Neonates born through meconium-stained amniotic fluid (MSAF) may develop complications including meconium aspiration syndrome, persistent pulmonary hypertension of newborn and death. The approach to the resuscitation of these neonates has significantly evolved for the past few decades. Initially, under direct visualization technique, neonates with MSAF were commonly suctioned below the vocal cords soon after delivery. Since 2015, Neonatal Resuscitation Program (NRP^®) of the American Academy of Pediatrics has recommended against "routine" endotracheal suctioning of non-vigorous neonates with MSAF but favored immediate resuscitation with positive pressure ventilation via face-mask bagging. However, the China neonatal resuscitation 2021 guidelines continue to recommend routine endotracheal suctioning of non-vigorous neonates born with MSAF at birth. This review article discusses the differences and the rationales in the approach in the resuscitation of neonates with MSAF between Chinese and American NRP^® guidelines over the past 60 years.
Female ; Infant, Newborn ; Humans ; Child ; Meconium Aspiration Syndrome/therapy* ; Meconium ; Resuscitation ; Amniotic Fluid ; Intubation, Intratracheal/methods* ; Infant, Newborn, Diseases ; China

Objective: To investigate the scientificity and feasibility of the ten-fold rehydration formula for emergency resuscitation of pediatric patients after extensive burns. Methods: A retrospective observational study was conducted. The total burn area of 30%-100% total body surface area (TBSA) and body weight of 6-50 kg in 433 pediatric patients (250 males and 183 females, aged 3 months to 14 years) with extensive burns who met the inclusion criteria and admitted to the burn departments of 72 Class A tertiary hospitals were collected. The 6 319 pairs of simulated data were constructed after pairing each body weight of 6-50 kg (programmed in steps of 0.5 kg) and each total burn area of 30%-100% TBSA (programmed in steps of 1%TBSA). They were put into three accepted pediatric rehydration formulae, namely the commonly used domestic pediatric rehydration formula for burn patients (hereinafter referred to as the domestic rehydration formula), the Galveston formula, and the Cincinnati formula, and the two rehydration formulae for pediatric emergency, namely the simplified resuscitation formula for emergency care of patients with extensive burns proposed by the World Health Organization's Technical Working Group on Burns (TWGB, hereinafter referred to as the TWGB formula) and the pediatric ten-fold rehydration formula proposed by the author of this article--rehydration rate (mL/h)=body weight (kg) × 10 (mL·kg^-1·h^-1) to calculate the rehydration rate within 8 h post injury (hereinafter referred to as the rehydration rate). The range of the results of the 3 accepted pediatric rehydration formulae ±20% were regarded as the reasonable rehydration rate, and the accuracy rates of rehydration rate calculated using the two pediatric emergency rehydration formulae were compared. Using the maximum burn areas (55% and 85% TBSA) corresponding to the reasonable rehydration rate calculated by the pediatric ten-fold rehydration formula at the body weight of 6 and 50 kg respectively, the total burn area of 30% to 100% TBSA was divided into 3 segments and the accuracy rates of the rehydration rate calculated using the 2 pediatric emergency rehydration formulae in each segment were compared. When neither of the rehydration rates calculated by the 2 pediatric emergency rehydration formulae was reasonable, the differences between the two rehydration rates were compared. The distribution of 433 pediatric patients in the 3 previous total burn area segments was counted and the accuracy rates of the rehydration rate calculated using the 2 pediatric emergency rehydration formulae were calculated and compared. Data were statistically analyzed with McNemar test. Results: Substitution of 6 319 pairs of simulated data showed that the accuracy rates of the rehydration rates calculated by the pediatric ten-fold rehydration formula was 73.92% (4 671/6 319), which was significantly higher than 4.02% (254/6 319) of the TWGB formula (χ²=6 490.88,P<0.05). When the total burn area was 30%-55% and 56%-85% TBSA, the accuracy rates of the rehydration rates calculated by the pediatric ten-fold rehydration formula were 100% (2 314/2 314) and 88.28% (2 357/2 670), respectively, which were significantly higher than 10.98% (254/2 314) and 0 (0/2 670) of the TWGB formula (with χ² values of 3 712.49 and 4 227.97, respectively, P<0.05); when the total burn area was 86%-100% TBSA, the accuracy rates of the rehydration rates calculated by the pediatric ten-fold rehydration formula and the TWGB formula were 0 (0/1 335). When the rehydration rates calculated by the 2 pediatric emergency rehydration formulae were unreasonable, the rehydration rates calculated by the pediatric ten-fold rehydration formula were all higher than those of the TWGB formula. There were 93.07% (403/433), 5.77% (25/433), and 1.15% (5/433) patients in the 433 pediatric patients had total burn area of 30%-55%, 56%-85%, and 86%-100% TBSA, respectively, and the accuracy rate of the rehydration rate calculated using the pediatric ten-fold rehydration formula was 97.69% (423/433), which was significantly higher than 0 (0/433) of the TWGB formula (χ²=826.90, P<0.05). Conclusions: The application of the pediatric ten-fold rehydration formula to estimate the rehydration rate of pediatric patients after extensive burns is more accurate and convenient, superior to the TWGB formula, suitable for application by front-line healthcare workers that are not specialized in burns in pre-admission rescue of pediatric patients with extensive burns, and is worthy of promotion.
Male ; Female ; Humans ; Child ; Burns/therapy* ; Hospitalization ; Resuscitation ; Fluid Therapy/methods* ; Body Surface Area ; Retrospective Studies

