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

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.

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.

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.

Acute kidney injury in children is frequently a component of the multiple organ dysfunction syndrome. It often occurs within the severe catabolic phase determined by critical illness and is intensified by metabolic derangements. Nutritional support is critical for these children to improve outcomes. Meeting the special nutritional needs of these critical children with acute kidney injury often requires nutritional supplemen-tation by either the enteral or the parenteral route. The nutritional requirements of these children should be frequently reassessed for individualized nutritional support and carefully integration with renal replacement therapy.

The adenovirus pneumonia is one of the severe pneumonia in infants and young children.Adenovirus serotype 3 and 7 can cause severe clinical presentation,a wide range of clinical syndrome,difficult treatment,high mortality and serious pulmonary sequelae.The epidemiology,pathogenesis,clinical manifestation,treatment and prognosis of severe adenovirus pneumonia in children are reviewed in the paper.

Acute respiratory distress syndrome(ARDS) is a lung inflammation caused by variety of promoting inflammation factors induced by many causes.High permeability pulmonary edema is the basic pathophysiology characteristics of ARDS.Reasonable fluid management of ARDS helps to improve the pulmonary edema and reduce the mortality.Timely and effective nutrition therapy is one of the most important interventions.Nutrition support goals of ARDS patients have already been changed from purely providing the energy and substrate of the cells' and body's metabolism to regulating metabolism disorders,regulating immune,and acting as a disease treatment drug for the target.In the treatment of patients with ARDS,how to develop the nutrition strategies which can not only satisfy patients' nutrition requirements,and at the same time,but also restrain inflammatory reaction,improve the oxygenation of ARDS patients even reduces mortality is worth concerned.

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.