high risk ANE-SS at PICU admission were risk factors for death in children with ANE. High-dose methylprednisolone may improve the prognosis of children with ANE.
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Affiliation(s)
- K C Li
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - L J Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - G Liu
- Pediatric Intensive Care Unit, Hebei Children's Hospital, Hebei Medical University, Shijiazhuang 050031, China
| | - P Jin
- Pediatric Intensive Care Unit, Bao'an Maternity & Child Health Hospital, Shenzhen 518133, China
| | - Y Q Wang
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - T Zhang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - M X Xu
- Pediatric Intensive Care Unit, Hebei Children's Hospital, Hebei Medical University, Shijiazhuang 050031, China
| | - C Y Liu
- Pediatric Intensive Care Unit, Bao'an Maternity & Child Health Hospital, Shenzhen 518133, China
| | - H M Gao
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - T Zhou
- Pediatric Intensive Care Unit, Bao'an Maternity & Child Health Hospital, Shenzhen 518133, China
| | - C F Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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22
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Lu GP, Liu CF, Qian SY. [Continuous blood purification in critically ill children: improvement and standardization]. Zhonghua Er Ke Za Zhi 2021; 59:349-351. [PMID: 33902217 DOI: 10.3760/cma.j.cn112140-20210302-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- G P Lu
- Pediatric Intensive Care Unit, Children's Hospital of Fudan University,Shanghai 201102, China
| | - C F Liu
- Pediatric Intensive Care Unit, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hosptial, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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23
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He YS, Yang M, Qian SY. [Predictive role of cytokines in children with refractory mycoplasma pneumoniae pneumonia]. Zhonghua Er Ke Za Zhi 2021; 59:422-425. [PMID: 33902231 DOI: 10.3760/cma.j.cn112140-20201125-01056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Y S He
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - M Yang
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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24
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Gao HM, Liu J, Qian SY. [Approach to diagnosis and treatment of hyperlactatemia]. Zhonghua Er Ke Za Zhi 2021; 59:345-347. [PMID: 33775060 DOI: 10.3760/cma.j.cn112140-20210202-00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- H M Gao
- Department of Pediatric Critical Care Medicine, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - J Liu
- Department of Pediatric Critical Care Medicine, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Department of Pediatric Critical Care Medicine, Beijing Children's Hospital, Capital Medical University; National Center for Children's Health, Beijing 100045, China
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25
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Li GY, Zhang RY, Pang MF, Liang ZR, Yang XP, Wu JW, Li ZJ, Liu G, Song R, Ding J, Wang Q, Qi XP, Qian SY. [Multisystem inflammatory syndrome in children: its current situation and potential direction in prevention and treatment]. Zhonghua Er Ke Za Zhi 2020; 58:780-783. [PMID: 32872722 DOI: 10.3760/cma.j.cn112140-20200611-00611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- G Y Li
- Center for Global Public Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - R Y Zhang
- Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - M F Pang
- Center for Global Public Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Z R Liang
- Center for Global Public Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - X P Yang
- Center for Global Public Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - J W Wu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Z J Li
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - G Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - R Song
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - J Ding
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Q Wang
- Department of Emergency, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - X P Qi
- Center for Global Public Health, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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26
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Zeng JS, Qian SY. [Applicability and influences of pediatric acute respiratory distress syndrome criteria]. Zhonghua Er Ke Za Zhi 2020; 58:949-952. [PMID: 33120473 DOI: 10.3760/cma.j.cn112140-20200323-00297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- J S Zeng
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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27
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Gao HM, Wang LJ, Qian SY, Ren XX, Liu CF, Zhu YM. [A comparative study of four cross-sectional investigations on the status of pediatric intensive care unit in China over the past 30 years]. Zhonghua Er Ke Za Zhi 2020; 58:488-492. [PMID: 32521961 DOI: 10.3760/cma.j.cn112140-20191118-00735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To understand the history, current situation and trends of intensive care unit (ICU) of pediatrics in China over the past 30 years. Methods: The results of the cross-sectional investigation on the status of ICU of pediatrics in 2014 were compared with those in 1993, 2001 and 2009. The main measurements were the number of participated provinces and hospitals, the availability of equipment, staffing, and medical technologies, the major diseases and the source of the patients. Besides, the equipment allocation and technology implementation in 2014 were compared with the standards in the "recommendations on grading construction and management of children's intensive care unit in China" published