Comparison of Opinions and Practices of Pediatric Intensive Care and Pediatric Emergency Departments in High-flow Nasal Cannula Oxygen Therapy: A National Survey Study

Introduction:The purpose of this study is to compare the practice and opinions of tertiary pediatric intensive care units and pediatric emergency departments on high flow nasal cannula oxygen therapy in Turkey.Methods:A questionnaire was sent to the clinical chiefs of the tertiary intensive care units or pediatric emergency departments who are members of the Pediatric Emergency and Intensive Care Association via e-mail. In the questionnaire, the features of the unit, the high-flow nasal cannula oxygen therapy practice and their opinions on this treatment were asked. Pathologies using highflow nasal cannula and the success expected were asked to score between 0 and 10 (0: Completely ineffective; 10: Very effective).Results:A total of 14 pediatric intensive care units and 17 pediatric emergency departments were included in the study. The most frequently used and the highest success score belonged to bronchiolitis. It is used more frequently for neuromuscular diseases in emergency departments (p0.05). In the follow-up, intensive care units use the chest radiography and the emergency departments use a respiratory severity score more frequently (p<0.05). Complication of air leak syndrome was more common in intensive care units (35.7% vs. 0; p<0.05). All units described high-flow nasal cannula oxygen therapy as an easy-to-use method. 94.1% of the emergency departments and all intensive care units stated that the treatment was comfortable for the patient.Conclusion:High flow nasal cannula oxygen therapy is used in various pathologies that cause respiratory distress. The treatment practice of the units partially overlaps. It is considered to be easy to apply, comfortable and effective treatment for patients

A Rare Cardiotoxicity: Butane Inhalation

The number of cases of voluntary inhalation of volatile substances is increasing all over the world and in our country. This is a social health problem that can be encountered in different socioeconomic and cultural levels. The number of applications to pediatric emergency services cannot be underrated because the age of first use of such illegal substances has decreased gradually. Inhalation of volatile substances can cause pathologies in a very broad spectrum, including sudden death. In this paper, we report a case of cardiac arrest developing after lighter fluid inhalation

Comparison of Syrian and Turkish Patients with Trauma Who Hospitalized in the Pediatric Surgery Department

Introduction:In recent years, Turkey has become a destination for many Syrian refugees due to the civil war. The objective of our study was to describe the epidemiological characteristics of injuries among refugee children admitted to our tertiary clinic and compare them with Turkish children.Methods:This retrospective study was conducted between December 2013 and December 2017. Syrian refugees were compared with the local population according to the epidemiology of the trauma. Data on age, gender, trauma mechanism, trauma type, first referral center, transfer status, affected body region, affected organ, injury severity score, hospitalization in intensive care unit and pediatric surgery clinic, need for mechanical ventilation and operation, and clinical course were noted.Results:Four hundred fifteen Turkish citizens and 46 Syrian refugees were enrolled. The median age was similar (8 and 9; respectively) (p=0.815), but there were more boys among the refugees (65.3% and 80.4%; respectively) (p=0.025). The causes of trauma, type of trauma, transfer status, affected body region, need for mechanical ventilation, need for operation, and discharge status were similar between the groups. Lung trauma was more common in refugees than in Turkish patients (21.7% and 9.6%, respectively) (p=0.018). The rate of admission to intensive care unit was higher among Syrian children (p0.05).Conclusion:The findings suggest that the injury characteristics were similar between refugees and local children. We suppose that the higher incidence of intensive care unit admission among refugees was due to the fact that lung injury and high energy trauma mechanisms such as fall from heights or motor vehicle accident were more common in Syrian refugee children. We suggest that preventive measures and parenteral education would contribute to decrease the prevalence of traumatic injuries

The Performance of the Pediatric Trauma Score in a Pediatric Emergency Department: A Prospective Study

