Failure to deliver sufficient oxygen to the tissues and failure to utilize oxygen in the tissues are essential pathophysiological changes in circulatory failure situations.This is common in all kinds of shocks.Monitoring oxygen delivery and metabolism not only changes the ways to assess the shock but also affects the managements of shocks deeply.Monitoring and controlling global and tissue oxygen delivery and metabolism are goals for circulatory failure assessment and management in the future.

The virus is a common pathogeny in children,especially for infants and young children. The immuno-inflammation process for virus-induced sepsis is extremely complex. For different virus and dif-ferent target organs of invasion,the clinical features and evolution progresses are quite different. Specific and effective treatment measures are very limited. For virus-induced sepsis should pay high attention to it.

Neurally adjusted ventilatory assist ( NAVA ) and non-invasively-NAVA are safe and feasible mode of ventilation in both the pediatric and the neonatal populations. NAVA mode has excellent synchrony and is superior over conventional mode at improving patient-ventilator interaction. NAVA is least vulnerable to changes in airway disease or airway resistance patterns. Non-invasively-NAVA delivers synchro-nized ventilation independent of leaks. NAVA offers maintenance of physiologic variability in breathing. NAVA can effectively avoid excessive ventilation,assist the weaning and has a lung protective function. Bed-side monitoring of Edi is a useful tool for evaluating diaphragm function,central apnea,clinical interventions, and decision support. Further high-quality studies are required to evaluate the long-term clinical prognosis for NAVA mode utilizing in pediatric patients.

The nutritional support of pediatric critically ill obese patients is more challenging. In addition to the critical condition of the primary illness,a series of pathophysiological changes and multi-organ dysfunction that are brought by obesity make higher nutritional risks, more complex clinical conditions and more variable metabolic status in critically ill obese children. Continuous indirect calorimetry is the ′gold standard′in the assessment of energy requirements and guiding nutritional support in critically ill obese chil-dren. Optimal protein intake,reasonable carbohydrates/lipid ratio for the total non-protein energy and objec-tive dynamic assessment are essential for successful nutrition support.

Enterovirus 71 infection was the most important agent related to severe and fatal cases of hand,foot and mouth disease in children. Some severe and fatal cases had cardiovascular dysfunction, which extremely possibly caused by central nervous system involvement and lesions with EV71 infection. But the mechanism was complex and unclear. Monitoring circulation condition and hemodynamic parameters, assessing cardiac function carefully were helpful to detect children at risk of cardiovascular involvement and dysfunction. Early recognition and intervention of children at risk of cardiovascular disorder is the key to rescue severe cases and reduce the mortality.

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) provides support for the neonate,infants and children with acute severe reversible respiratory failure by substituting for the most or part of the lung function and providing enough time for disease resolution.Mounting evidence shows V-V ECMO is effective therapy for acute severe respiratory failure.

Acute kidney injury (AKI) is a complex crtical disorder with multi-etiologies.The evolution of diagnosing and classifying for AKI reflected the better understanding to it and feedback effects of clinical practice.Each diagnostic criteria had their strengths and limitations.Continuous monitoring and comprehensive evaluation for AKI patients are offer better value.At present,looking for more appropriate diagnosis time window and clinical observation parameters are on going work,more scientific and reasonable diagnostic and staging criteria will make the earlier detection and interventions,so that reduce the mortality of AKI in children.

During cardiopulmonary resuscitation (CPR),PetCO2 monitoring helps to judge the status of circulation.Marked elevation of PetCO2 level is early sign for restoration of spontaneous circulation and successful CPR.PetCO2 level monitoring can predict probability of CPR success and it is also helpful to assist in confirming endotracheal tube placement,to assess for chest compression and ventilation.PetCO2 levels should be monitored during CPR.

Genetic polymorphisms takes an important roll in pathophysiological course of sepsis.It influences the susceptibility and resistance to an invading pathogen;it influences the diversity of the clinical presentation and the response to current medical treatment for sepsis.Polymorphisms contributes to the susceptibility,severity,and clinical outcome of sepsis.

Point-of-care testing(POCT) has developed rapidly in recent years and is widely used in families, communities, hospitals and all kinds of rescue sites.It plays an important role in the fields of infection, tumor, metabolic diseases, acute and severe diseases and so on.It has technical advantages in disease epidemiological investigation, disease diagnosis, condition and curative effect evaluation.With fast, portable, easy to operate characteristics, the future development potential of POCT is huge.