PICU呼吸机相关肺炎44例病原学分析

目的　 总结我院PICU近 2年来 44例呼吸机相关肺炎 (VAP)的病原学及致病相关因素。 方法 　总结 2年来PICU 44例VAP病例临床及实验室资料。 结果 　MV≥ 48h 6 3例 ,诊断VAP 44例 ,发病率 6 9 8%。主要病原是铜绿假单胞菌等革兰氏阴性杆菌。 结论 　对呼吸机相关肺炎病原有参考意义     

Respiratory syncytial virus morbidity, premorbid factors, seasonality, and implications for prophylaxis

Objectives

We investigated factors associated with morbidity and pediatric intensive care unit (PICU) admission in children with respiratory syncytial virus (RSV) infection and explored seasonality and implication of prophylaxis.

Methods

A retrospective study between 2006 and 2008 of every child with a laboratory-confirmed RSV infection was included.

Results

Six hundred seventy RSV admissions were identified. Ten (1.5%) required PICU admissions. Children admitted to PICU were younger than non-PICU admissions (median [interquartile range] age, 0.3 [0.11-0.48] vs 1.18 [0.46-2.49] years; P = .001). Odds associated with PICU admissions included history of chronic lung disease (odds ratio [95% confidence interval], 18.08 [2.29-114.95]; P = .010), history of acyanotic heart disease (7.61 [1.04-42.59], P = .043), and neurodevelopmental conditions (mental retardation, cerebral palsy, or neuromuscular disease; 8.41 [1.63-38.57], P = .012). Odds of bacterial coinfections was 13.50 (1.77-81.29), P = .017. There appeared no significant PICU predilection in terms of sex, history of prematurity, cyanotic heart disease, seizure disorders, chromosomal disorders, or malignancy. Admissions associated with proven RSV infections accounted for 2.4% of PICU annual admissions. The duration of PICU stay was generally brief (median, 3 days). However, median length of hospital stay was significantly longer in the PICU category (8.5 vs 3 days, P < .001). There was no death in the study period. Only 5 (0.75%) of 665 patients were readmitted to the pediatric infectious disease isolation ward in consecutive years, and none required PICU support. Twenty (3%) of admissions involved neonates younger than 30 days. There was no definite seasonality, but incidence was lowest between October and January.

Conclusions

Most infants have mild disease and do not require PICU support. Young infants with history of chronic lung disease, congenital heart disease, and neurodevelopmental conditions appear to be at significantly increased risk for PICU support. There is no winter seasonality for RSV disease in Hong Kong. Therefore, any prophylaxis for at-risk population should provide adequate coverage for the warmer months in subtropical regions.     

儿科重症监护病房10a死亡因素分析

为减少重症患儿的死亡率．经常评估主要死因，有助于提高PICU的诊治质量。方法从引起儿童主要死亡疾病及不同年龄段的死因对375例死亡患儿进行回顾性分析总结。结果死亡原因：婴幼儿期以肺炎（尤以先天性心脏病并肺炎）以及败血症为主；学龄前期以肺炎及中枢感染为主。学龄期儿童以白血病、肿瘤及心肌病为主。比较前后5a死因显示致死病种无显著差异，死亡率后5a比前5a呈明显下降趋势。结论不同时期致死原因无明显改变，不同年龄段的致死原因不同。     

Construction of the Sophia Observation withdrawal Symptoms-scale (SOS) for critically ill children