in 2016. Results: The contents of the four surveys were slightly different, with only a few measurements not documented in one or more surveys. (1) The number of provinces and hospitals involved in the four surveys were 20 hospitals in 14 provinces in year 1993, 27 hospitals in 17 provinces in year 2001, 33 hospitals in 25 provinces in year 2009 and 108 hospitals in 25 provinces in year 2014. (2) In 1993, 2001, 2009 and 2014, the ratio of doctors/beds were 0.7∶1,0.8∶1, (0.4-0.5) ∶1 and 0.5∶1, and the ratio of nurses/beds were 1.1∶1,1.4∶1, (1.1-1.7) ∶1 and 1.3∶1, respectively. (3) Regarding the equipment availability, in 1993, 2001, 2009, and 2014, the numbers of monitors were 0.3/ICU, 0.3/bed, 1.1-1.4/bed and 1.0/bed; the numbers of invasive ventilators were 0.4/bed, 0.5/bed, 0.6/bed and 0.4/bed, respectively. In 2001, 2009 and 2014, there were 60.0%, 100.0% (33/33) and 88.0% (95/108) of the participating ICU equipped with blood gas analyzer, and 70.0%, 93.9% (31/33) and 90.7% (98/108) with bedside X-ray machines, respectively. In 2009 and 2014, 69.7% (23/33) and 92.6% (100/108) ICU were equipped with non-invasive ventilators respectively. In 2014, 10.2% (11/108) ICU were equipped with extracorporeal membrane oxygenation (ECMO) equipment and 45.4% (49/108) ICU with bedside continuous blood purification equipment. In 1993, 2001 and 2014, the numbers of infusion pump were 0.5/ICU, 1.1/bed and 1.7/bed, respectively. (4) Regarding the conducted medical technology, in 2014, invasive mechanical ventilation was used in 100% (108/108) ICU, and non-invasive ventilation in 89.8% (97/108) ICU. High frequency ventilation was used in 78.8% (26/33) and 38.0% (41/108) ICU in 2009 and 2014 respectively. Blood purification was used in 22.0%, 69.7% (23/33) and 47.2% (51/108) ICU, and the application of surfactant was in 48.0%, 97.0% (32/33) and 24.1% (26/108) ICU in 2001, 2009 and 2014, respectively. Nitric oxide inhalation (iNO) was used in 24.0% and 9.3% (10/108) in 2001 and 2014 respectively. ECMO was used in 6 and 7 hospitals in 2009 and 2014 respectively. (5) Compared with the criteria in the "recommendations on grading construction and management of children's intensive care units in China" in 2016, only the availability of monitors and conventional mechanical ventilation in 2014 met the standards.The original data in 2001 was not shown due to the lack of absolute values. Conclusions: The number of ICU of pediatrics and its beds in China increased significantly from 1993 to 2014, as well as the equipment availability and the conducted medical technology. But the status in 2014 was still far behind the recommendations in 2016, with a significant shortage of professional staff.
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Affiliation(s)
- H M Gao
- Pediatric Intensive Care Unit, Beijing Children's Hosptial, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - L J Wang
- Pediatric Intensive Care Unit, Beijing Children's Hosptial, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hosptial, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - X X Ren
- Department of Intensive Care Unit, Beijing Children's Hospital, Capital Institute of Pediatrics, Beijing 100020, China
| | - C F Liu
- Department of PICU, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Y M Zhu
- Hunan Provincial Institute of Emergency Medicine, Changsha 410005, China
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28
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Leung KKY, Hon KL, Qian SY, Cheng FWT. Contrasting evidence for corticosteroid treatment for coronavirus-induced cytokine storm. Hong Kong Med J 2020; 26:269-271. [PMID: 32536610 DOI: 10.12809/hkmj208517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- K K Y Leung
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
| | - K L Hon
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - F W T Cheng
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
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29
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Hon KL, Tse TT, Au CC, Lin WS, Leung TC, Chow TC, Li CK, Cheung HM, Qian SY, Leung AKC. Brain death in children: a retrospective review of patients at a paediatric intensive care unit. Hong Kong Med J 2020; 26:120-126. [PMID: 32285804 DOI: 10.12809/hkmj198126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Among patients in paediatric intensive care units (PICUs), death is sometimes inevitable despite advances in treatment. Some PICU patients may have irreversible cessation of all brain function, which is considered as brain death (BD). This study investigated demographic and clinical differences between PICU patients with BD and those with cardiopulmonary death. METHODS All children who died in the PICU at a university-affiliated trauma centre between October 2002 and October 2018 were included in this retrospective study. Demographics and clinical characteristics were compared between patients with BD and patients with cardiopulmonary death. RESULTS Of the 2784 patients admitted to the PICU during the study period, 127 died (4.6%). Of these 127 deaths, 22 (17.3%) were BD and 105 were cardiopulmonary death. Length of PICU stay was shorter for patients with cardiopulmonary death than for patients with BD (2 vs 8.5 days, P=0.0042). The most common mechanisms of injury in patients with BD were hypoxic-ischaemic injury (40.9%), central nervous system infection (18.2%), and traumatic brain injury (13.6%). The combined proportion of accident and trauma-related injury was greater in patients with BD than in patients with cardiopulmonary death (27.3% vs 3.8%, P<0.001). Organ donation was approved by the families of four of the 22 patients with BD (18.2%) and was performed successfully in three of these four patients. CONCLUSIONS These findings emphasise the importance of injury prevention in childhood, as well as the need for education of the public regarding acceptance of BD and support for organ donation.