This study used nasal lavage fluid for metabolomics to explore its feasibility, and applied it to the clinical metabolomics study of Xiaoqinglong Decoction in the treatment of allergic rhinitis(AR), aiming to investigate the molecular mechanism of Xiaoqing-long Decoction in the treatment of AR through differential changes in local nasal metabolism. AR patients were selected as the research subjects, and nasal lavage fluid was collected as the sample. Metabolomics analysis using liquid chromatography-mass spectrometry was performed on normal group, AR group, and Xiaoqinglong Decoction group. The differences in metabolic profiles among the groups were compared using principal component analysis and partial least squares discriminant analysis, and differential metabolites were identified and subjected to corresponding metabolic pathway analysis. The results showed that Xiaoqinglong Decoction significantly improved the symptoms of AR patients. The metabolomics analysis revealed 20 differential metabolites between AR group and Xiaoqinglong Decoction group. The core metabolite with a trending return in comparison to normal group was trimethyladipic acid. The metabolites were involved in multiple pathways, including β-alanine metabolism, glutathione metabolism, and phenylalanine, tyrosine, and tryptophan biosynthesis. The feasibility of applying nasal lavage fluid in nasal metabolomics was preliminarily demonstrated. Differential metabolites and enriched pathways in the treatment of AR patients with Xiaoqinglong Decoction were identified, indicating that it may improve rhinitis symptoms through the regulation of various metabolites, including antioxidant effects and correction of Th1/Th2 imbalance.
Humans ; Nasal Lavage Fluid ; Rhinitis, Allergic/drug therapy* ; Metabolomics/methods* ; Metabolome

Objective Although goal-directed fluid therapy (GDFT) has been proven to be effective in reducing the incidence of postoperative complications, the underlying mechanisms remain unknown. The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications. We further tested the role of this mediation effect using mean arterial pressure, a hemodynamic indicator. Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis. We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications. We conducted mediation analysis using the mediation package in R (version 3.1.2), based on 5,000 bootstrapped samples, adjusting for covariates. Results Among the 300 patients in the study, 40% (120/300) developed postoperative complications within 30 days. GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders (odds ratio: 0.460, 95% CI: 0.278, 0.761; P = 0.003). The total effect of GDFT on postoperative complications was -0.18 (95% CI: -0.28, -0.07; P < 0.01). The average causal mediation effect was -0.08 (95% CI: -0.15, -0.04; P < 0.01). The average direct effect was -0.09 (95% CI: -0.20, 0.03; P = 0.17). The proportion mediated was 49.9% (95% CI: 18.3%, 140.0%). Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications. Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.
Humans ; Blood Pressure ; Goals ; Postoperative Complications/epidemiology* ; Hemodynamics ; Fluid Therapy/methods*