Introduction: The aim of this study was to assess the efficacy of the Pediatric Trauma Score (PTS) in predicting significant trauma in patients presenting with blunt trauma to a high-level pediatric emergency department. Methods: Patients younger than 15 years of age presenting to the pediatric emergency department of the Tepecik Training and Research Hospital with acute high-energy blunt trauma were analyzed prospectively. The PTS was calculated on arrival at the pediatric emergency department. The patients were classified into two groups as follows: patients with a PTS of ≤8 comprised the significant trauma group, while patients with a PTS of >8 made up the non- significant trauma group. Results: Two-hundred-thirteen children with a mean age of 6.1±3.9 years (range: 10 days-15 years) were included in the study. The frequency of coagulation testing and thorax computed tomography in the pediatric emergency department, need for critical interventions and therapies in the pediatric emergency department, rate of hospitalization, need for transfer to the pediatric intensive care unit, mechanical ventilation, operation, blood transfusion, and mortality rate were statistically higher in the significant trauma group (p<0.05). PTS ≤8 exhibited a sensitivity of 56.2% and a specificity of 90.8% for hospitalization (AUROC: 0.682; 95% confidence interval: 0.610-0.755). The PTS was significantly correlated with length of hospital stay (r=-0.493; p<0.001) and length of observation in the pediatric emergency department (r=-0.442; p<0.01). Conclusion: PTS on arrival at a high-level pediatric emergency department is a good predictor of the need for critical interventions/therapies and mortality in children with high-energy blunt trauma. However, its accuracy is moderate for the prediction of hospitalization

A Case of Fatal Malignant Hyperthermia During Pes Equinovarus Surgery in a Child

Malignant hyperthermia (MH) is a genetic syndrome characterized by hyperthermia, tachycardia, acidosis, and muscle rigidity, often triggered by depolarizing muscle relaxants such as volatile anesthetics and/or succinylcholine. MH usually develops following anesthesia induction, but may occur during and after a surgical intervention. A 4.5-year-old boy was admitted to the pediatric intensive care unit considering MH due to persistent fever, tachycardia and end-tidal carbon dioxide elevation which developed during pes equinovarus surgery. In the follow-up, hypercapnia, fever and refractory metabolic acidosis recurred. Despite the administration of dantrolene sodium and supportive treatments, the patient died. This case is presented to remind the possibility of MH which may be fatal in patients receiving general anesthesia and to emphasize the follow-up and treatment of the patients with MH in pediatric intensive care unit

Successful Decompressive Craniectomy in a Child with Severe Head Trauma

In developed countries, trauma is the most common cause of mortality and morbidity in children. Severe traumatic brain injury is the most important cause of death in these patients. The main goal of treatment is to provide airway, respiratory and circulatory support and to prevent increased intracranial pressure. An 8-year-old girl with a severe traumatic brain injury due to traffic accident was admitted. The patient had a Glasgow Coma scale score of 8. She was intubated and provided respiratory and hemodynamic support. Cranial tomography showed bilateral diffuse frontal hemorrhagic contusion areas, traumatic subarachnoid hemorrhage, a slim subdural hemorrhage, basal cistern effacement, and severe brain edema with a midline shift to the left of 1 cm. Mannitol, 3% sodium chloride and phenytoin were given to the patient. At the 4th hour of the follow-up in pediatric intensive care, decompressive craniectomy was performed because the patient developed clinical herniation findings. The patient was extubated on the 3rd day and discharged on the 13th day. She did not have any neurological sequelae at 6 months of follow-up. Decompressive craniectomy should be considered without delay in children with severe head trauma with neurological deterioration or intracranial pressure elevation refractory to medical treatment and in those with herniation

Risk Factors of Bloodstream Infections Caused by Carbapenem-resistant Gram-negative Pathogens in Pediatric Critical Care Settings

Aim: Infections and sepsis are the leading causes of death in non-cardiac intensive care units (ICUs) and account for 40 percent of all ICU expenditures. Data regarding bloodstream infections (BSIs) due to a carbapenem-resistant gram negative (CRGN) microorganisms in pediatric ICUs still remain limited. Materials and Methods: This study was conducted retrospectively in patients who were admitted to two pediatric critical care units between January 2011 and December 2017. Patients were assigned to two groups. Patients with BSI caused by a CRGN microorganism and infections were assigned to the BSI group and those other than BSI were assigned to the non-BSI group. Results: This study included 89 critically ill children with a mean age of 52.1 (±65.1) months. the requirements for invasive procedures including tracheostomy, Foley catheter and central venous catheter were not statistically different among the groups, p values were 0.159, 0.291 and 0.803, respectively. the majority of the patients admitted to pediatric intensive care unit were due to sepsis/septic shock in the BSI group (n=18, 58%) and in the non-BSI group, this figure was 37.9% (n=24). Prior third/fourth generation cephalosporin exposure was significantly more common in the BSI group (51.6% vs 15.5%, p<0.001), carbapenem exposure was not significantly different among the groups (35.5% vs 56.9%, p=0.054). Neutropenia (<500/mm3) and thrombocytopenia (150x103/mm3) were significantly more common in the BSI group (p=0.011 and p=0.010) and the C-reactive protein level was significantly higher (p=0.018). Crude and attributable mortality did not show any significance between the groups, p values were 0.578 and 0.955, respectively. Conclusion: CRGN infections are still a major cause of morbidity, mortality and healthcare associated infections. in this study, we evaluated patients with BSI due to a CRGN microorganism and compared them with other infection types. the risk factors and outcomes were similar except for prior cephalosporin exposure. As a conclusion, we have to enhance infection control programs and prevent patients from redundant antibiotic exposure