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Affiliation(s)
- K L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.,Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Hong Kong
| | - T T Tse
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - C C Au
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Hong Kong
| | - W S Lin
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - T C Leung
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - T C Chow
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - C K Li
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.,Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Hong Kong
| | - H M Cheung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children, Beijing, China
| | - A K C Leung
- Department of Paediatrics, The University of Calgary and The Alberta Children's Hospital, Calgary, Alberta, Canada
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30
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Li KC, Hao CJ, Qian SY, Wang TY. [Progress in the genetics of acute necrotizing encephalopathy in children]. Zhonghua Er Ke Za Zhi 2020; 58:336-338. [PMID: 32234146 DOI: 10.3760/cma.j.cn112140-20190812-00507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- K C Li
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - C J Hao
- Medical Genetics Center of Beijing Pediatric Research Institute, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - T Y Wang
- Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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31
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Qian SY, Hon KL. [Progress in diagnosis and treatment of severe influenza in children]. Zhonghua Er Ke Za Zhi 2020; 58:281-283. [PMID: 32234133 DOI: 10.3760/cma.j.cn112140-20200204-00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - K L Hon
- Department of Pediatrics, Chinese University of Hong Kong, Department of Pediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong 999077, China
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32
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Qian SY, Wang Q, Su YY. [Interpretation of criteria and practical guidance for determination of brain death in children]. Zhonghua Er Ke Za Zhi 2019; 57:826-829. [PMID: 31665835 DOI: 10.3760/cma.j.issn.0578-1310.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Q Wang
- Department of Emergency, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Y Y Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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33
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Zhang XX, Geng ZX, Zhu L, Li MH, Wang YJ, Qian SY, Liu G. [Clinical analysis of children with group B streptococcal meningitis in 2013-2017 in a single center]. Zhonghua Er Ke Za Zhi 2019; 57:452-457. [PMID: 31216803 DOI: 10.3760/cma.j.issn.0578-1310.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical features, the risk factors of mortality and drug resistance of the isolates in patients with group B streptococcus (GBS) meningitis. Methods: A retrospective analysis was performed in 96 children with GBS meningitis (46 males and 50 females) at Beijing Children's Hospital Affiliated to Capital Medical University from January 2013 to October 2017. The clinical characteristics, prognosis and drug resistance were reviewed and analyzed. According to the onset time, the patients were divided into early onset disease (EOD, 0-6 days), late onset disease (LOD, 7-89 days) and very late onset disease (VLOD, 90 days-16 years), the clinical features were compared. According to the results of cranial imaging examination, the patients were divided into two groups: those with neurological complications and those without neurological complications. The influencing factors of neurological complications were analyzed. According to the outcome of 28 days after discharge, patients were divided into death group and survival group. The risk factors of mortality were analyzed by multivariate Logistic regression analysis. Non-numeric variables were analyzed with χ(2) test or Fisher's exact test. Numeric variable between groups were compared with nonparametric test. Results: A total of 96 patients were enrolled, including 18 (19%) EOD, 71 (74%) LOD and 7 (7%) VLOD cases. The median age of EOD cases was 2 days, with a range from 0 to 6 days. The median age of LOD cases was 31 days, with a range from 7 to 81 days. The median age of VLOD cases was 153 days, with a range from 95 to 214 days. Before the onset of the disease, the mother had mastitis in 6 cases and premature rupture of membranes in 6 cases. The common clinical manifestations of patients were fever (95%, 91/96), anorexia (65%, 62/96), seizure (56%, 54/96), and consciousness changes (36%, 35/96). The differences were statistically significant in gender (13/18 vs. 28/71 vs. 5/7, χ(2)=7.705, P=0.024), the number of cases who was admitted to intensive care unit (ICU) (5/18 vs. 31/71 vs. 0, χ(2)=6.065, P=0.042) and peripheral blood leukocyte (12(4, 18)×10(9)/L vs. 6(3, 11)×10(9)/L vs. 13(6, 17)×10(9)/L, H=9.885, P=0.007) in EOD group, LOD group and VLOD group. Cranial imaging was performed in 94 patients, 60 patients (64%) developed neurological complications, including subdural effusion (31/94, 33%), followed by intracranial hemorrhage (26/94, 28%), cerebral softening (19/94, 20%), cerebral atrophy (15/94, 16%), ependinitis (8/94, 9%) and hydrocephalus (4/94, 4%). By univariate χ(2) test analysis, seizure (63% (38/60) vs.41% (14/34), χ(2)=4.310, P=0.038) was a risk factor of neurological complications. Within 28 days after discharge, 88 patients survived and 8 patients died, with a fatality rate of 8%. The independent risk factors for the death were septic shock (OR: 9.548, 95% CI 1.439-63.356, P=0.019) and respiratory failure (OR: 7.053, 95% CI 1.160-42.888, P=0.034). All of isolates were susceptible to penicillin (68/68), ceftriaxone (47/47), cefepime (50/50), vancomycin (60/60) and linezolid (54/54), while the rates of resistance to tetracycline, levofloxacin, clindamycin and erythromycin were 5/12, 17/45, 38/46 and 32/37, respectively. Conclusions: The main type of GBS meningitis is late onset cases. The incidence of neurological complications was high. The independent risk factors for death were septic shock and respiratory failure. The strains were severely resistant to clindamycin and erythromycin.
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Affiliation(s)
- X X Zhang
- Key Laboratory for Major Disease in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Z X Geng
- Key Laboratory for Major Disease in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - L Zhu
- Key Laboratory for Major Disease in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - M H Li
- Key Laboratory for Major Disease in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Y J Wang
- Key Laboratory for Major Disease in Children, Ministry of Education, Neonatal Center, Beijing Children's Hospital, National Center for Children's Health, Beijing 100045, China
| | - S Y Qian
- Key Laboratory for Major Disease in Children, Ministry of Education, Pediatric Intensive Care Unit, Beijing Children's Hospital, National Center for Children's Health, Beijing 100045, China
| | - G Liu
- Key Laboratory for Major Disease in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Song Y, Qian SY, Li Y, Liu J, Li Z, Jia XL, Gao HM, Zeng JS. [Effectiveness and safety of nimodipine in preventing cerebral vasospasm after subarachnoid hemorrhage in children]. Zhonghua Er Ke Za Zhi 2019; 57:338-343. [PMID: 31060125 DOI: 10.3760/cma.j.issn.0578-1310.2019.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effect of prophylactic nimodipine in vasospasm prevention and outcome improvement in children with subarachnoid hemorrhage (SAH). Methods: A prospective, randomized controlled clinical trial which enrolled children with SAH who were admitted to pediatric intensive care unit (PICU) of Beijing Children's Hospital from January 2015 to October 2018 was conducted. A total of 43 patients were randomly divided into nimodipine group (24 patients) and control group (19 patients) according to random number table. Transcranial Doppler (TCD) was used to dynamically monitor blood flow velocity and spectrum monography of bilateral middle cerebral artery (MCA) for vasospasm evaluation. Pediatric cerebral performance category (PCPC) scale was used to evaluate patients' brain function on 28(th) day after discharge. Data were analyzed by t test, Mann-Whitney U test, χ(2) test. Results: Except heart rate ((157±26) vs. (137±34) beats/min, t=2.079, P=0.045), no significant differences existed between the two groups in basic demographic characteristics, primary diseases, and clinical manifestations (all P>0.05). The peak velocities of bilateral MCA on the 5(th) day after admission were significantly lower in nimodipine group (left MCA (136±34) vs. (158±23) cm/s, t=-2.890, P=0.006; right MCA (129±34) vs. (176±27) cm/s, t=-3.717, P=0.001). Likewise, a lower peak velocity of left MCA was observed on the 7(th) day after admission in nimodipine group ((127±45) vs. (152±13) cm/s, t=-2.903, P=0.007), but no significant difference existed in that of right MCA ((131±48) vs. (150±22) cm/s, t=-1.760, P=0.090). Eleven patients suffered from vasospasm, 25% (6/24) in nimodipine group and 26% (5/19) in control group (χ(2)=0.010, P=1.000), within whom 8 patients had complete remission after continuing nimodipine treatment, one died in hospital and the other two's vasospasm still existed at the time of discharge. No significant differences were found between the two groups in mean length of hospitalization, proportion of mechanical ventilation, Glasgow coma scale at discharge, survival rate at discharge or survival rate on 28(t)h day after discharge (all P>0.05). However, nimodipine group had a higher proportion of favorable PCPC brain function (92% (22/24) vs. 63% (12/19), χ(2)=5.208, P=0.030). No side effects such as hypotension, rash or injection site erythema were observed. Conclusion: Prophylactic nimodipine cannot reduce vasospasm incidence in children with SAH but may improve short-term brain function, without any significant safety issues.
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Affiliation(s)
- Y Song
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Xu F, Qian SY. [Interpretation of experts' consensus on sedation and analgesia for children in pediatric intensive care unit of China (2018)]. Zhonghua Er Ke Za Zhi 2019; 57:336-337. [PMID: 31060124 DOI: 10.3760/cma.j.issn.0578-1310.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- F Xu
- Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing 400014, China
| | - S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Affiliation(s)
- X T Chen
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Qian SY, Yang M. [Influenza in children should not be underestimated]. Zhonghua Er Ke Za Zhi 2019; 57:321-323. [PMID: 31060121 DOI: 10.3760/cma.j.issn.0578-1310.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- S Y Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - M Yang
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
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Tang SH, Lu Y, Zhang PS, Liu XH, Du XH, Chen D, Li SY, Cao JJ, Chen LG, Le J, Qian SY, Hong YW, Pei RZ. [Ikaros family zinc finger 1 mutation is a poor prognostic factor for adult Philadelphia chromosome positive acute lymphoblastic leukemia]. Zhonghua Nei Ke Za Zhi 2019; 58:301-306. [PMID: 30917424 DOI: 10.3760/cma.j.issn.0578-1426.2019.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the prognostic impact of Ikaros family zinc finger 1(IKZF1) mutation on adult Philadelphia chromosome (Ph1) positive acute lymphoblastic leukemia (ALL) patients. Methods: IKZF1 mutation was detected in 63 adult Ph1 positive ALL patients at diagnosis using capillary electrophoresis. Recruited patients were treated in our center and other three hospitals in Ningbo from January 2014 to January 2017. Clinical data were collected and retrospectively analyzed. Results: Thirty-nine (61.9%) patients were positive IKZF1 mutation in this cohort. The white blood cell (WBC) count in IKZF1 mutation group was significantly higher than that of mutation negative group [(64.6±11.3)×10(9)/L vs. (33.7±5.6)×10(9)/L, P<0.05]. Patients with WBC count over 30×10(9)/L accounted for 56.4% in IKZF1 mutation group. Complete remission (CR) rate in the IKZF1 mutation group was also lower than that of negative group after induction chemotherapy (64.1% vs. 75.0%, P>0.05). IKZF1 was a negative prognostic factor but not independent factor for survival by univariate and multivariate analyses. Patients were divided into chemotherapy and allogeneic transplantation groups. The 3-year overall survival (OS) rate and 3-year leukemia-free survival (LFS) rate in IKZF1 mutation group were significantly lower than those of negative group in both transplantation group (42.3% vs. 59.3%; 31.2% vs. 50.0%; respectively, both P<0.05) and chemotherapy group (24.8% vs. 40.0%; 19.0% vs. 34.3%; respectively, both P<0.05). Conclusion: IKZF1 mutation is a poor prognostic factor for adult Ph1 positive ALL patients.
