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The Relation between Role of Serum Cortisol Level and Response to Various respiratory support Strategies among Preterm Infants

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Open Journal of Pediatrics 2020年第3期10卷 504-514页

作者： Amani E. Arafa Safaa A. ElMeneza Shaimaa A. EL Hafeez Sheikh Zayed Hospital Department of Pediatrics Giza Egypt Department of Pediatrics Faculty of Medicine for Girls Al-Azhar University Cairo Egypt Department of Clinical Pathology Faculty of Medicine for Girls Al-Azhar University Cairo Egypt

Introduction: Preterm infants are liable to various health problems including respiratory distress syndrome (RDS). There is variation in response to respiratory support. In preterm infants, cortisol hormone is secreted by the adrenocortical gland in response to stress. Objectives: To compare the serum cortisol levels in blood among preterm infants who needed different respiratory support strategies e.g. headbox, continuous positive airway pressure (CPAP), intubation surfactant extubation (INSURE) and mechanical ventilation (MV) and to correlate the cortisol levels to the severity of respiratory distress syndrome (RDS). Material and Methods: Observational prospective study that assessed the serum cortisol levels in preterm infants with RDS after initial respiratory support aged 28 - 34 gestational weeks that were admitted to the neonatal intensive care unit of Al Zahraa hospital of Al-Azhar University and Al-Estekama hospital between February 2019 and November 2019. Infants were classified into three groups, Group 1: 29 infants with severe RDS who needed a mechanical ventilator. Ten of them needed surfactant therapy. Group 2: 33 infants with moderate RDS who needed CPAP. Three of them needed surfactant therapy. Group 3: 28 infants with symptoms of mild RDS who needed headbox. None of them needed surfactant therapy. Blood samples were collected on the first day of life and were processed using the colorimetric ELISA method. Demographic and medical information was collected. Results: A total of 90 preterm infants were included. The ser

关键词： respiratory Distress Syndrome Cortisol Preterm respiratory support

Simplified lung ultrasound method to predict the respiratory support needs of neonates whose mothers had pregnancy complications: a diagnostic accuracy study

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Reproductive and Developmental Medicine 2023年第3期7卷 149-155页

作者： Xin-Ao Lin Xue-Feng Wang Xiao-Bo Fan Guan-Nan Xi Ji-Mei Wang Department of Neonatology Obstetrics and Gynecology Hospital of Fudan UniversityShanghai 200090China

Objective:Some pregnancy complications are associated with respiratory problems in *** identification and implementation of respiratory support are needed for these *** study aimed to(1)use lung ultrasound(LU)for predicting the respiratory support requirements of infants and(2)simplify the examination method to facilitate its clinical ***:Neonates underwent LU examinations within 1 hour of *** infants were divided into a pregnancy complication(PC)group and a control group according to their mothers'clinical *** primary outcome measure was the need for respiratory *** models were established based on the differences in LU patterns between the two *** predictive value of the models was compared with that of the LU score(LUS)system,which has been widely used in other *** models were established by analyzing the predictive effects of LU patterns in different parts of the *** reliability was tested using the receiver operating characteristic curve ***:PC and control groups had 29 and 117 neonates,respectively;a total of 22 neonates required respiratory *** PC and control groups showed differences in respiratory support requirements,A-lines,and coalesced *** percentages of A-lines and coalesced B-lines were associated with respiratory support *** optimal cutoff values for the percentages of the A-lines and coalesced B-lines were 55.7%and 24.5%,*** effects were obtained by calculating the percentage of coalesced B-lines in four areas(R3,R4,L3,and L4).These methods were judged as more visual and convenient than LUS ***:The percentages of A-line and coalesced B-lines on LU images can be used to predict the respiratory support needs of neonates whose mothers had pregnancy *** four areas(R3,R4,L3,and L4)had similar predictive values.

关键词： Lung ultrasound respiratory support Pregnancy complications

respiratory support in Severely or CriticallyⅢICU Patients With COVID-19 in Wuhan,China

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Current Medical Science 2020年第4期40卷 636-641页

作者： Hong-tao HU Shen XU Jing WANG Xin RAO Department of Critical Care Medicine Zhongnan Hospital of Wuhan UniversityWuhan 430071China Department of Nephrology General Hospital of the Yangtze River ShippingWuhan 430010China

Summary:This case series aimed to describe the clinical characteristics of severely or critically ill patients with COVID-19 and compare the clinical characteristics of patients who received invasive respiratory support with those of patients who received noninvasive respiratory *** included all confirmed severe or critical illness cases of COVID-19 admitted to the Intensive Care Unit(ICU)of Zhongnan Hospital of Wuhan University,a COVID-19-designated hospital,from January 8 to March 12,*** were analyzed for cpidemiological,demographic,clinical,APACHE II,SOFA,radiological features and laboratory *** of all patients were followed up as of March 12,*** newly emerging virus had caused 55 confirmed severe or critical illness cases in ICU of a COVID-19-designated *** of the infected patients were men;more than half had underlying diseases,including hypertension,coronary artery disease and *** median age was 63 years *** symptoms at onset of ilness were fever,fatigue and dry ***(9.1%)hospitalized patients were presumed to have been infected in the hospital,and 4(7.3%)health care workers were infected in their *** the 55 confirmed severe or critical ilncss cases,10(18.2%)patients died during the follow-up period as of March 12 with the median follow-up period of 28 days(interquartile range 1635).Nine patients received VV-ECMO for severe respiratory failure and 4(44.4%)patients ***,28 patients received invasive respiratory support and 14(50.0%)patients *** this single-center study,55 severely or critically ill ICU patients were confirmed to have COVID-19 in Wuhan and the overall mortality was 29.1%。Totally 28(50.9%)of severely or critically ill ICU patients received invasive respiratory support and 14(50.0%)died during the follow-up period.

