The Effect of Tracheostomy Timing on Clinical Outcomes in Children

Introduction:Optimal timing for tracheostomy in children is not well defined. Our aim is to examine the pre-tracheostomy morbidities, indications and association of early tracheostomy on clinical outcomes.Methods:This retrospective cohort study included all patients who underwent tracheostomy in the Dokuz Eylül University Pediatric Intensive Care Unit (ICU) between January 2012 and September 2020. We categorized patients into the early and late tracheostomy groups according to time on a mechanical ventilator before tracheostomy using a cut-off of 14 days. Pre-tracheostomy morbidities [ventilator associated pneumonia (VAP), central line associated bloodstream infection], indications and clinical outcomes (including length of ICU and hospital stay, incidence of VAP and mortality) were compared between early and late groups.Results:Of the 104 patients undergone tracheostomy, 90 were included in the study: Thirty patients in the early group, 60 patients in the late group. Tracheostomy rate of our unit was 6.06%, with a median ventilator time before tracheostomy of 20 days. VAP and lung tissue disease indication for tracheostomy independently increased pre-tracheostomy mechanical ventilation time by 8 and 12.6 days, respectively. There was no statistically significant difference in VAP rate after tracheostomy, successful decannulation and mortality between early and late group. Early group had lower post-tracheostomy ICU-length of stay (LOS) (8.5 vs. 13 days p=0.041) and total ICU-LOS (17.5 vs. 45 days p<0.001). Controlling for age, tracheostomy indication, central line associated bloodstream infection and VAP; tracheostomy timing was independently associated with ICU-LOS. Late tracheostomy timing increased the ICU-LOS by 10.7 days (p=0.041).Conclusion:Our results suggest that early timing of tracheostomy is associated with reduced ICU-LOS and VAP in children, consistent with the current literature

Ultrasound Guided Pleural Drainage with the Seldinger Technique Using a Central Venous Catheter Santral Venöz Kateter Kullanılarak Seldinger Tekniği ile Ultrason Eşliğinde Plevral Drenaj

Introduction: Pigtail catheters are currently recommended for draining pleural effusions. However, specific catheters manufactured for this purpose may not be feasible in resource-limited settings. This study evaluated the safety and effectiveness of a central venous catheter for treating uncomplicated pleural effusions with point-of-care ultrasound in children. Methods: The study was a single-center retrospective review of the clinical records of pediatric patients with symptomatic uncomplicated pleural effusion who had underwent bed-side ultrasound guided pleural drainage with a central venous catheter, between 2014 and 2019. Results: We determined 93 patients who had undergone 98 central venous catheter insertions during the study period. The patient’s median age was 4.5 years (range, 7 days to 15 years) and median weight was 19 kg (range, 3 to 60 kg). The most underlying cause was cardiovascular surgery. The technical success rate was 95.9% and only 2 (2.2%) complications were observed. Conclusion: Point of care ultrasound guided pleural drainage with a central venous catheter is safe and effective in critically ill children with uncomplicated pleural effusion

Epidemiology and Acute Respiratory Distress Syndrome Propensity of Viral Respiratory Infections in Pediatric Intensive Care Units Prior to the Coronavirus Disease 2019 Pandemic

© 2023. Thieme. All rights reserved.This study aimed to determine the epidemiology and acute respiratory distress syndrome (ARDS) propensity of common respiratory viruses in a tertiary pediatric intensive care unit (PICU) among hospitalized children who were tested for respiratory viruses by polymerase chain reaction (PCR) prior to the coronavirus disease 2019 (COVID-19) pandemic. Respiratory tract samples were collected from patients who were followed up in the Dokuz Eylul University Hospital pediatric intensive care unit between March 2015 and March 2020 and tested for viral pathogens. The results of 269 patients between 1 month and 18 years of age were evaluated retrospectively. In the 5 years preceding the COVID-19 pandemic, 269 patients with a lower respiratory infection were admitted to the PICU. A positive viral PCR result was detected in 160 patients (59.5%). Human rhinovirus was the most common virus (40%), followed by respiratory syncytial virus (26.3%), human bocavirus (10%), and seasonal coronaviruses (10%). Five (33.3%) of the fifteen children who developed ARDS were infected with influenza A/B, while four (26.7%) were infected with human metapneumovirus (hMPV).Although rhinovirus was the most common viral agent in critically ill children, the incidence of ARDS was higher in children aged over 1 year who had influenza or hMPV infection