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Affiliation(s)
- S H Tang
- Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, China
| | - Y Lu
- Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, China
| | - P S Zhang
- Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, China
| | - X H Liu
- Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, China
| | - X H Du
- Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, China
| | - D Chen
- Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, China
| | - S Y Li
- Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, China
| | - J J Cao
- Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, China
| | - L G Chen
- Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, China
| | - J Le
- Department of Hematology, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo 315040, China
| | - S Y Qian
- Department of Hematology, Ningbo No.2 Hospital, Ningbo 315010, China
| | - Y W Hong
- Department of Hematology, Ningbo Yinzhou No.2 Hospital, Ningbo 315192, China
| | - R Z Pei
- Department of Hematology, Ningbo Yinzhou People's Hospital, Ningbo 315040, China
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Yan GF, Cai XD, Zhou CB, Hong XY, Wang Y, Zhang CM, Yang ZH, Zhang YC, Cui Y, Cui YQ, Cheng YB, Qian SY, Zhang PF, Jin YP, Zhu XD, Gao H, Li ZP, Lu XL, Miao HJ, Zhang QY, Li YM, Yang WG, Liu CY, Li B, Li Y, Bo ZJ, Chu JP, Wang X, Lu GP. [Multicenter investigation of extracorporeal membrane oxygenation application in pediatric intensive care unit in China]. Zhonghua Er Ke Za Zhi 2018; 56:929-932. [PMID: 30518007 DOI: 10.3760/cma.j.issn.0578-1310.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To survey the conduction and evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) therapy in pediatric intensive care unit (PICU) in China mainland. Methods: In a questionnaire-based survey, we retrospectively reviewed the application of ECMO in children's hospital and general hospital in China mainland to summarize and analyze the categories of diseases and prognosis of children treated with ECMO therapy. Results: By December 31, 2017, a total of 23 hospitals using ECMO, including 22 tertiary referral hospitals and 1 secondary hospital, among which 16 were children's hospitals and 7 were general hospitals. Thirty-seven ECMO equipment was available. A total of 518 patients treated with ECMO, within whom 323 (62.4%) successfully weaned from ECMO and 262 (50.6%) survived to discharge. Among 375 pediatric patients, 233 (62.1%) were successfully weaned from ECMO and 186 (49.6%) survived to discharge. Among 143 newborn patients, 90 (62.9%) successfully weaned from ECMO, 76 (53.1%) survived to discharge. ECMO was applied in veno-arterial (VA) mode to 501 (96.7%) patients, veno-venous (VV) mode to 14 (2.7%) patients, and VV-VA conversion mode to 3 (0.6%) patients. Sixty-nine patients required extracorporeal cardiopulmonary resuscitation (ECPR), including 20 newborn patients (29.0%) and 38 pediatric patients (71.0%), who were all with cardiovascular disease. Neonatal respiratory distress syndrome (26/61), persistent pulmonary hypertension of the newborn (PPHN) (12/61), and meconium aspiration syndrome (MAS) (11/61) are the most common pulmonary diseases in newborn patients; among whom, infants with PPHN had highest survival rate (10/12), followed by MAS (9/11). Among newborn patients with cardiovascular diseases, those who admitted were after surgery for congenital cardiac disease were the most common (54/82), while those with septic shock had the highest survival rate (2/3). In pediatric pulmonary diseases, acute respiratory distress syndrome was the most common (42/93), while plastic bronchitis was with the highest survival rate (4/4), followed by viral pneumonia (13/16). Among pediatric cardiovascular diseases, congenital cardiac defect was the most common (124/282), while fulminant myocarditis had the highest survival rate (54/77). Conclusion: The application of ECMO as a rescue therapy for children with severe cardiopulmonary failure has dramatically developed in China mainland.