Objective  To construct a reliable and clinically practical instrument for monitoring opioids and benzodiazepine withdrawal symptoms in pediatric ICU patients. Design  Instrument development. Setting  Intensive care unit in an academic children’s hospital. Patients and participants  79 patients up to age 16 years on intravenous midazolam and/or opioids for ≥5 days. An expert panel of 85 physicians and nurses rated clinical relevance of withdrawal symptoms. Intervention  During drug weaning repeated observations were performed with a checklist of 24 withdrawal symptoms described in the literature. Measurements and results  For 76 children, 932 observations were obtained within 24 h after decrease and/or discontinuation of midazolam or opioids. Most frequent symptoms were tachypnea, agitation, motor disturbance, diarrhea, fever, anxiety, sleep disturbance and hypertension (14.6–29.6%). Multidimensional scaling (MDS) was performed to detect the underlying empirical structure of co-occurrences of symptoms. An expert panel judged clinical relevance of each withdrawal symptom on a four-point scale ranging from ‘definitively so’ to ‘definitively not’. Agitation, anxiety, inconsolable crying, increased muscle tension, tremors, tachycardia and sweating were considered relevant by 85–95% of the experts. On the basis of the MDS results and the experts’ opinions, 15 symptoms were included in the final instrument. Conclusions  We are the first to develop an assessment tool for withdrawal symptoms in pediatric ICU patients on the basis of the underlying empirical structure of co-occurrences of withdrawal symptoms that experts considered relevant. Future studies need to define cut-off points and clarify psychometric issues. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

PICU机械通气患儿肠内营养摄入能量与蛋白质的现状

目的了解儿童重症监护病房(PICU)机械通气患儿肠内营养摄入能量及蛋白质的现状,为制定PICU机械通气患儿能量及蛋白质推荐摄入量提供参考依据。方法回顾性分析2016年1月-2017年1月四川省妇女儿童医院PICU机械通气患儿的临床资料,分析机械通气期间肠内营养摄入能量/蛋白质的平均水平;分别以60 k Cal·kg^-1·d^-1和以美国肠内肠外营养学会危重患儿营养支持指南(ASPEN指南)蛋白质推荐量为标准,计算能量及蛋白质摄入充分性和未达标患儿比例;总结分析机械通气患儿肠内营养供给不当的原因。结果机械通气期间患儿肠内营养平均能量摄入为(54.4±24.3)k Cal·kg^-1·d^-1,充分性为90.7%;机械通气期间肠内营养平均摄入能量≥60 k Cal·kg^-1·d^-1的患儿仅为16例(36.4%),不达标者28例(63.6%)。患儿机械通气期间肠内营养蛋白质摄入量为(1.5±0.7)g·kg^-1·d^-1,蛋白质摄入量达到ASPEN指南推荐的患儿仅有10例(22.7%),不达标者34例(77.3%)。能量和蛋白质摄入不足的主要原因为液体量限制和胃肠道不耐受。结论患儿在机械通气期间肠内营养摄入能量/蛋白质不足,且不足的比例高,尤其是蛋白质的摄入不足比例更高。目前PICU机械通气患儿能量及蛋白质摄入不足情况严峻,亟待改善。     

A child’s admission to hospital: a qualitative study examining the experiences of parents

Aims To compare the experiences of parents and children during inpatient admission to either a paediatric intensive care unit (PICU) or a general paediatric ward (GPW) with a specific focus on identifying factors which may influence psychological outcome.Methods Semi-structured qualitative interviews of 20 parents whose children had been admitted to hospital. Cases were sampled purposively to ensure representation of both groups (PICU and GPW admissions). Interviews were tape recorded, transcribed and subjected to a thematic analysis.Results The experiences of parents were explored with regard to illness onset, admission to PICU or GPW and the discharge period. In the PICU group, the sources of stress differed according to the stage: at onset, they were mainly related to their childs illness; during admission, concerns were focused on their childs appearance; finally, on discharge, possible relapse of the illness, impact of the admission on the child and family and the lack of clear follow-up were the central themes. In the GPW group, parents reported similar themes but with lower levels of associated stress. Both groups identified good communication with the medical team and opportunities for participation as helpful in reducing stress.Conclusions Admission to hospital is stressful for parents particularly if the child is admitted to PICU. Hospital staff should enhance communication with parents and maximise opportunities for parental participation in the childs treatment. Such interventions may reduce parents experience of stress during the admission and have the potential to improve psychological outcome.