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.

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.

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.

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

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.

Nearly every patient admitted into PICU is administered sedation and analgesia therapy.The precise control of the depth of sedation and the intensity of pain are often not well managed.Inappropriate treatment will cause more adverse effects.Self-assessment is considered the gold standard in pain rating,other complementary methods being the behavioural measures and the biological measures,that reflect the body's answer to pain.There is a growing need for reliable and valid sedation and pain instruments that can easily be incorporated into daily care.There are many methods for assessing pain and sedation in critical children,but none is completely accepted as an objective measure or suitable for all ages of children.The clinicians should choose appropriate assessment tools and even combine different tools according to the environment,condition and the characteristics of patients.

Early recognition of severe sepsis and septic shock,early initiation of effective interventions,implementation of early goal-directed therapy may be key approaches for reducing the mortality and improving the prognosis.This article focused on the staging diagnosis systems for sepsis (PIRO sepsis classification system) and the systematic early warning or rapid response system.We also discussed the diagnostic value of biomarkers,proteomics and metabolomics in sepsis and severe sepsis.No single marker as golden standard has emerged that can provide clinicians with all the information they need for early recognition of sepsis.Therefore,we suggested that clinicians should have even more reason to combine the sepsis symptoms,signs and biomarkers for a comprehensive evaluation,and that they needed to dynamically monitor the changes in these parameters,in order to make reasonable clinical decisions and strategies.

Acute liver failure (ALF) is rare in children but carries high mortality.It can progress to multi-organ failure and death.The etiology,clinical manifestations,diagnosis and prognosis of pediatric acute liver failure (PALF) are different from that of adults,and vary with age.The classic adult symptoms are often absent in children and the clinical encephalopathy may not be present.Children correctly diagnosed with well-characterized causes of PALF may benefit from the early implementation of directed medical therapies.Early recognition,diagnosis,and identification of prognostic factors will help in optimizing treatment and selecting patients for liver transplantation or artificial support,and improved their survival chances.

Objective To detect the incidence and monality of the pediatric sepsis/severe sepsis,and to investigate the risk factors for poor prognosis in these patients.Methods From Jan.1 to Dec.31,2008,all pediatric patients admitted to PICU in Beijing Children's Hospital were prospectively surveyed.Both Chinese pediatric critical care scoring system and American guidelines for PICU admission and discharge were applied for screening subjects.The diagnosis criteria of pediatric sepsis/severe sepsis were made according to the definition determined on the International Pediatric Sepsis Consensus Conference held in the United States in early 2002.The qualified subjects were surveyed by questionnaire until discharge.After three months,the subjects were followed up by telephone.Results In a total of 742 children were screened.545 cases were critically ill,143 cases (26.2%) developed sepsis,and 104 cases (19.1%) deteriorated into a state af severe sepsis.Hospital mortality of severe sepsis was 21.2%,and that of sepsis was 0.7%.At the end of three months after discharged from hospital,mortality of severe sepsis was 30.8%.and that of sepsis was 1.4%.Patients under 3-year-old accounted for 72.5%.Pneumonia was the most common primary disease.The respiratory dysfunctions in severe sepsis cases were most common organ dysfunction (73.1%) . In surviving patients with severe sepsis,the PICU stay was significantly longer than that in deceased patients,and the PICU costs and average per capita costs were higher than the critically ill patients.Muhiple stepwise logistic regression analysis showed that pediatric critical illness score (PCIS score),capillary refilling Lime,respiratory dysfunction and hypoalbuminemia were the risk factors for death.Conclusions Sepsis/severe sepsis are common in the PICU,which have high mortality,high hospital charges.Infants and young children were the most commonly affected.Pneumoma was the most common primary disease.PCIS score.capillary filling time,respiratory dysfunction and hypoalbuminemia were the risk factors for death.