Septic shock remains a major cause of morbidity and mortality in intensive care unit(ICU). Abun-dant fluid resuscitation is one of the most common therapies for septic shock patients;but some fundamental questions about its efficacy and safety remain. In this paper,recent insight derived from clinical trials in terms of fluid type,dose, rate and toxicity are discussed.

The incidence of nosocomial infections in the neonatal intensive care unit(NICU) is high. Nosocomial infections is one of the most common causes of neonatal death in critically ill neonates. Strategies for the prevention nosocomial infections include hand hygiene practices,prevention of central venous catheter-related infection and ventilator-associated pneumonias, antifungal prophylaxis, skin care, early enteral feeding and probioties. Effective prevention and control nosocomial infections in NICU may decrease neonatal mortality,hospitaliztion stay and hospital costs.This review focuses on the latest preventive strategies for nosocomial infections in NICU.

Shock is the hypoperfusion or blood flow distribution abnormality and leads to systemic tissue hypoperfusion and organ dysfunction.Cardiac output and tissue perfusion pressure are major factors affecting tissue and organ peffusion.Continuous assessment of hemodynamic parameters is crucial for the diagnosis and treatment of shock.The pulse indicator continuous cardiac output technology combines hemodynamic monitoring and volumetric measures to assess a variety of hemodynamic parameters including cardiac output,afterload and volume,which is a kind of low-risk,convenient,accurate,and continuous technology.

Sepsis is a group of clinical syndrome in response to overwhelming inflammation,which is a major problem associated with high morbidity and mortality among critically ill patients.Recently,an abundance of basic and clinical findings suggest that stem cell can be attributed to anti-inflammatory,tissue healing and immunomodulatory,which may provide a promising idea in the treatment of sepsis.

Extracorporeal membrane oxygenation (ECMO) is a technology of cardiopulmonary life-support,where blood is drained from the venous vascular to an oxygenator,circulated outside the body by a mechanical pump,and then reinfused into the circulation.Recently,the application of ECMO in China is increasing gradually.Effective prevention and treatment of complications of ECMO is an important factor for the success of this technology.The aim of this paper is to discuss cardiac stun during ECMO support.

Acute respiratory distress syndrome(ARDS) is a critical illness in children with high mortality.Extracorporeal membrane oxygenation (ECMO) is an effective rescue method for the severe ARDS,and is usually used in ARDS patient who does not respond to conventional respiratory support including mechanical ventilation.The principle of ECMO is to afford a cardiopulmonary bypass support and gives enough blood oxygen delivery.The effectiveness of ECMO on ARDS is influenced by the severity and causes of the sickness because of its respiratory support character.The reported survival rate of the ECMO children with ARDS ranged from 40％ to 78％.The traumatic procedure,need anticoagulation,noted complication and treatment cost are the important factors that restrain ECMO at the rescue role.

Patients with respiratory crisis occupied a large numbers in extracorporeal membrane oxy-genation(ECMO) group. ECMO is able to give a plenty amount of gas exchange for body essential metabolic needs by ECMO oxygenator whoever the lungs are of function or not. The key indications for respiratory ECMO are that the patient had no response to all medical treatment except ECMO,and the origin cause of the disease is potentially recoverable. Besides the contraindications and accessibility, ECMO has no special settings among the different ages or cause of diseases. The VV-ECMO is preferred for respiratory support. VA-ECMO should be considered if cardiovascular failure exists. ECMO may offer a powerful respiratory support to patient with critically ill conditions until recovery. The outcomes are influenced by some factors including the reversibility and the cause of diseases.

Objective To investigate the correlation between drug resistance and β-actamase genes of multi-drug resistance Acinetobacter baumannii (MDR-AB) in neonatal intensive care unit to provide evidence for rational antibiotics administration and nosocomial infection control.Methods Twenty-six MDR-AB strains were separated and collected from clinical specimens.The minimum inhibitory concentrations of 13 antimicrobial agents were determined by agar dilution method.Genotypes of β-lactamase were detected by polymerase chain reaction.Results The resistant rates of the 26 strains to Ceftazidime,Cefoxitin,Piperacillin-tazobactam and Ciprofloxacin were 100.0%.About 80.8% to 96.2% of these strains were resistant to the other antimicrobial drugs.Among the 26 MDR-AB strains,100% (26/26) strains possessed oxa-51,77% (20/26) possessed oxa-23 gene,54% (14/26) carried arnpC gene,both oxa-23 and ampC were identified in 42% (11/26) strains,while oxa-24,oxa-58,imp-1,imp-4 and vim-2 gene were not identified.Conclusions The drug resistance of Acinetobacter baumannii is serious,oxa-23 and ampC are the major plactamase genes carried by MDR-AB in neonatal intensive care unit.