COVID-19 Hastalığı ile İlişkili Çoklu Sistemik İnflamatuvar Sendrom Tanılı Çocuk Olguların Değerlendirilmesi

Giriş: Nisan 2020 yılında, SARS-CoV-2 enfeksiyonu geçiren bazı çocuklarda ateş, karın ağrısı, inotrop desteği gerektiren hipotansiyon ve miyokardiyal disfonksiyona yol açan COVID-19 hastalığı ile ilişkili Çoklu Sistemik İnflamatuvar Sendrom(Multisystem Inflammatory Syndrome in Children-MIS-C) olarak adlandırılan hastalık tanımlanmıştır.Bu çalışmada ülkemizde görülen MIS-C tanılı olguların değerlendirilmesi amaçlanmıştır. Materyal-Metod: Bu çalışmada retrospektif olarak Nisan2020-Ağustos2020 tarihleri arasında birden fazla merkezde MIS-C tanısıyla izlenen olguların sosyodemografik, klinik, laboratuvar bulgularıyla tedavi rejimleri ve izlem sonuçları irdelendi. Bulgular: Çalışmaya alınan 29 olgunun 16'sı(%55.2) erkekti ve ortanca yaşları 66 ay(2-208 ay) idi. Olguların 7'si fazla kilolu(vücut kitle indeksi persentili &gt;=%85) olarak değerlendirildi. On bir olguda SARS-CoV-2 RT-PCR pozitifliği, 12'sinde antikor testlerinde pozitiflik saptanırken 4 olguda PCR ve antikor testlerinde pozitiflik görüldü. İki olgunun ise PCR negatif gelmekle birlikte COVID-19 tanılı olguyla temas öyküsü mevcuttu. Olguların tamamında ateş, 22'sinde (%75.9) gastrointestinal semptomlar ve yorgunluk, 20'sinde(%69) döküntü, 17'sinde(%58.6) bulbar konjoktivit ve el-ayaklarda renk değişikliği, 16'sında (%55.2) dudaklarda fissür, 14'ünde (%48.3) kas ağrısı ve çilek dil mevcuttu.Ateş süresinin ortanca değeri 7 (3-17gün) gün saptandı.Olguların 21'inde (%72.4) dehidratasyon, 14'ünde (%48.3) taşikardi, 11'inde hipotansiyon (%37.9) saptandı.Laboratuvar bulgularından ortanca lökosit sayısı 6365 mm³ (3300-31220 mm³), ortanca lenfosit sayısı 1135(570-5800 mm³), ortanca trombosit sayısı 160500 mm³ (46000-747000 mm³) saptandı. Ortalama CRP değeri 165±102 mg/L, ESH değeri 62.6±31.4 mm/s saptandı.Tedavide; olguların 23'üne (%79.3) IVIG, 15'ine (%51.7) asetil salisik asit, 11'ine (%37.9) steroid, 8'ine (%27.6) antikoagülan tedavi uygulandı.Antiviral tedavi 7 (%24.1) olguya uygulandı. 2 olguya tocilizumab tedavisi verildi.Ortanca yatış süreleri 10 gün(1-27) saptanırken 9 olguda yoğun bakım ihtiyacı geliştiği görüldü.3 olgu entübe edildi ve 2 olguda exitus gelişti.Sonuç: MIS-C; yeni tanımlanan, kesin bir tedavisi olmayan hayati tehlikeye neden olabilen organ tutulumu ve şok gelişimine yol açabilecek bir hastalıktır.Çalışmamızda MIS-C olgularında, 3 günden uzun süren ateş, gastrointestinal şikayetler ve yorgunluk en sık görülen yakınmalar olarak belirlendi.COVID-19 pandemi döneminde bu yakınmalarla gelen çocuklarda MIS-C akılda tutulmalı; hızlı tanı ve agresif tedavinin klinik olumlu etkileri unutulmamalıdır