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Pulmonary symptoms as the main manifestation of Mycoplasma infection in 16 cases did not improve with ventilator support; for mechanical ventilation >2d, a tracheotomy should be performed as soon as possible. The ventilation mode is intermittent pressure ventilation, tidal volume of 10ml/kg, FiO2 0.5 to 0.6, respiratory rate 16~24/min, and sedatives are given if the patient resists the ventilator. PaO2 values can be improved by adding a certain amount of PEEP to increase functional residual capacity, prevent or reduce airway and alveolar collapse, and enhance alveolar oxygen diffusing capacity; increased alveolar pressure reduces pulmonary capillary effective filtration pressure and promotes absorption of pulmonary interstitial edema. As PaO2 improves, adjust the FiO2.

① Erythromycin (azithromycin) treatment is effective. In all cases, erythromycin was administered at 30~50mg·kg·d^-1 for two weeks of treatment; or azithromycin at 10 mg·kg·d on day 1, then stop for 3~5 days and change to oral administration for two weeks. All cases were cured.

Discussion: Mycoplasma pneumoniae (MP) is a microorganism between viruses and bacteria that has been previously associated with pneumonia. The typical presentation includes persistent dry cough and chest radiographic findings, with less severe signs as the main feature. Nowadays, literature reports increasingly more cases of encephalitis and liver damage caused by Mycoplasma infections, leading to organ changes beyond the pulmonary system. Diagnosis relies on epidemiological information, clinical experience, and laboratory tests. Pulmonary infections can cause changes in the digestive tract, skin and mucous membranes, blood, nervous system, cardiovascular system, skeletal muscles, joints, kidneys, and other systems. Dr. Yushan Chang suggests that MP shares some common antigens with human heart, lung, liver, brain, kidney, and smooth muscle. When MP infects the body, it can produce corresponding antibody complexes, which may lead to organ damage outside the respiratory tract, such as myocarditis, hepatitis, arthritis, meningitis, and even shock in patients with mycoplasma infections. Patients present with prolonged fever, and anti-inflammatory treatments are inefficient, especially when pulmonary symptoms persist, leading to misdiagnosis. Although erythromycin (azithromycin) treatment shows good efficacy, early diagnosis and treatment are still very necessary. Conventional agglutination tests can be done. For hospitalized children with fever, this method is convenient, simple, and economical. Observing suspected cases under conventional anti-inflammatory treatment for 3 days before switching to erythromycin (azithromycin or other factors) during treatment is feasible.