Child ; Critical Care ; standards ; Humans ; Pediatrics ; standards

Vitamin D deficiency and sepsis are both worldwide problems with health consequences.The pleiotropic actions of vitamin D might synergistically influence pathogenesis of sepsis.Sepsis is associated with local immune responses to pathogens and the activation of systemic inflammatory pathways,which may be the novel targets of vitamin D activity.Clinical observational trials have found vitamin D deficiency is associated with respiratory infections,critical illness and sepsis.The causal relationship has yet to be clearly defined.

Pain and anxiety are common unpleasant feelings that an ICU patient may experience.Modem medicine has increasingly recognized the importance of enhancing therapeutic comfort of the ICU patients.The analgesia and sedation protocol has received more attention and improvement,and has been becoming an essential part of a comprehensive multidisciplinary treatment plan for ICU patients.This paper reviews the history of the development of analgesia and sedation either in modem or in ancient times,in China or elsewhere;introduces the current starus of analgesia and sedation in the ICU setting;and then emphasizes the difference between children and adults.

Acute poisoning in children is closely related with the surrounding environment. In China,acute poisoning in children,mainly caused by wrong intake of pesticides,drugs and rodenticide,still leads to high mortality in severe acute poisoning cases. Particular emphasis on safe storage of drugs and toxic chemicals mentioned above may reduce poisoning accidents at the source. Of the suspected poisoning cases, besides the detailed medical history and physical examination, poison identification is the most direct and objective method to confirm the diagnosis and evaluate the poisoning severity. Timely diagnosis, appropriate antidote use, extensive application of blood purification therapy, and emphasis on supportive therapy remain critical for the successful treatment. Accurate and comprehensive clinical epidemiological data are considered to be of informative value to identifying poisoning of different regions, ages and sexes.

Hand,foot and mouth disease has become more widespread in mainland China in recent years and has shown an increasing trend in the annual prevalence, which has attracted considerable attention as a major public health problem. Enterovirus 71 (EV71) and coxsackievirus A16 (Cox A16) are major pathogens. Ninety-five percent of severe patients and death cases were younger than 3 years old. Unfortunately,there is no effective anti-enteroviral drug for hand, foot and mouth disease, therefore symptomatic treatment and supportive care remain as the mainstream therapy. Intravenous immunoglobulin (IVIG) is expected to be used in recent clinical trials, but its efficacy remains to be seen. Glucocorticoid therapy is still controversial in critical cases. EV71 vaccine is under development; however, it takes time to launch a mass vaccination. Multidisciplinary prospective, multicentral study is essential to control the spread of hand, foot and mouth disease and to tackle the problems of diagnosis and treatment.

Glucocorticoids have been widely prescribed for various indications of critically illness. The clinical efficacy is persistently investigated but controversy still remains. Recent advances in pharmacological mechanisms of corticosteroid action has attracted much attention. This review focuses on the role of corticosteroids therapy in critically ill children with severe sepsis and septic shock,severe hand-foot-mouth disease,severe asthma,acute respiratory dis-tress syndrome,severe pneumonia,or increased intracranial pressure. Although the debate has been on,recommend that use of glucocorticoid therapy in critically ill children should be tailored for the individual based on clinical guidelines.

Child ; Consensus ; Disease Management ; Humans ; Pediatrics ; Shock, Septic ; therapy

In Oct 2010,American Heart Association (AHA) released new guidelines for pediatric basic life support and pediatric advanced life support.The new AHA guidelines are based on an extensive review of thousands of resuscitation studies by experts who reached a consensus over a 3-year period.Compared with the 2005 AHA guidelines for pediatric basic and advanced life support,the new guidelines made major changes on some key issues,including the change of basic life sequence from A-B-C to C-A-B,high-quality chest compression,defibrillation and the use of automated external defibrillator in infants,medications during resuscitation,resuscitation of children with congenital heart disease,post-resuscitation management and evaluation of sudden cardiac death victims.This paper summarized the substantial changes and the reasons to change.

Nutrition support,including parenteral nutrition and enteral nutrition,has been one of the important treatment for critical illness in children.The risk of nutrition support attracts more and more attention.The complications of nutrition support include nutrition support access associated mechanical injuries,catheter related bloodstream infection,enteral nutrition intolerance and metabolic complications.Most of these complications are preventable.The most effective prevention is evaluating and controlling the risk factors.Prevention and treatment of the complications is the key of successful nutrition support and improving the prognosis.

There are much more multidrug-resistant organisms (MDRO) in the intensive care unit than ever.If the doctors could distinguish the colonization from infection of MDRO,they can make right decision on the rational clinical use of antibiotics to reduce resistant organisms and nosocomial infection.However,it's a confused problem for clinicians to distinguish between colonization and infection.Bacterial culture combined with clinical symptoms and signs maybe helpful,but it is limited.There should be more objective indicators.This article was aimed to state the definition and relationship between colonization and infection,and how to determine the colonization and infection of MDRO.