Objective: To explore the scientificity and feasibility of the tenfold rehydration formula for emergency resuscitation of adult patients after extensive burns. Methods: A retrospective observational study was conducted. The total burn area (30%-100% total body surface area (TBSA)) and body weight (45-135 kg) of 170 adult patients (135 males and 35 females, aged (42±14) years) with extensive burns admitted to the Fourth Medical Center of PLA General Hospital from December 2016 to December 2019 were collected. The 6 461 pairs of simulated data obtained after pairing each body weight in 45 to 135 kg (programmed in steps of 1 kg) with each area in 30% to 100% TBSA (programmed in steps of 1%TBSA) were plugged into four recognized rehydration formulas--Parkland's formula, Brooke's formula, the 304th PLA Hospital formula, and the Third Military Medical University formula and two emergency rehydration formulas--the simplified first aid resuscitation plan for extensive burn patients proposed by the World Health Organization's Technical Working Group on Burns (TWGB, hereinafter referred to as the TWGB formula) and the tenfold rehydration formula proposed by the author of this article to calculate the rehydration rate within 8 hours after injury (hereinafter referred to as the rehydration rate), with results being displayed by a programming step of 10%TBSA for the total burn area. Taking the calculation results of four recognized rehydration formulas as the reasonable rehydration rate, the accuracy of rehydration rates calculated by two emergency rehydration formulas were calculated and compared. The body weight of 45-135 kg was divided into three segments by the results of maximum body weight at a reasonable rehydration rate calculated by the tenfold rehydration formula when the total burn area was 30% and 100% TBSA, respectively. The accuracy of rehydration rate calculated by two emergency rehydration formulas in each body weight segment was compared. When the rehydration rates calculated by two emergency rehydration formulas were unreasonable, the differences in rehydration rates between the two were compared. Statistical distribution of the aforementioned three body weight segments in the aforementioned 170 patients was counted. Using the total burn area and body weight data of the aforementioned 170 patients, the accuracy of rehydration rate calculated by two emergency rehydration formulas was calculated and compared as before. Data were statistically analyzed with McNemar test. Results: When the total burn area was 30%, 40%, 50%, 60%, 70%, 80%, 90%, and 100% TBSA, respectively, and the body weight was 45-135 kg, the rehydration rates calculated by two emergency rehydration formulas did not exceed the maximum of the calculated results of four recognized rehydration formulas; the rehydration rate calculated by the TWGB formula did not change accordingly with total burn area, while the rehydration rate calculated by the tenfold rehydration formula did not change accordingly with body weight. Substituting 6 461 pairs of simulated data showed that the accuracy of rehydration rate calculated by the tenfold rehydration formula was 43.09% (2 784/6 461), which was significantly higher than 2.07% (134/6 461) of the TWGB formula, χ²=2 404.80, P<0.01. When the body weights were 45-62 kg and 63-93 kg, the accuracy rates of rehydration rate calculated by the tenfold rehydration formula were 100% (1 278/1 278) and 68.42% (1 506/2 201), respectively, which were significantly higher than 0 (0/1 278) and 0.05% (1/2 201) of the TWGB formula, χ²=1 276.00, 1 501.01, P<0.01; when the body weight was 94-135 kg, the accuracy rate of rehydration rate calculated by the tenfold rehydration formula was 0 (0/2 982), which was significantly lower than 4.46% (133/2 982) of the TWGB formula, χ²=131.01, P<0.01. When the rehydration rates calculated by two emergency rehydration formulas were both unreasonable, the rehydration rate calculated by the tenfold rehydration formula was greater than that calculated by the TWGB formula in most cases, accounting for 79.3% (2 808/3 543). Among the 170 patients, the proportions of those weighing 45-62, 63-93, and 94-135 kg were 25.29% (43/170), 65.88% (112/170), and 8.82% (15/170), respectively. Among the 170 patients, the accuracy rate of rehydration rate calculated by the tenfold rehydration formula was 69.41% (118/170), which was significantly higher than 3.53% (6/170) of the TWGB formula, χ²=99.36, P<0.01. Conclusions: Applying the tenfold rehydration formula to calculate the emergency rehydration rate in adults after extensive burns is simpler than four recognized rehydration formulas, and is superior to the TWGB formula. The tenfold rehydration formula is suitable for the front-line medical staffs that are not specialized in burns in pre-admission rescue of adult patients with extensive burns, which is worth popularizing.
Adult ; Body Surface Area ; Burns/therapy* ; Female ; Fluid Therapy/methods* ; Humans ; Male ; Middle Aged ; Resuscitation/methods* ; Retrospective Studies