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Affiliation(s)
- G F Yan
- Department of Pediatric Emergency Medicine, Children's Hospital of Fudan University, Shanghai 201102, China
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Liu ZM, Fang F, Ding CH, Zhang WH, Deng J, Chen CH, Wang X, Liu J, Li Z, Jia XL, Zeng JS, Qian SY. [Clinical and genetic characteristics of congenital myasthenia syndrome with episodic apnea caused by CHAT gene mutation: a report of 2 cases]. Zhonghua Er Ke Za Zhi 2018. [PMID: 29518833 DOI: 10.3760/cma.j.issn.0578-1310.2018.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical and genetic features of congenital myasthenia syndrome with episodic apnea (CMS-EA) caused by gene mutation of choline acetyltransferase (CHAT) Methods: The clinical data of 2 patients with congenital myasthenia syndrome were collected, and both were diagnosed from 2013 to 2015 in Beijing Children's Hospital, Capital Medical University. The clinical features and gene mutation characteristics were analyzed, and the patients were followed-up for therapeutic efficacy. Results: The two patients (case 1 and case 2) had the onset soon after birth and at 3 months after birth respectively. The two patients were admitted to the PICU due to dyspnea, cyanotic episodes that required intubation. The patients had repeated apnea and became ventilator dependent. Case 1 died due to refusal of any treatment. Case 2 had a tracheotomy, and gradually weaned from ventilator after using pyridostigmine. The hospitalization of case 2 lasted 162 days. Case 2 was followed up to the age of 3 years and 4 months, and was extubated and was maintained on oral neostigmine but still had fluctuating ptosis and minor physical and mental retardation. Both cases were negative for anti-AChR, anti-acetylcholinesterase, anti-MuSK antibodies. Neostigmine test was negative in case 1 and suspiciously positive in case 2. Low-frequency repetitive nerve stimulation testing of case 2 was negative. Cranial MRI scans of both cases showed brain atrophy-like change. Genetic testing showed compound heterozygous deletions (exon 4, 5, 6) and pathogenic variant c.914T>C (p.I305T) in CHAT in case 1, compound heterozygous variants c.1007T>C (p.I336T) and c.64C>T (p.Q22X) in CHAT in case 2. To our knowledge, compound heterozygous deletions (exon 4, 5, 6) and p.Q22X were novel, previously unreported variants. Conclusion: CMS-EA usually presents at birth or in the neonatal period with hypotonia, ptosis, dysphagia due to severe bulbar weakness, and respiratory insufficiency with cyanosis and apnea. Early treatment with pyridostigmine is helpful to the improvement of clinical symptoms and prognosis.
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Affiliation(s)
- Z M Liu
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Ji J, Qian SY. [Interpretation of guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient of the 2017 edition of the United States]. Zhonghua Er Ke Za Zhi 2018; 56:332-335. [PMID: 29783817 DOI: 10.3760/cma.j.issn.0578-1310.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Yang X, Qian SY, Zhu YM, Xu X, Liu CF, Xu F, Ren XX, Wang Y, Zhang YC, Lu GP. [Survey on the prevalence of continuous blood purification in Chinese pediatric critical care]. Zhonghua Er Ke Za Zhi 2018; 56:128-133. [PMID: 29429201 DOI: 10.3760/cma.j.issn.0578-1310.2018.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the current application status of continuous blood purification (CBP) technology and equipment in pediatric intensive care unit (PICU) in China. Methods: A cross-sectional survey was conducted to understand the current popularization of CBP technology and equipment, the management of CBP equipment and consumables, and the application of CBP in different diseases. A questionnaire named Application Status of Continuous Blood Purification Technology was applied. Children's hospitals and polyclinic hospitals with the pediatric qualification (pediatric emergency or critical care unit members of Chinese Medical Association and Chinese Medical Doctor Association) were selected. Results: From December 2016 to February 2017, 53 hospitals completed the questionnaire, including 7 in northeast, 6 in north China, 16 in east China, 9 in south China, 5 in central China, 4 in the northwest, and 6 in the southwest region. Continuous renal replacement therapy (CRRT), the most widely used technology, was carried out in 51 hospitals. Other technologies were peritoneal dialysis (IPD) (n=37), artificial liver support (ALSS) (n=26) and blood adsorption (PA) (n=13). There were 107 CBP machines in the 51 hospitals used CBP technology, with an average of 2.10/hospital. In 36 hospitals CBP machines were managed independently by PICU (70%). Hospitals made their own displacement liquid (n=40, 78%), or purchased displacement liquid (n=11, 22%). Hospitals prepared dialysate on their own (n=38, 75%), or purchased dialysate (n=13 hospitals, 25%). In 46 (90%) hospitals, hemodialysis catheter was placed independently by PICU doctors. The routine operation and maintenance of CBP were mainly completed by the PICU nurses in 36 hospitals (71%). There were 39 hospitals (76%) where professional nurses manage and maintain CBP. Puncture sites were femoral vein (n=26, 51%), internal jugular vein (n=21, 41%) and venae subclavia (n=4, 8%). Forty-two hospitals (82%) selected B-mode ultrasound positioning and guidance when performing internal jugular vein puncture. A total of 40 (78%) hospitals have developed post dilution and combined dilution techniques during the implementation of CBP. The most common indications of CBP technology were different in different regions. They were sepsis in northeast (24.0%, 243/1 011) and east China region (32.0%, 982/3 069), multiple organ dysfunction syndrome in south China (29.2%, 444/1 520), north China (15.8%, 126/796), and southwest region (30.1%, 460/1 526), drug poisoning in central China region (21.6%, 325/1 506), and renal failure in northwest region (53.0%, 44/83). Conclusions: CBP technology is widely used in the field of pediatric severe diseases in China. The eastern regions possess more CBP equipment than the western regions. CBP is widely used in the treatment of sepsis.
