Emergency treatment and nursing of children with severe pneumonia complicated by heart failure and respiratory failure: 10 case reports

Li, Wanli; An, Xinjiang; Fu, Mingyu; Li, Chunli

Emergency treatment and treatment of heart failure. When children patients coughed, their body temperature increased to ≤40˚C and was accompanied by dyspnea, dysphoria, pale face, cyanosis, drowsiness, fixed moist rales in lung, respiratory rate of ≥60 beats/min, heart rate of ≥160-180 beats/min in quiet state, low and blunt heart sound, gallop rate, and a progressively enlarged liver, 3 cm beyond the ribs or an increase of ≥1.5 cm in a short period of time. The above, as well as cold extremities and weak pulse, constituted clinical manifestations of a heart failure. In this situation, oxygen inhalation and tranquilizers were given immediately, 0.5 µg/(kg x min) and milrinone, a second generation of phosphodiesterase Ⅲ (PDE-Ⅲ) inhibitor, which acts on the β receptor accessory pathway, was administered to maintain heart function. By selectively inhibiting PDE-Ⅲ in myocardial cells, increasing intracellular cyclic adenosine monophosphate levels, promoting calcium influx, enhancing calcium concentration in myocardial cytolymph, milrinone strengthens myocardial contractility, increases cardiac output, and exerts direct relaxation on vascular smooth muscle, dilates blood vessels and reduces cardiac preload and afterload. Milrinone demonstrates a better clinical efficacy in the treatment of children with pneumonia complicated by heart failure than catecholamines (37) .