OBJECTIVE: Stroke volume (SV) measurements have been used to guide fluid management. Noninvasive, indirect, and convenient measurements of the SV for fluid therapy are required for most patients during spontaneous breathing (SB). On the other hand, the preferred method for an indirect prediction of the SV is unclear. This study examined the best of the indirect and predictable parameters responding to a SV variation during SB. METHODS: Hemodynamic parameters, such as collapsibility of the inferior vena cava (cIVC), peak velocity variation in the common carotid artery (pvvCCA), collapsibility of the internal jugular vein (cIJV), and end-tidal carbon dioxide (ETCO₂) were measured 180 times (6 different positions each in 30 normal subjects). The variables changed with the SV at the upper body elevation of 60°and 30°, in the supine position, at the lower body elevation of 60°and 30°, and lumbar elevation. RESULTS: The SV showed the highest value at 30°of lower body elevation. Following fixed position changes, the ETCO₂ during SB was the factor most correlated with the SV when compared to cIVC, cIJV, and pvvCCA (β coefficient, 2.432 vs. −0.41, −0.033, and −0.654; P=0.004). The adjusted ETCO₂ showed a significant change with the SV, even though the change in ETCO₂ was not large. CONCLUSION: ETCO₂ was less influenced by the SB than cIVC, pvvCCA, and cIJV because the ETCO₂ change was in accordance but the variations of the other blood vessels did not coincide with a SV change. Therefore, ETCO₂ monitoring for predicting the SV would be more important than the variations in the vessels during SB.
Blood Vessels ; Carbon Dioxide ; Carbon ; Cardiac Output ; Carotid Artery, Common ; Fluid Therapy ; Hand ; Hemodynamics ; Humans ; Jugular Veins ; Methods ; Respiration ; Stroke Volume ; Stroke ; Supine Position ; Ultrasonography ; Vena Cava, Inferior

PURPOSE: The measurement of heart rate variability (HRV) is a non-invasive method to analyze the balance of the autonomic nervous system. The aim of this study was to compare the changes of HRV and base deficit (BD) during the treatment of trauma patients. METHODS: Forty-three trauma patients with a low injury severity scores (ISS < 24) and negative base excess on admission were included in this study. Based on the BD changes, patients were divided into three groups: 'end pointed' group (n = 13), patients' BDs instantly cleared after primary hydration; 'needs further resuscitation' group (n = 21), patients' BDs did not reach the end point and thus required further hydration or packed red blood cells transfusion; and 'hydration minimal change' group (n = 9), patients' BDs lower than 2.5 mmol/L at the onset of admission and thereafter had minimal change (near normal range). The changes in HRV during fluid resuscitation were detected and compared to BD changes in their arterial blood gases. All data were analysed using the SPSS software Version 15.0. Repeated measures ANOVA was used to determine the changes in HRV, heart rate, blood pressure, and BD among groups. RESULTS: A significant reverse correlation was found between the BD ratio and the HRV ratio (r = -0.562; p = 0.01). The HRV of patients with aggravated BDs after fluid resuscitation was decreased. There was an increase in HRV at the time of BD clearance. A decrease in HRV after primary crystalloid hydration bore a significant connection with the need for an ICU (p = 0.021) and transfusion of packed red blood cells (p < 0.001). CONCLUSION Increase in HRV may be a new non-invasive index for the end point of resuscitation in trauma patients.
Adolescent ; Adult ; Aged ; Autonomic Nervous System ; physiopathology ; Crystalloid Solutions ; administration & dosage ; Fluid Therapy ; Heart Rate ; Humans ; Injury Severity Score ; Middle Aged ; Resuscitation ; methods ; Wounds and Injuries ; diagnosis ; physiopathology ; Young Adult

