Continuous tracheal gas insufflation during protective mechanical ventilation in juvenile piglets with acute lung injury induced by endotoxin

Low tidal volume mechanical ventilation is difficult to correct hypoxemia, and prolonged inhalation of pure oxygen can lead to oxygen poisoning. We suggest that continuous tracheal gas insufflation （TGI） during protective mechanical ventilation could improve cardiopulmonary function in acute lung injury. Totally 12 healthy juvenile piglets were anesthetized and mechanically ventilated at PEEP of 2 cmH2O with a peak inspiratory pressure of 10 cmH2O. The piglets were challenged with lipopolysaccharide and randomly assigned into two groups （n=6 each group）： mechanical ventilation （MV） alone and TGI with continuous airway flow 2 I/min. FIO2 was set at 0.4 to avoid oxygen toxicity and continuously monitored with an oxygen analyzer. Tidal volume, ventilation efficacy index and mean airway resistant pressure were significantly improved in the TGI group （P〈0.01 or P〈0.05）. At 4 hours post ALl, pH decreased to below 7.20 in the MV group, and improved in the TGI group （P〈0.01）. Similarly, PaCO2 was stable and was significantly lower in the TGI group than in the MV group （P〈0.01）. PaO2 and PaO2/FIO2 increased also in the TGI group （P〈0.05）. There was no significant difference in heart rate, respiratory rate, mean artery pressure, central venous pressure, dynamic lung compliance and mean resistance of airway between the two groups. Lung histological examination showed reduced inflammation, reduced intra- alveolar and interstitial patchy hemorrhage, and homogenously expanded lungs in the TGI group. Continuous TGI during MV can significantly improve gas exchange and ventilation efficacy and may provide a better treatment for acute lung injury.

Investigation on Factors Associated with Severe Hand, Foot and Mouth Disease

Objective To analyze the clinical and laboratory features of patients with mild and severe HFMD to identify early predictive or diagnostic markers for severe cases. Methods Samples of feces, nasopharyngeal-swab specimens, peripheral blood, serum and cerebral spinal fluid were collected. Postmortem pathological examination was conducted on 2 dead patients with complication due to neurogenic pulmonary edema. Reverse transcription-polymerase chain-reaction(RT-PCR), culture and isolation of enterovirus 71(EV71) were performed to detect EV71 infection. Both univariate and multivariate logistic analysis were used to identify factors associated with severe cases. Results EV71 was mainly responsible for HFMD. In this study, 5 isolated EV71 strains belonged to C4 gene subtype. Compared with mild patients, EV71-RNA detection rate was higher and Cox A16 detection rate was lower among severe patients(P < 0.01). Inflammatory cell infiltration in the lung, cardiac and liver tissues were mild by postmortem pathological examination. It was found that body temperature, vomitting, limb tremor, neutrophil, blood glucose and EV71 infection were significantly related to the severe cases by univariate logistic analysis. However, after multivariate logistic regression analysis, only vomiting(OR 16.1, CI 2.3-110.5, P < 0.01) and limb tremor(OR 117.6, CI 13.8-1004.5, P < 0.01) were significantly and independently correlated with the severe cases.Conclusions EV71 was mainly responsible for HFMD, particularly for severe cases. Vomiting and limb tremor were predictive markers for severe cases.

Atypical Hemolytic Uremic Syndrome in a Post-COVID-19 Child: Its Differential Diagnosis with COVID-19, Multisystemic Inflammatory Syndrome and Outcome

Pediatric Multisystemic Inflammatory Syndrome (MIS-C) is one of the most severe manifestations of SARS-CoV-2 in pediatrics [1]. This is a report of MIS-C with clinical presentation in infants with atypical Hemolytic Uremic Syndrome (aHUS).

Survey of attitudes and behaviors of healthcare professionals on delirium in ICU

Objective： To assess the medical community＇s awareness and practice regarding delirium in the intensive care unit （ICU）. Methods： One hundred and ten predesigned questionnaires were distributed to ICU practitioners in the affiliated hospitals of Zhejiang University. Results： A total of 105 valid questionnaires were collected. Totally, 55.3% of the clinicians considered that delirium was common in the ICU. Delirium was believed to be a significant or serious problem by 70.5% of respondents, and under-diagnosis was acknowledged by 56.2% of the respondents. The incidence of ICU delirium is even more under-estimated by the pediatric doctors compared with their counterparts in adult ICU （P〈0.05）. Primary disease of the brain （agreed by 82.1% of the respondents） was believed to be the most common risk factor for delirium. None of the ICU professionals screened delirium or used a specific tool for delirium assessment routinely. The vast majority （92.4%） of respondents had little knowledge on the diagnosis and the standard treatment of delirium. Conclusions： Although delirium is considered as a serious problem by a majority of the surveyed ICU professionals, it is still under-recognized in routine critical care practice. Data from this survey show a disconnection between the perceived significance of delirium and the current practices of monitoring and treatment in ICU in China.