关键词： COVID-19 SARS-CoV-2 acute respiratory distress syndrome intensive care unit respiratory support

Perioperative extracorporeal membrane oxygenation in pediatric congenital heart disease:Chinese expert consensus

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World Journal of Pediatrics 2023年第1期19卷 7-19页

作者： Ru Lin Wei Wang Xu Wang Zhuo-Ming Xu Jin-Ping Liu Cheng-Bin Zhou Xiao-Yang Hong Xu-Ming Mo Shan-Shan Shi Li-Fen Ye Qiang Shu Department of Extracorporeal Life support Heart InstituteNational Clinical Research Center for Child HealthChildren's HospitalZhejiang University School of MedicineHangzhouChina Department of Thoracic and Cardiovascular Surgery Shanghai Children's Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina Department of Pediatric Intensive Care Unit National Center for Cardiovascular Disease and Fuwai HospitalChinese Academy of Medical SciencesPeking Union Medical CollegeBeijingChina Department of Cardiopulmonary Bypass National Center for Cardiovascular Disease and Fuwai HospitalChinese Academy of Medical SciencesPeking Union Medical CollegeBeijingChina Department of Cardiovascular Surgery Guangdong Provincial Cardiovascular InstituteGuangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina Pediatric Intensive Care Unit Faculty of PediatricsChinese PLA General HospitalBeijingChina Department of Cardiothoracic Children's Hospital of Nanjing Medical UniversityNanjingChina Department of CICU Heart InstituteNational Clinical Research Center for Child HealthChildren's HospitalZhejiang University School of MedicineHangzhouChina Department of Cardiac Surgery National Clinical Research Center for Child HealthChildren's HospitalZhejiang University School of MedicineBinsheng Road 3333Hangzhou 310052China

Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in *** management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant *** survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life support Organization *** expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical *** The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert *** The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition *** and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed *** conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be *** The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.

关键词： Circulatory support Congenital heart disease Extracorporeal membrane oxygenation Pediatric respiratory support

Use of a modified tracheal tube in a child with traumatic bronchial rupture:A case report and review of literature

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World Journal of Clinical Cases 2021年第29期9卷 8915-8922页

作者： Qi-Meng Fan Wei-Guo Yang Pediatric Intensive Care Unit Shenzhen Children's HospitalShenzhen 518000Guangdong ProvinceChina Medical College Shantou UniversityShantou 515063Guangdong ProvinceChina

BACKGROUND Trauma is one of the leading causes of death in the pediatric *** rupture is rare,but there are potentially severe *** and maintaining a patent airway is the key issue in patients with bronchial *** we describe an innovative method for maintaining a patent *** SUMMARY A 3-year-old boy fell from the seventh *** worsened rapidly with pulse oxygen saturation decreasing below 60%,as his heart rate *** pneumothorax was observed with insertion of the chest *** bronchoscopy was performed,which confirmed the diagnosis of bronchial rupture.A modified tracheal tube was inserted under the guidance of a fiberoptic *** oxygen saturation improved from 60%to 90%.Twelve days after admission,right upper lobectomy was performed using bronchial stump suture by video-assisted thoracic surgery without complications.A follow-up chest radiograph showed good *** child was discharged from hospital three months after *** A modified tracheal tube could be selected to ensure a patent airway and adequate ventilation in patients with bronchial rupture.

关键词： Bronchial rupture Children respiratory support Tracheal tube Case report

What we learned in the past year in managing our COVID-19 patients in intensive care units?

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World Journal of Critical Care Medicine 2021年第4期10卷 81-101页

作者： Jain Nitesh Rahul Kashyap Salim R Surani Department of Medicine Mayo Clinic Health SystemMankatoMN 56001United States Department of Anesthesiology Mayo ClinicRochesterMN 55905United States Department of Medicine Texas A&M UniversityCorpus ChristiTX 78404United States

Coronavirus disease 2019 is a pandemic,was first recognized at Wuhan province,China in December *** disease spread quickly across the globe,spreading stealthily from human to human through both symptomatic and asymptomatic individuals.A multisystem disease which appears to primarily spread via bio aerosols,it has exhibited a wide clinical spectrum involving multiple organ systems with the respiratory system pathology being the prime cause of morbidity and *** unleashing a huge destructive trail at Wuhan China,Lombardy Italy and New York City,it has now spread to all parts of the globe and has actively thrived and mutated into new *** care systems and Governments responded initially with panic,with containment measures giving way to mitigation *** global medical and scientific community has come together and responded to this huge *** medical societies quickly laid out“expert”guidelines which were conservative in their *** drugs were re formulated and tested quickly with the help of national and international collaborative groups,helping carve out effective treatment strategies and help build a good scientific foundation for evidencebased *** of the darkness of chaos,we now have an orderly approach to manage this disease both from a public health preventive and therapeutic *** preventive measures such as masking and social distancing to the development of highly effective and potent vaccines,the public health success of such measures has been tempered by behavioral responses and resource *** a therapy standpoint,we now have drugs that were promising but now proven ineffective,and those that are effective when given early during viral pathogenesis or later when immune dysregulation has established,and the goal is to help reign in the destructive *** has been a fascinating journey for mankind and our work here recapitulates the evolution of various aspects of

关键词： COVID-19 respiratory support Renal replacement therapy Extracorporeal membrane oxygenator Medications Therapeutics