PURPOSE: Acute burn resuscitation in initial 24 h remains a challenge to plastic surgeons. Though various formulae for fluid infusion are available but consensus is still lacking, resulting in under resuscitation or over resuscitation. Parkland formula is widely used but recently its adequacy is questioned in studies. This study was conducted to see how closely the actual volume of fluid given in our center matches with that of calculated volume by Parkland formula. METHODS: All patients admitted with more than 20% flame burn injury and within 8 h of incident were included in this study. Crystalloid solution for infusion was calculated as per Parkland formula; however, it was titrated according to the urine output. Data on fluid infusion were collected from patient's inpatient records and analyzed. RESULTS: The study included a total of 90 patients, about 86.7% (n = 78) of the patients received fluid less than the calculated Parkland formula. Rate of fluid administered over 24 h in our study was 3.149 mL/kg/h. Mean hourly urine output was found to be 0.993 mL/kg/h. The mean difference between fluid administered and fluid calculated by Parkland formula was 3431.825 mL which was significant (p < 0.001). CONCLUSION The study showed a significant difference in the fluid infused based on urine output and the fluid calculated by Parkland formula. This probably is because fluid infused based on end point of resuscitation was more physiological than fluid calculated based on formulae.
Adolescent ; Adult ; Burns ; etiology ; physiopathology ; therapy ; Female ; Fluid Therapy ; methods ; Humans ; Male ; Resuscitation ; methods ; Ringer's Lactate ; administration & dosage ; Urination ; Young Adult

BACKGROUND AND OBJECTIVE: Stroke volume variation (SVV) has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit (ICU) patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of PiCCO-monitoring (primary endpoint) and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis. METHODS: The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients. RESULTS: In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent: the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter (36.1% vs. 21.9%; P<0.001). Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis. CONCLUSIONS The applicability of SVV in a predominantly medical ICU is only about 25%-35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.
Adult ; Aged ; Analysis of Variance ; Blood Pressure ; Female ; Fluid Therapy ; Hemodynamics ; Humans ; Intensive Care Units ; Liver Failure ; physiopathology ; therapy ; Male ; Middle Aged ; Monitoring, Physiologic ; methods ; statistics & numerical data ; Pancreatitis ; physiopathology ; therapy ; Prospective Studies ; Respiration, Artificial ; Sepsis ; physiopathology ; therapy ; Stroke Volume

As a newly developed technique for hemodynamic monitoring, pulse contour cardiac output (PiCCO) monitoring takes great advantages in guiding shock resuscitation and fluid administration. PiCCO has been used more and more in burn patients in recent years, however there is no clinic consensus on how to apply PiCCO monitoring, understand the significance of PiCCO monitored parameters, and guide the treatment using PiCCO monitored parameters in patients with severe burns. Based on the current literatures and the experts' clinical experience, (2018 ) is now issued by the Burn and Trauma Branch of Chinese Geriatrics Society, aiming to provide practical guidance for its usage in clinic.
Burns ; therapy ; Cardiac Output ; Consensus ; Fluid Therapy ; Hemodynamics ; Humans ; Monitoring, Physiologic ; methods ; standards ; Resuscitation ; Shock ; therapy