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.

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.

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.

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

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.

Pulmonary surfactant is a complex mixture of lipoproteins synthesized,secreted and recy-cled by type Ⅱ alveolar cells. The primary function of PS is to minimize the surface tension at the alveolar air-liquid interface. Surfactant dysfunction with quantitative and qualitative abnormalities of both phospholipids and proteins are characteristics of patients with acute respiratory distress syndrome ( ARDS ) . Exogenous surfactant replacement shows consistent improvements in gas exchange,but had limited success in improving survival. These may be due to variety of aetiologies in ARDS、surfactant compositiones, delivery methods, optimal time and doses. At this time,surfactant therapy cannot be recommended as routine therapy in pediatric ARDS.

Myasthenia gravis is an autoimmune disorder resulting from the production of antibodies against acetylcholine receptors leading to the destruction of the postsynaptic membrane at the neuromuscular junction.Myasthenic crisis is defined as any myasthenia gravis exacerbation necessitating mechanical ventila-tion or post-operation extubation delayed beyond 24 hours because of respiratory weakness.Most patients presenting with myasthenic crisis have an identifiable risk factor.The diagnosis of myasthenic crisis should be suspected in all patients with respiratory failure,particularly those with unclear etiology.Acute management of myasthenic crisis includes ventilatory therapy,removal of the offending trigger and immunomodulatory treat-ments.The latter includes plasma exchange or intravenous immunoglobulin,and high dose corticosteroids therapy.

Paraquat is a commonly used herbicide,which can cause acute poisoning due to misusage or suicide.The mortality of acute paraquat poisoning is high,the prognosis is poor,and there is no specific an-tidote for the poisoning.Most scholars believe that early blood purification is the first choice for the treatment of acute paraquat poisoning.However,there is not a unified standard about what kind of blood purification methods and the specific parameters should be taken for the different periods of paraquat poisoning.

Pediatric invasive fungal disease( IFD)often lacks characteristic clinical manifestations and imaging changes. It is a severe disease in ICU and is unlikely to be diagnosed early. The diagnosis of IFD is typically based on laboratory tests targeting at the population at risk. The laboratory tests for IFD generally include direct tests( smear microscopy,fungal culture,histopathologic examination,etc. ),serologic tests( tests for 1,3-β-D dextran and galactomannan,etc. ),and certain progresses have been made in molecular biologi-cal tests in recent years. It is key to diagnosis of IFD to use laboratory tests rationally and accurately interpret the laboratory results.