Acute respiratory distress syndrome(ARDS) is a serious disease that remains an ongoing diagnostic and therapeutic challenge.The American-European Consensus Conference definition of ARDS has been applied since its publication in 1994 and has helped to improve knowledge about ARDS.However,18 years later,in 2011,the European Intensive Medicine Society requested a team of international experts to meet in Berlin to review the ARDS definition.This article discusses the evolution of the definition of ARDS to the new Berlin definition of ARDS proposed in 2012 and its novel iterative refinement.

Objective To analyze the efficacy of IMRT in the treatment of recurrentnasopharyngeal carcinoma. Methods Clinical data of 22 patients with recurrent nasopharyngeal carcinoma ( NPC ) were retrospectively analyzed,We have recurrent NPC tune the amount of synchronization push radiation therapy in patients with clinical data,treatment efficacy and acute toxicity were analyzed.Results All patients were hospitalized on average 50 days, between median follow-up period of 12 months.At the end of 22 patients with no treatment deaths,three deaths ( both metastasis) during follow-up,overall survival 86.3%(19/22),local recurrence in 2 cases,2 cases of bone metasta-sis,1 case of throat and neck lymph node metastasis.The local control rate was 63.6%(14/22).Acute toxicity main-ly acute skin,oropharyngeal mucosa (12 cases) and bone marrow suppression (4 cases).1 patient had symptoms of hearing loss and auditory nerve damage,1 case of necrosis of the mandible,all symptoms of dry mouth in patients with radiotherapy were heavier than that of the first drive.Conclusion With the growing popularity of IMRT,NPC patients had significantly improved overall survival, but distant metastasis and recurrence of the tumor, radiotherapy again cause adverse reactions in clinical practice still needs further development and improvement,IMRT treatoffing with re-current nasopharyngeal has broad prospects.

Almost all children in PICU need analgesia and/or sedation.A therapeutic plan for analgesia and sedation should be established for each patient and regularly reviewed.The most often used sedation agents in PICU patients are Morphine or Fentanyl alone or in combination with Midazolam.There are several agents that have been used to provide sedation and analgesia in the PICU patient including benzodiazepines,opioids,ketamine,propofol,chloral hydrate,barbiturates,NSAIDs and paracetamol and α-adrenoreceptor agonists.This review described the various agents for sedation and discussed their advantages and disadvantages as they pertain to the PICU.Consequences of and treatment strategies for adverse effects with sedation and analgesia including respiratory depression,hypotension,withdrawal syndrome and propofol infusion syndrome were reviewed.

Acute respiratory distress syndrome (ARDS )is a severe disease with high short term mortality.We introduce a pediatric clinical practice protocol of diagnosis and treatment of ARDS which in-clude its origin,diagnosis standard,diagnosis flowchart,accessory examination and treatment.Lung protective ventilation,fluid therapy,prone position ventilation and sedation are underlined in the treatment of ARDS.

The definition of severe sepsis has been renewed in 2012 international guidelines for management of severe sepsis and septic shock.This article summarizes briefly respiratory support strategy of severe sepsis which incorporated with new guideline and recent progress in sepsis and mechanical ventilation (MV).Oxygen therapy,indication of mechanical ventilation,the support roles of MV on septic shock,drug selection,MV strategy and hemodynamic monitoring are included in this article.

Acute respiratory distress syndrome (ARDS) is one of the most severe disease in pediatric intensive care units.The purpose of this article is to introduce the Berlin's definition of ARDS and review the current knowledge base related to non-ventilator therapy in pediatric intensive care unit,including prevention of predisposing factor,nutrition therapy,conservative fluid therapy,transfusion and transfusion related acute lung injury,etc.The article also reviews the role of pulmonary surfactant,nitric oxide,prone position and glucocorticoid in pediatric ARDS.

Clinical symptoms and signs and diagnostic steps of unknown poisoning in children were discussed in this article. Present history and past history ,physical examination and laboratory evaluation were the three most important steps in establishing diagnosis. The treatment principles of unknown poisoning in children were also discussed.

Acute respiratory distress syndrome(ARDS) can be divided into pulmonary ARDS and extrapulmonary ARDS according to its origin.The prevalent damage in early stages of pulmonary ARDS is intra-alveolar,whereas in extra-pulmonary ARDS it is the interstitial edema.In pulmonary ARDS,lung compliance is worse than in extrapulmonary ARDS,whereas the main abnormality is the decrease in chest Wall compliance.due to abnormally high intra-abdominal pressure.Positive end expiratory pressure,recruitment maneuver and prone position ventilation are more effective in extrapulmonary ARDS,whereas low tidal volume ventilation play equal role in rescuing the two types of ARDS.

For the last 20 years,lung protective strategy which comprises of low tidal volume,higher positive end expiratory pressure,and limited plateau pressure has become a standard care for acute respiratory distress syndrome (ARDS),but still do not know the best way to ventilate patients with ARDS.This article reviews clinical trials related to lung protective strategy published in recent years and give some suggestions in optimal mechanical ventilation.In addition,the article also introduces some concept of ventilator related lung injury and new understanding in lung protective strategy using stress and strain theory.

The purpose of this article was to review the current knowledge base related to the risk factors,pathogens,diagnosis and to review and evaluate the strategies to reduce ventilator associated pneumonia (VAP),especially ventilator bundles for prevention of VAP which including elevation of the head of the bed,daily sedative interruption and daily assessment readiness of extubate,peptic ulcer disease prophylaxis,deep venous thrombosis prophylaxis,daily oral care with chlorhexidine.This article also reviewed the role of new type endotracheal tube in reducing incidence of VAP.