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.

There are much more multidrug-resistant organisms (MDRO) in the intensive care unit than ever.If the doctors could distinguish the colonization from infection of MDRO,they can make right decision on the rational clinical use of antibiotics to reduce resistant organisms and nosocomial infection.However,it's a confused problem for clinicians to distinguish between colonization and infection.Bacterial culture combined with clinical symptoms and signs maybe helpful,but it is limited.There should be more objective indicators.This article was aimed to state the definition and relationship between colonization and infection,and how to determine the colonization and infection of MDRO.

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.

Child ; Continuous Positive Airway Pressure ; Humans ; Pediatrics

Objective To assess the effect of scene simulation-based teaching on pediatric advanced life support(PALS)skills in medical students.Methods The students of two grades of Department of Pedi-atrics in Capital Medical University participated in the PALS training.All of them had the examination of the-ory and skills of critical illness management and cardiopulmonary resuscitation in children before and after the scene simulation-based teaching on PALS.The questionnaire was filled out and the data was analyzed after the training.Results Fifty-one students completed the training.The average score after the training was sig-nificantly higher than that before the training(86.51 ±7.16 vs.53.85 ±14.24,P ﹤0.05).After the training, the error rate of ECG recognition,etiological identification and treatment of the disease,and the dosage as well as usage of medicine was significantly decreased (64.7% vs.15.7%,71.0% vs.10.5%,73.2%vs.25.9%).All of the students could use the defibrillator correctly and the students'satisfaction rate was more than 94%.Conclusion Scene simulation-based teaching on PALS skills can improve the theory and skills of critical illness management and cardiopulmonary resuscitation of children in medical students.

Objective To investigate the effects of airway pressure release ventilation (APRV) in children with severe pneumonia-related acute respiratory distress syndrome(ARDS).Methods Ten children suffering severe pneumonia-related ARDS with APRV were included in Pediatric Intensive Care Unit, Beijing Children's Hospital,Capital Medical University from March 2011 to October 2014.Ventilation variables, changes of airway pressure and Ramsay scores were collected and compared with that in conventional ventilation (CV).Clinical variables were measured at CV before APRV and at 1,4,12,24 hours after transition to APRV.Results High airway pressure(Phigh) at each time point during APRV was significantly lower than peak airway pressure (Ppeak) or plateau airway pressure (Pplat) in CV[(26.00 ±2.94) cmH2O(1 cmH2O =0.098 kPa) ,(24.40 ±3.34) cmH2O,(23.30 ±3.46) cmH2O,(23.00 ± 3.80) cmH2O vs (31.80 ± 5.59) cmH2O, P ＜ 0.01].Mean airway pressure (Pmean) at each time point during APRV was significantly higher than that in CV [(23.00 ± 2.86) cmH2 O, (21.69 ± 3.12) cmH2 O, (20.89 ± 3.31) cmH2 O, (20.46 ± 3.48) cmH2 O vs (17.50 ± 2.37) cmH2 O, P ＜ 0.05].Fraction of inspired oxygen (FiO2) were significantly decreased at 4, 12 and 24 hours after APRV than that in CV [(73.00 ± 22.39) ％, (63.50 ± 20.16) ％, (63.00 ± 21.11) ％ vs (88.00 ± 15.49) ％, P ＜ 0.05].Ramsay scores were significantly decreased at each time point during after APRV than that in CV [(3.90 ± 0.74) scores, (2.90 ± 0.88) scores, (3.00 ± 1.15) scores,(3.50 ± 0.71) scores vs (4.60 ± 0.52) scores, P ＜ 0.05].Conclusions Compared with CV, APRV had a lower Phigh and FiO2 ,a higher Pmean and more shallow sedation.APRV may be an effective ventilation mode in children's severe pneumonia-related ARDS.

Objective To analyse the reasons for patients′long PICU stay and to discuss how to de-crease their PICU stay length and optimize medical resource utilization.The another objective is to identify these patients′long-term outcome.Methods We retrospectively analysed the basic information of patients who stayed in our PICU more than 30 days during January 1,2013 to July 31,2014,including pediatric criti-cal illness score on admission,primary diseases and outcome on discharge,in order to determine main reasons for their long PICU stay.Follow-up prognosis was made by Paediatric Overall Performance Category.We used SPSS 19.0 to do data analysis.Results Sixty-seven patients enrolled in this study included 43 boys and 24 girls,49.2%of whom came from emergency department.The median age was 24 months(IQR 8,108), while median length of PICU stay was 39 days(IQR 31,49).Mean pediatric critical illness score on admi-ssion was 78.39 ±9.57.Mean hospital fees was(144 071.74 ±76 944.74)Yuan.Thirty(44.8%)patients did not have any medical insurance.Top three primary diseases were respiratory disease(30 cases),neurolog-ical disease(8 cases)and systemic infection(6 cases).Top three underlying diseases were tracheostenosis or bronchopulmonary dysplasia(6 cases),congenital heart disease(5 cases)and immunodeficiencies(4 cases). Top three complications were respiratory failure(30 cases),multiple organ dysfunction or failure(16 cases), shock(9 cases).Top three reasons for longer PICU stay were weaning off mechanical ventilation difficulty (29 cases),department or hospital transference difficulty(20 cases),feeding difficulty(16 cases).Fifty-four patients were discharged with better health condition,10 patients were auto-discharge.The mortality at dis-charge,1 month after discharge,3 months after discharge and 6 months after discharge were 4.5%,20.9%, 25.4% and 25.4%,respectively.Total 36(53.7%)patients had a good or mildly abnormal Paediatric Over-all Performame Category score(1-2 points)at 6 months after discharge.Conclusion Sequential noninvasive ventilation,timely tracheotomy,timely patients′transference to general ward,development of family ward and rehabilitation wards,appropriate nutrition delivery,regularly difficult disease consultation,reduction of hospi-tal infection and complications may do contribution to shorten these patients′length of PICU stay.Children who survive longer than 3 months after discharge have better long-term prognosis.