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Affiliation(s)
- X Yang
- Department of Critical Care Medicine, Children's Hospital of Fudan University, Shanghai 201102, China
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Li XH, Ji J, Qian SY. [Optimal energy supply in different age groups of critically ill children on mechanical ventilation]. Zhonghua Er Ke Za Zhi 2018; 56:39-42. [PMID: 29342996 DOI: 10.3760/cma.j.issn.0578-1310.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the resting energy expenditure and optimal energy supply in different age groups of critically ill children on mechanical ventilation in pediatric intensive care unit (PICU). Methods: Patients on mechanical ventilation hospitalized in PICU of Beijing Children's Hospital from March 2015 to March 2016 were enrolled prospectively. Resting energy expenditure of patients was calculated by US Med Graphic company critical care management (CCM) energy metabolism test system after mechanical ventilation. Patients were divided into three groups:<3 years, 3-10 years, and >10 years. The relationship between the measured and predictive resting energy expenditure was analyzed with correlation analysis; while the metabolism status and the optimal energy supply in different age groups were analyzed with chi square test and variance analysis. Results: A total of 102 patients were enrolled, the measured resting energy expenditure all correlated with predictive resting energy expenditure in different age groups (<3 years (r=0.3, P=0.0) ; 3~10 years (r=0.6, P=0.0) ;>10 years (r=0.5, P=0.0) ) . A total of 40 cases in < 3 years group, including: 14 cases of low metabolism (35%), 14 cases of normal metabolism (35%), and 12 cases of high metabolism (30%); 45 cases in 3-10 years group, including: 22 cases of low metabolism (49%), 19 cases of normal metabolism (42%), 4 cases of high metabolism (9%); 17 cases in>10 years group, including: 12 cases of low metabolism (71%), 4 cases of normal metabolism (23%), 1 case of high metabolism (6%). Metabolism status showed significant differences between different age groups (χ(2)=11.30, P<0.01, r=-0.01). Infants had higher metabolic status, which lessened with aging. The total average actual energy requirement was (210±84) kJ/ (kg⋅d) . There were significant differences in actual energy requirement between age groups (F=46.57, P<0.001), with (277±77) kJ/ (kg⋅d) in<3 years group, (184±53) kJ/ (kg⋅d) in 3-10 years group, and (120±30) kJ/ (kg⋅d) in>10 years group. Conclusion: The resting energy metabolism of the critically ill children on mechanical ventilation is negatively related to the age. The actual energy requirement should be calculated according to different ages.
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Affiliation(s)
- X H Li
- Department of Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Zeng JS, Qian SY. [Noninvasive ventilation in pediatric respiratory failure: use at the right time]. Zhonghua Jie He He Hu Xi Za Zhi 2017; 49:645-648. [PMID: 28910904 DOI: 10.3760/cma.j.issn.1001-0939.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Fang BL, Qian SY, Jia XL, Li Z, Liu J. [Current situation of enteral nutrition interruptions in sepsis children in pediatric intensive care unit]. Zhonghua Er Ke Za Zhi 2017; 54:665-8. [PMID: 27596080 DOI: 10.3760/cma.j.issn.0578-1310.2016.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To analyze the interruptions of enteral nutrition (EN) and it's relationship to prognosis in children with sepsis in pediatric intensive care unit (PICU). METHOD Daily EN intake and reasons for EN interruptions were prospectively observed and recorded in children with sepsis who were admitted to our PICU from November 2012 to April 2013. Clinical prognosis was compared between children with and without EN interruptions by t, rank-sum and χ(2) tests. RESULT Totally 60 consecutive children were included, 42 males, median age 9.67 (5.36, 37.0) months; 50 children suffered from EN interruptions, while 10 children did not. Median time to EN initiation was 2.59 (1.53, 3.67) h; EN was interrupted in 83% (50/60) of children, for a total of 108 times and 696 h, the most common reasons were fibrobronchoscopy and radiologic procedures, 27 and 29 times respectively. Children spent 0.04 (0.02, 0.08) of their total observation period without EN nutrition due to EN interruptions, and was not correlated with pediatric critically ill score (r=0.12, P=0.38). Children with EN interruptions suffered from longer PICU duration ((12±7) vs. (7±4) d, t=2.18, P=0.03), but there was no significant difference in the 28(th) hospital day's mortality between these two groups (6 cases vs. 1 case, χ(2)=0.00, P=1.00). CONCLUSION EN is frequently interrupted due to procedures needed fasting, EN intolerance and other reasons in children with sepsis. EN interruptions may have something to do with prolonged PICU length of stay, but the relationship needs to be examined in future studies.
