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

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.

@@

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.

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.

Child ; Consensus ; Disease Management ; Humans ; Pediatrics ; Shock, Septic ; therapy

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.

Bedside ultrasonography is used to provide information about the cardiovascular system and the function and anatomy of certain internal organs,and help to guide the invasive procedures.Compared to traditional ultrasonography,bedside ultrasonography is more focused on the optimization of the treatment.It has become a necessary tool,as a powerful adjunct to the physical examination,in the management of critically ill patients in advanced countries.The development trend is the clinical protocol based on bedside ultrasonog-raphy.The application of bedside ultrasonography in China is limited,especially in PICU.Standardized educa-tion and quality assurance system are needed to its popularization.