The Usefulness of Perfusion Index for Predicting Mortality in Pediatric Intensive Care Unit

Introduction:The aim of this study is to the usefulness of the perfusion index to predict mortality in the pediatric intensive care unit.Methods:The study included patients aged >28 days and <18 years old, who were admitted to Mersin University Faculty of Medicine, Department of Pediatric Intensive Care Unit between 2018 and 2019. Characteristic variables of patients, pediatric risk of mortality III and pediatric logistic organ dysfunction scores, the reason for hospitalization, surgical history, underlying disease, mechanical ventilation, transfusion, perfusion index value at the zeroth hour (at the admission) and at the sixth hour, lactate levels, and prognosis were recorded.Results:A total of 372 patients who met the study criteria were included in the study. Median perfusion index values at the zeroth and sixth hours were significantly lower in patients who were exitus than the survivors (p<0.001). Considering mortality and organ failure scores, the median values of pediatric risk of mortality III and pediatric logistic organ dysfunction scores were higher in those who were exitus and when compared with the perfusion index values at the zeroth hour, a negative significance was found between them. In receiver operating characteristic analysis, the specificity and sensitivity values for mortality were 90.1% and 75.9% at a perfusion index cut-off of ≤0.63, respectively.Conclusion:Perfusion index is a reliable method to predict mortality for patients admitted to pediatric intensive care unit

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Relationship of Hemoglobin Concentration at Admission and Need for Erythroyte Transfusion During Hospitalization with Mortality in Pediatric Critical Care Patients

Introductıon: This study aimed to investigate the relationship of hemoglobin concentration at admission to pediatric intensive care unit and erythrocyte transfusion during hospitalization with mortality. Methods: In this prospective study, we included 260 patients who were admitted to a 12-bed pediatric intensive care unit in a one-year period. Demographic characteristics, admission etiologies, length of stay in the pediatric intensive care unit, mechanical ventilation rates, pediatric risk of mortality III and pediatric logistic organ dysfunction scores, complete blood count on admission and erythrocyte transfusion during hospitalization were recorded prospectively. Results: Of the 260 cases, 34 were exitus. The mortality rate was 13%. The mean hemoglobin concentration of patients who were exitus was lower than that of patients who survived (10.55±2.45 g/dL vs. 10.55±2.45 g/dL, p=0.011). Although platelet levels were lower in patients who were exitus than in survivors, the difference was not statistically significant (320.352±181.731/mm3 vs. 352.231±174,129/mm3 p=0.325). The mortality rate in transfused patients was higher than in patients who were not transfused. (40.2% vs. 1.6%, p<0.001). Conclusion: Hemoglobin concentration at admission in patients who die in pediatric intensive care unit is significantly lower than in those who survive. In this study, increased mortality risk in patients admitted to pediatric intensive care unit was found to be associated with the presence of anemia and need for erythrocyte transfusion

The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey.

Aim of the study Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. Methods This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. Results A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). Conclusions The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures

Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study

Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. Impact: MIS-C is a life-threatening condition.Patients need to be followed up in the intensive care unit.Early detection of factors associated with mortality can improve outcomes.Determining the factors associated with mortality and length of stay will help clinicians in patient management.High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients.We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality