Purpose To investigate the risk factors for the failure of nasal noninvasive ventilation (NIV) in infants with severe community acquired pneumonia (SCAP). Methods This was a case-control study from the Pediatric Intensive Care Unit of the National Children’s Regional Medical Center in Northeast China. Comprehensive data was sourced from all infants (28 days − 3 years) diagnosed with SCAP and using NIV as the initial ventilation therapy from 2017 to 2021. NIV failure referred to endotracheal intubation, infant death or termination of treatment. Results Among the 168 infants, the failure rate of NIV was 47.0%. After adjusting by a binary logistic regression model, neuromuscular disorder (NMD) (odds ratio 6.47, 95% confidence interval 1.06–39.56), alanine aminotransferase (ALT) (2.25, 1.15–4.39), the differences of respiratory rate-oxygenation (ΔROX) index < -0.41 (2.20, 1.06–4.55), the duration before start NIV (0.97, 0.94–0.99), and the initial FIO2 of NIV (1.05, 1.02–1.09) were associated with NIV failure (all P values < 0.05). The predictive ability of PRISM III score (area under curve 0.588, P = 0.049) and modified PIRO scale (0.615, P = 0.010) for intubation were significant, not included PELOD-2 score (0.584, P = 0.060). 19.0% (15/79) infants experienced late intubation (> 72 hours of admission), which correlated to a lower improvement rate (76.6% vs. 40.0%, P = 0.011). Conclusions NMD history, reduced ΔROX index, increased ALT, early use and higher initial FIO2 requirements for NIV were risk factors for intubation during NIV for infants.
BackgroundChildren with influenza B virus infection have a higher susceptibility and higher severity of illness. The activation and disorder of immune function play an important role in the severity of influenza virus infection. This study aims to investigate whether early lymphocyte count and cytokines can provide predictive value for the progression in children with influenza B virus pneumonia.MethodsA retrospective cohort study was conducted to analyze the clinical data of children with influenza B virus pneumonia from December 1, 2021, to March 31, 2022, in the National Children’s Regional Medical Center (Shengjing Hospital of China Medical University). According to the severity of the disease, the children were divided into a mild group and a severe group, and the clinical characteristics, routine laboratory examination, lymphocyte subsets, and cytokines were compared.ResultsA total of 93 children with influenza B virus pneumonia were enrolled, including 70 cases in the mild group and 23 cases in the severe group. Univariate analysis showed that drowsiness, dyspnea, white blood cell (WBC), lymphocytes, monocytes, procalcitonin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), fibrinogen (FIB), Immunoglobulin M (IgM), lung consolidation, total T cell count, CD4+ T cell count, CD8+ T cell count, NK cell count, NK cell % and B cell % had statistical differences between the mild and severe groups (P<0.05). In multivariate logistic regression analysis, reduced ALT (OR = 1.016), FIB (OR = 0.233), CD8+ T cell count (OR = 0.993) and NK cell count (OR = 0.987) were independently associated with the development of severe influenza B virus pneumonia.ConclusionsThe levels of T lymphocytes and NK cells were related to the progression of influenza B virus pneumonia in children, and the reduction of CD8+ T cell count and NK cell count can be used as independent risk factors for predicting the severity of influenza B virus pneumonia.
Background: To investigate the characteristics of sleep cycle in children with severe acute bronchopneumonia treated with invasive mechanical ventilation at different sedation depths. Methods: We included 35 pediatric patients with severe acute bronchopneumonia treated using mechanical ventilation in Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University. They were divided into deep sedation group (n=21; ramsay score 5-6) and light sedation group (n=14; ramsay score3-4) based on sedation depth achieved during mechanical ventilation. Long-term video electroencephalography (EEG) monitoring was performed within the first 24h after starting mechanical ventilation and after weaning from mechanical ventilation and discontinuing sedatives and analgesics. The results were analyzed and compared with those of normal children to analyze changes in sleep cycle characteristics at different sedation depths and mechanical ventilation stages.Results: There were 29 cases altered sleep architecture. The deep sedation group had a significantly higher incidence of sleep architecture altered, total sleep duration, and non-rapid eye movement sleep-1(NREM-1) loss incidence than the light sedation group. Moreover, the deep sedation group had a significantly lower awakening number and rapid eye movement sleep (REM) percentage than the light sedation group. The sleep cycle returned to normal in 27 (77%) patients without NREM-1 or REM sleep loss. Conclusions: Deep sedation during mechanical ventilation allows longer total sleep duration, fewer awakenings, and an increased deep sleep proportion, butsleep architecture is severely altered. After weaning from mechanical ventilation and sedative discontinuation, lightly sedated children exhibit better sleep recovery.
Mycoplasma (M.) pneumoniae is a common pathogen causing respiratory infections in children. Pulmonary embolism is a rare complication that may be life-threatening if not diagnosed early and treated promptly. Here, we report the case of an 11-year-old patient with pulmonary embolism associated with M. pneumoniae pneumonia. The patient developed uncorrectable hypoxemia and received venovenous extracorporeal membrane oxygenation treatment. Although the mechanism of thrombosis after M. pneumoniae infection remains unknown, an increase in the cold agglutinin titer indicates that cold agglutinin syndrome might be the mechanism of this pathological change. We thought that patients who have positive cold agglutinin after M. pneumoniae infection should be monitored for the possibility of thrombosis formation.
Mycoplasma (M.) pneumoniae is a common pathogen causing respiratory infections in children. Pulmonary embolism is a rare complication that may be life-threatening if not diagnosed early and treated promptly. Here, we report the case of an 11-year-old patient with pulmonary embolism associated with M. pneumoniae pneumonia. The patient developed uncorrectable hypoxemia and received venovenous extracorporeal membrane oxygenation treatment. Although the mechanism of thrombosis after M. pneumoniae infection remains unknown, an increase in the cold agglutinin titer indicates that cold agglutinin syndrome might be the mechanism of this pathological change. Finally, the patient was cured with antibiotic and anticoagulant therapies. Patients who have significantly increased C-reactive protein and D-dimer levels and positive cold agglutinin after M. pneumoniae infection should be monitored for the possibility of thrombosis formation.
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