Comparison of Ultrasound Guided Optic Nerve Sheath Diameter Measurements with Other Cranial Imaging Methods (Cranial Computed Tomography and Magnetic Resonance Imaging) in Pediatric Intensive Care Patients

Introduction:Optic nerve sheath diameter (ONSD) measurements aid in diagnosis of increased intracranial pressure (ICP). Computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used modalities for detecting ICP. Lately, ONSD measurements via ultrasound (US) are getting popular as an alternative method due to the ease of performance at the bedside and repeatability. Our study objective was to investigate whether US measurements correlated with CT/MRI counterparts.Methods:This was a single-center, prospective study. All intubated patients aged 1 month-18 years with a cranial CT/MRI for any indications, who could be scanned ultrasonographically, were included after parental consent. Optic nerve US was performed by a single investigator. CT/MRI ONSDs were measured by a neuro-radiologist. Data obtained from US and CT/MRI scans were compared.ResultsA total of 94 different measurements were obtained. The mean ONSD in US and CT was 4.56±0.66 cm and 4.65±0.72cm on the right side, whereas the mean left ONSD was 4.52±0.63 cm and 4.46±0.67 cm, respectively (p=0.4). Correlation coefficient for right ONSD was r=0.448 (p=0.002) while it was r=0.448 (p=0.001) for left ONSD. Both CT and US measurements showed a linear increase, and the correlation between them was moderate. A subgroup of 8 patients who had less than 5 hours between their central imaging and US scan showed strong correlation between measurements for both right and left ONSD [r=0.774, (p=0.024) and r=0.811 (p=0.014), respectively].Conclusion:There was a correlation between US and CT/MRI ONSD measurements in our study. The correlation was stronger when the time interval was less than 5 hours between measurements. Our findings suggest that US may be a useful, reliable and cost-effective method for assessment and clinical follow-up of increased ICP in intubated pediatric intensive care unit patients

Neuronal Rat Brain Damage Caused by Endogenous and Exogenous Hyperthermia

OBJECTIVE: Hyperthermia may induce pathologic alterations within body systems and organs including brain. In this study, neuronal effects of endogenous and exogenous hyperthermia (41°C) were studied in rats. METHODS: The endogenous hyperthermia (41°C) was induced by lipopolysaccharide and the exogenous by an (electric) heater. Possible neuronal damage was evaluated by examining healthy, apoptotic and necrotic cells, and heat shock proteins (HSP 27, HSP 70) in the cerebral cortex, cerebellum and hypothalamus RESULTS: At cellular level, when all neuronal tissues are taken into account; (i) a significant increase in the necrotic cells was observed in the both groups (p0.05). CONCLUSION: The neural tissue of brain can show different degree of response to hyperthermia. But we can conclude that endogenous hyperthermia is more harmful to central nervous system than exogenous hyperthermi

Mortality Risk Factors among Critically Ill Children with Acute COVID-19 in PICUs: A Multicenter Study from Turkish Pediatric Critical COVID-19 and MIS-C Study Group

© 2022 Lippincott Williams and Wilkins. All rights reserved.Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality