The Surviving Sepsis Guidelines were first published in 2004,with revisions in 2008 and 2012.In January 2017,the fourth revision of the Surviving Sepsis Guidelines was presented at the 46th annual SCCM meeting and published online in Critical Care Medicine.The updated guideline was generated by 55 international experts and providing 93 recommendations on early management of sepsis and septic shock.There are numerous major advances in the revision of the guidelines.Among the various topics covered,initial resuscitation and antibiotic therapy are the domains in which the most important changes and advances were made.

Objective To evaluate the efficacy and safety of remifentanil and propefol combined with local anesthesia for cobiation-assisted upper-airway procedure (CAUP). Methods Eighty ASAⅠorⅡpatients aged 25-60 yr body mass index ≤ 35 kg/m2 with sleep apnea hypopnea syndrome scheduled for CAUP were randomly divided into 4 groups (n=20 each): normal saline group (S), propefol group (P), remifentanil group (R) and propoful + remifentanil group (PR). After topical anesthesia with 1% decicaine, the patients in group S, P, R or PR received iv infusion of normal saline 0.15 ml·kg-1·h-1 , propofol 25 μg·kg-1·min-1 , remifentanil 0.05 μg·kg-1·min-1, or propefol + remifentanil at the same rate respectively. Ten minutes later local infiltration anesthesia was performed in operative field with lidocaine containing epinephrine 1:200 000. Ramsay sedation score and verbal rating scale (VRS) were assessed every 5 min. VRS Ⅲwas defined as anesthesia failure in group S. It was also defined as anesthesia failure that Ramsay sedation score > 3 or occurrence of respiratory depression during increment of propofol or remifentanil in patients with VRS Ⅲ in the other 3 groups. BP and HR were recorded before coblation and 5 rain after coblation. Airway obstruction and apnea were also observed. Results Anesthesia achievement ratio was significantly higher in group R and PR (90% and 100% respectively) than in group S and P (40% and 65% respectively) (P<0.05). SP, DP and HR were significantly lower 5 rain after coblation in group R and PR than in group S (P < 0.05). There was no significant difference in incidence of adverse effects between the 4 groups(P>0.05). Conclusion Remifentanil or propofol-remifentanil combined with local anesthesia is safe and effective for CAUP.

Objective To search and evaluate the quality of reports of clinical trial studies published in Chinese Pediatric Emergency Medicine according to CONSORT statement.Methods We collected all articles published in Chinese Pediatric Emergency Medicine from January 1,2011 to November 31,2015 through searching the WanFang Database,then evaluated and analyzed clinical trial studies.Results Among all 1317 articles we retrieved,62 (4.7％)of them belong to clinical trial study.According to CONSORT statement,all the articles satisfied items from 1b to 6b (including abstract,introduction,trial design,participants,interventions and outcomes),only 30(48.4％) and 4(6.5％) articles mentioned item 8a (method used to generate the random allocation sequence)and 8b(type of randomization;details of any restriction),respectively.None of the editors reported item 9(mechanism used to implement the random allocation sequence,describing any steps taken to conceal the sequence until interventions were assigned)and 10(who generated the random allocation sequence,who enrolled participants,and who assigned participants to interventions).Among 62 included studies,33(53.2％)studies concentrated on respiratory system diseases.However,studies about nervous system,circulatory system and digestive system were 5(8.1％),4(6.5％)and 4 (6.5％) respectively.Although all the results had statistical significance,only 38(61.3％),7(11.3％) and 5 (8.1％)mentioned randomization,follow-up and blinding respectively.Flow diagram was only included in one (1.6％) article.Conclusion The articles of clinical trial studies published in Chinese Pediatric Emergency Medicine did not take CONSORT statement as reference completely.

Objective:To investigate the prognostic value of pentraxin 3(PTX3)levels in patients with sepsis through meta-analysis.Methods:Databases including PubMed, The Cochrane Library, Embase, Web of Science, China Science and Technology Journal Database(VIP), China National Knowledge Infrastructure(CNKI), Wanfang Data and China Biology Medicine disc(CBM)from inception to April 2020 were searched for clinical studies that reported the relationship between PTX3 levels and the prognosis of patients with sepsis.Literature selection was based on inclusion and exclusion criteria.The quality of the included studies was evaluated with Newcastal-Ottawa scale and the Meta-analysis was conducted with Review Manager 5.3 software.Results:Ten studies with 1 710 cases were included.Meta-analysis results showed that compared with survivors, PTX3 levels of non-survivors significantly increased(in the random effects model, I2=95%, P<0.001), the combined standard mean difference between non-survivors and survivors was 1.31(95% CI 0.73-1.90). A combined analysis of six studies on the predictive value of PTX3 for 28-day mortality in patients with sepsis was carried out, and the pooled sensitivity was 0.799(95% CI 0.730-0.854), the pooled specificity was 0.735(95% CI 0.649-0.807), the pooled odds ratio was 11.02(95% CI 6.60-18.40), the pooled positive likelihood ratio was 3.02(95% CI 2.24-4.06), the pooled negative likelihood ratio was 0.27(95% CI 0.20-0.37), and the area under summary receiver operator characteristic was 0.83(95% CI 0.79-0.86). Conclusion:PTX3 has a good prognostic value for sepsis.

Sepsis-induced thrombocytopenia-associated multiple organ failure（TAMOF）is a severe subtype of sepsis-related organ dysfunctions，which has high mortality and poor prognosis.The main clinical characteristics are thrombocytopenia caused by infection and multiple organ dysfunction.However，the exact molecular mechanism of TAMOF remains unclear.The current studies have shown ADAMTS-13，which is a von Willebrand factor lyase，plays an important role during the disease.Plasma exchange could be a treatment method，but still need more large-scale randomized controlled trials to verify.In the future，von Willebrand factor and ADAMTS-13 could become the therapeutic targets for new drug development.

The mortality rate of septic shock in children is high，and the number of cases has been increasing year by year.In recent years，the number of deaths has decreased with the development of medical technology.With the increasing number of surviving children with septic shock，the prognosis regarding these patients is gaining more attention of PICU physicians than before.The long-term sequelae of patients with septic shock，which often leads to multiple organ dysfunction and complications，severely affects the quality of children life after discharge from the hospital.Notably，the meaningful outcomes mainly include physical，mental，emotional，and social functioning.Currently，few studies focusing on quality of life in children surviving from septic shock have been reported in China.Herein，this review summarized the progress of research on the long-term prognosis of patients with septic shock.