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Affiliation(s)
- B L Fang
- Pediatric Intensive Care Unit, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
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Liu J, Wang Q, Qian SY, Xu WM, Li LL, Ning LM, Ren XX, Lyu F, Cheng YB, Gao LJ, Liu CF, Xu W, Pei L, Lu GP, Chen WM. [Nasal continuous positive airway pressure ventilation in children with community-acquired pneumonia under five years of age: a prospective, multi-center clinical study]. Zhonghua Er Ke Za Zhi 2017; 55:329-333. [PMID: 28482381 DOI: 10.3760/cma.j.issn.0578-1310.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective: To analyze the clinical characteristics of community-acquired pneumonia (CAP) in children under five years of age and analyze the safety and efficiency of nasal continuous positive airway pressure (NCPAP) ventilation for CAP in this population. Method: This was a prospective multicenter study. Children who were admitted to these six centers with CAP and met the NCPAP ventilation indications, aged from 29 d to 5 years, were continuously included during November 2013 to October 2015. The baseline data were collected and NCPAP ventilation were then followed up by operation standards, and the vital signs and arterial blood gas change at special time points were observed and recorded. Any side effect associated with NCPAP were recorded. For categorical variables, comparisons were performed using Fisher test. Rank-sum test and t test were performed respectively for abnormal and normal distribution continuous variables. The variables pre-NCPAP and post-NCPAP were analyzed by repeated measures ANOVA analysis. Result: Totally 145 children were included, and 13 children were excluded due to incomplete data. One hundred and two children(77.3%)were ≤12 months; 91 children (68.9%) were from rural area. NCPAP ventilation was effective in 123 children, with a response rate of 93.2%, were all discharged with a better condition; it was ineffective in 9 children(6.8%), and they were all intubated and went on mechanical ventilation, 5 were discharged with a better condition, and 4 died after gaving up treatment. The gender, age, body weight, residence, main symptoms, main signs, imaging diagnosis, medications, partial pressure of oxygen(PaO(2)), breath and heart rate before NCPAP treatment of two groups had no significant differences(allP>0.05). The rates of combining underlying diseases, trouble with feeding and cyanosis, and the partial pressure of carbon dioxide(PaCO(2) ) before NCPAP ventilation were higher in NCPAP ineffective group ((59±11 )vs.( 49±11) mmHg, 1 mmHg=0.133 kPa, t=-2.597, P=0.028); while the PaO(2)/fraction of inspiration O(2) (FiO(2) ) before NCPAP was lower((150±37) vs. (207±63) mmHg, t=2.697, P=0.008). The breathing, heart rate and PaCO(2) of NCPAP effective group decreased significantly, while the PaO(2) and PaO(2)/FiO(2) increased significantly after 2, 8, 24 h of NCPAP ventilation(all P=0.000). PaCO(2) in children with hypercapnia before NCPAP ventilation in NCPAP effective group decreased significantly ((48±9), (47±12), (45±11)vs.(58±7)mmHg, all P=0.000). All children tolerated well to NCPAP ventilation, and there were no severe side effects or complications associated with NCPAP ventilation. Conclusion: NCPAP ventilation is safe and effectively improved the oxygenation and hypercapnia in infants with CAP. But it may not work well in children with underlying diseases, manifest as difficulty in feeding/cyanosis and extremely high PaCO(2) or low PaO(2)/FiO(2), and they may need early intubation.
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Affiliation(s)
- J Liu
- Pediatric Intensive Care Unit, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China
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Zeng JS, Qian SY. [Clinical application of noninvasive positive pressure ventilation in children]. Zhonghua Er Ke Za Zhi 2017; 55:321-323. [PMID: 28482379 DOI: 10.3760/cma.j.issn.0578-1310.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Xu F, Qian SY. [Pediatric acute respiratory distress syndrome: a severe problem than yet to be conquered by critical care medicine]. Zhonghua Er Ke Za Zhi 2016; 54:644-645. [PMID: 27596075 DOI: 10.3760/cma.j.issn.0578-1310.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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49
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Zheng JS, Qian SY. [Standardize the clinical application of noninvasive positive pressure ventilation in children]. Zhonghua Er Ke Za Zhi 2016; 54:641-643. [PMID: 27596074 DOI: 10.3760/cma.j.issn.0578-1310.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Kulkarni PS, Haldar MK, Confeld MI, Langaas CJ, Yang X, Qian SY, Mallik S. Mitochondria-targeted fluorescent polymersomes for drug delivery to cancer cells. Polym Chem 2016; 7:4151-4154. [PMID: 27833665 PMCID: PMC5098558 DOI: 10.1039/c6py00623j] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mitochondria is an attractive target to deliver anticancer drugs. We have synthesized a cationic triphenylphosphonium ion conjugated fluorescent polymer which self-assembles into nanosized polymersomes and targets the encapsulated anticancer drug doxorubicin to cancer cell mitochondria.
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Affiliation(s)
- P S Kulkarni
- Department of Pharmaceutical Science, North Dakota State University, Fargo ND, USA
| | - M K Haldar
- Department of Pharmaceutical Science, North Dakota State University, Fargo ND, USA
| | - M I Confeld
- College of health professions, North Dakota State University, Fargo ND, USA
| | - C J Langaas
- College of health professions, North Dakota State University, Fargo ND, USA
| | - X Yang
- Department of Pharmaceutical Science, North Dakota State University, Fargo ND, USA
| | - S Y Qian
- Department of Pharmaceutical Science, North Dakota State University, Fargo ND, USA
| | - S Mallik
- Department of Pharmaceutical Science, North Dakota State University, Fargo ND, USA
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