Objective To study the clinical features of invasive pneumococcus disease (IPD) with resistance to antimicrobial agents in children,and to improve the diagnosis and treatment of this disease.Methods The clinical data from 21 IPD patients younger than 13 years old were collected from January 2008 through December 2010 in Pediatric Intensive Care Unit in Beijing Children's Hospital for retrospective analysis. Specimens of blood,pleural effusion,cerebrospinal fluid and soft tissue aspirated were collected from these children,and 23 strains of streptococcus pneumonia (SP) were cultured,isolated and confirmed,and the antibiotics susceptibility to penicillin and other antibiotics of these strains were assayed.Results Among the 21 IPD children,the ratio of male to female was 0.9∶1,and the age was 5 months to 13 years,with 61.9％ of them under 2 years.Of them,12 patients (57.1％ ) had purulent pleurisy,and 1 (4.8％ )patient had an underlying disease diagnosed to be X - linked agammaglobulinemia (XLA).There was no seasonal difference in the occurrence rate of this disease. Eight (38.1％) patients were cured,11(52.4％ ) were improved,while 2 (9.5％ ) patients not improved without death.There was no statistically significant difference in the annual detection rate of invasive SP (x2 =3.711,P =0.156).The incidences of penicillin-intermediate susceptibility SP (PISP) and penicillin-resistant SP (PRSP) were 47.8％ and 26.1％ respectively.The rate of resistance to multiple antibiotics was 91.3％.Conclusions Children aged less than 5 years,especially younger than 2 years,are prone to IPD,and purulent pleurisy and septicemia are often seen in this disease. Some patients had the underlying diseases.The complications included hemophagocytic syndrome,acute respiratory distress syndrome,septic shock,bronchial pleural fistula and so on.The multidrug resistance rate was 91.3％.It is important to put great emphasis on the monitoring antibiotics resistance to invasive pneumococcal disease.

Objective To study the pulmonary functions of pediatric ALI/ARDS(acute lung injury/acute respiratory distress syndrome) survivors. Method A prospective cohort study of all survivors of ALI/ARDS in the PICU of Beijing Children's Hospital was performed. Patients were divided into three groups(0-3 years of age,3 ～ 7 years of age, and over 7 years of age) and followed up three months after diagnosis. Results There were 36 survivors in total of 44 ALl patients, three patients lost follow-up, 12 died and 21 survived. Five survivors refused to participate in the study because of asymptomatic, and one was unable to participate because of lymphoma com-bined with sepsis. A total of 15 children completed the whole survey (11 patients were less than 3 years old, andfour were over 7 years of age). Twelve patients had no discomfort in their respiratory tracts. Three months after be-ing enrolled, the pulmonary functions of all children improved, especially in terms of tidal volume and respiratory compliance (P<0.05). Conclusions The abnormal respiratory symptoms and signs in most children disap-peared three months after discharge. Most survivors still have pulmonary dysfunction at 3 monthes after discharge, but better than discharge.

Objective To summarize the clinical features and technical key points on brain death during decision-made process in children with suspected brain death.Methods Twenty-four coma children with Glasgow coma scale score 3 and no spontaneous respiration were collected from May 2015 to February 2017 in Beijing Children's Hospital,Capital Medical University to make the brain death determination.All children received at least one confirmatory test.According to the Chinese standards for determining brain death (pediatric),all patients were divided into brain death group and non-compliance group.The clinical features were analyzed.The sensitivity,specificity,false positive rate and false negative rate of electroencephalogram (EEG),short latency somatosensory evoked potential (SLSEP) and transcranial Doppler sonography (TCD) were calculated.Results Among these 24 cases,there were 16 males and 8 females,aged 5.6 (2.0,8.8) years old.Ten cases met the criteria of brain death.Twelve (50％,12/24 cases) cases received autonomic breathing test.A total of 25 tests were conducted,of which 21 were successful.The completion rates of EEG,TCD and SLSEP were 100.0％ (24/24 cases),83.3 ％ (20/24 cases) and 54.2％ (13/24 cases),respectively.EEG had the highest sensitivity (100％) and specificity (79％).SLSEP had good sensitivity (100％),but the specificity was only 40％.The combination of EEG with SLSEP had the highest specificity and sensitivity,both of which were 100％,and the false positive rate and false negative rate were 0.Conclusions The key to determine brain death successfully is to make adequate preparations,to receive formal training and to apply standard operation.In the determination of brain death in children,EEG has a good sensitivity and specificity in single confirmation test,which is the priority item.The combination of EEG with SLSEP is the most advantageous.