Objective To investigate the value of the interhospital transportation and the advantage of the cooperative network to the critically ill children.Methods The clinical data of 232 critically ill chil-dren transported from other hospitals in long distances to PICU of Fudan University Affiliated Children Hos-pital cooperated with Shanghai 120 interprovincial transport Department,between Oct 2010 and Oct 2013, were analyzed retrospectively.Results At otal of 232 critically ill childrne were transported from 31 hospi-tals of Eastern China region including five provinces and the city of Shanghai.Among thse e critically ill chil-dren 141 casse were male and 91 cases were femla e,with age from 29 days ot 13 years( median age was 12 months) and weight from 2.5 to 66 kg ( median weight was 10 kg ) .The average pediatric clinical illness score was 80.4 ±7.7,155 cases(66.8%) were single organ dysfunction,55 cases(23.7%) were multiple organs dysfunction,105 cases(45.3%) were mechanical ventilation required fort ransportait on.Referral radi-us was 50-1 000 km(median).Among these patients,87 cases(37.3%) weret ransported over 200 km radius and73 cases(36%) were transop rted 101-200 km,62 cases(26.7%) were transported 100 km or less.D ur-ing the transportation,0 case died,3 cases(1.3%) received cardiopulmonary resuscitation treatment,2 cases (0.9%) received electrical conversion treatment,2 cases(0.9%) were replaced endotracheal intuab tion,the success rate of transportation was 100%.The top 4 disae ses were respiratro y id seases(90 cases,38.8%), neural diseases(43 cases,18.5%) ,cardiovascular diseases(36 cases,15.5%) and acute pediatric trauma(28 cases,12.1%) .Al l 232 cir tically ill children were admitted to our PICU for further treatment through the Green Channel.In the end, 178 cases ( 76.7%) discharged, 24 cases ( 10.3%) gave up and 32 cases (13.8%) died.Among thse e 232 rc itically ill children,30 cases(12.9%) received special organ replacement treatment,4 casse ( 1.7%) of whom were treated with extracorporeal membrane oxyg enation, 26 cases (11.1%) received blood purification therapy.Conclusion Establishing the system of transportation between PICU of hospitals will be propitious to treat the critically ill children energetically and effectively.It is worth pro-moting to master the transportation indication of children with critical illness,which is safe and reliable.

Objective To review multi-center experience on rescue use of extracorporeal membrane oxygenation(ECMO) in pediatric patients with respiratory failure and to investigate its short-term outcome in China.Methods The survey was conducted in 4 tertiary hospitals in China mainland.All children<18 years old who had been supported with non-open chest ECMO to rescue respiratory failure in PICU were reviewed.Results Twenty-one patients with ECMO support were diagnosed respiratory failure.Male was 14,female was 7.Twelve patients successfully weaned off ECMO, 8 patients survived to discharge and 13 died.The largest part of protopathy was severe pneumonia(33%)and acute respiratory distress syndrome(29%).Their mean age was 29.0(9.0,81.5)months, mean weight was 12.0(9.0,20.8)kg,and mean OI index was 31.5(19.2,41.0).The average length of ECMO run was 149.0(91.2,242.0)hours.The blood gas analysis showed that PO2 increased from 49.5(40.4,61.9)mmHg(1mmHg=0.133kPa) at the beginning to 65.0(42.6,120.5)mmHg at 24h after ECMO treatment,and the increase of PO2 was higher in the survival compared with the nonsurvival[52.0(1.8,89.4) mmHg vs.8.2(-15.1,33.9) mmHg,P=0.036].The SO2 increased from 80.0%(70.4%,91.8%)at ECMO initiation to 98.0%(95.6%,100%)at 24h after ECMO treatment,and increase of SO2 was higher in survival group compared to that of nonsurvival group[23.5%(11.4%,27.1%) vs.4.3%(2.4%,23.8%),P=0.039].VV mode had higher survival rate than VA mode(3/3 vs.5/18).The longer the use of ventilator before ECMO,the mortality rate increased as well.The mechanical ventilation time before ECMO was significantly longer in nonsurvival group than that in the survival group[4.5(2.5,12.0)h vs.1.6(1.0,2.2)h,P=0.015].The most common complications during ECMO run were bleeding and disfunction of oxygenator.Conclusion ECMO is an effective support treatment for the pediatric patients with respiratory failure,which significantly improves oxygenation.