The Importance of Bedside Ultrasonography in Confirming the Location of Endotracheal Tube

Objective. Endotracheal intubation may be associated with lethal complications when not applied in appropriate manner. In this study, we aimed to examine the efficiency of transcricoid and pulmonary ultrasonography in confirming the position of the tube in comparison with classical methods. Methods. This study was carried out between 2016 and 2017 in Turkey and was registered in Clinical Trials under number NCT03081221. The location of the tube was confirmed using methods such as monitoring the vocal cords during direct laryngoscopy, condensation on endotracheal tube during respiration, epigastric-pulmonary auscultation, radiography and capnometry. After that, the transcricoid and pulmonary ultrasonography were implemented by the blinded pediatric emergency care specialist. Results. 64 cases who needed advanced airway requirements were involved in this study. The double-line appearance could not be obtained from one patient only when using transcricoid ultrasonography, but the bilateral pleural shift movement was observed among all the cases by using pulmonary ultrasonography (sensitive: 98%-100%). Conclusion. The determination of endoesophageal, endotracheal and endobronchial intubations can be easily made by using transcricoid and pulmonary ultrasonography. The use of ultrasonography may significantly contribute to critical airway management as fast, accurate and on time

Isoniazid Intoxication: Three Case Reports

WOS: 000287686200022Tuberculosis is still an important health problem in our country as its prevalence has increased in recent years. Isoniazid is one of the most commonly used antituberculous drugs because it is cheap and efficacious. When administered at high doses; it can cause convulsions, metabolic acidosis, lactic acidosis, rhabdomyolisis, coma, and even death. The basis of therapy consists of parenteral pyridoxine administration in a dose equivalent to that of the ingested isoniazid. Here we reported three cases of acute isoniazid intoxication presenting with convulsions and aimed to discuss the clinical signs, pathophysiology, and treatment of isoniazid intoxication

Appraisal of the "pediatric ARDS: consensus recommendations from the pediatric acute lung injury consensus conference" with the AGREE II instrument

WOS: 000425902900015PubMed ID: 29479961Background/aim: The "Pediatric Acute Lung Injury Consensus Conference" (PALICC) was convened in order to develop a taxonomy to define pediatric acute respiratory distress syndrome (ARDS). The Appraisal of Guidelines for Research and Evaluation (AGREE) assesses the quality of guidelines. The aim of this study is to evaluate the new pediatric ARDS guideline using the AGREE II instrument. To the best of our knowledge, this is the first assessment of the new pediatric ARDS clinical practice guideline in the English literature. Materials and methods: Four appraisers assessed the new pediatric ARDS guideline with the AGREE II instrument. At the end of the evaluation each appraiser rated the overall quality of the guidelines. Results: Results of the assessment were editorial independence 100%, clarity of presentation 94%, scope and purpose 89%, stakeholder involvement 78%, rigor of development 78%, and applicability 78%. Conclusion: The new pediatric ARDS guideline received good scores especially with respect to editorial independence and clarity of presentation. Our overall AGREE II review of the PALICC guideline indicates that it has been created using high quality methodology and should be recommended for use and implementation as currently published

Noninvasive ventilation in cancer children with acute respiratory failure

WOS: 000398493700005Objective: To establish the effectiveness of noninvasive ventilation in cancer children with acute respiratory failure. Methods: The data of 33 cancer patients were obtained prospectively from six different pediatric intensive care units in Turkey between the years of 2012 and 2013. Results: The diagnosis was leukemias in 25 (75.8%), lymphomas in 3 (9.1%) and other solid tumors in 5 (15.1%) patients. Pneumonia in 12 (36.3%) and sepsis in 15 (45.4%) patients were seen as the common reasons of respiratory failure. The mean PaO2/ FiO2 ratios were (164.22 +/- 37.24) and (126.80 +/- 42.73) in noninvasive ventilation success and failure group, respectively. Noninvasive ventilation was successful in 18 (54.5%) patients. The failure group consisted of 15 patients required intubation. A total of 14 (42.4%) patients died. The clinical outcome in terms of success and failure was meaningful statistically (P = 0.0 00 1). Conclusions: Our results could encourage the use of noninvasive ventilation in children with cancer who develop acute respiratory failure. It should be considered as a useful therapeutic approach to avoid endotracheal intubation

Hyperinsulinemic Euglycemia and Intravenous Lipid Emulsion Treatments for Calcium Channel Blocker and Beta Blocker Poisoning: A Report of Two Cases

WOS: 000433248300004Poisoning with calcium channel blockers and beta blockers are associated with high mortality and morbidity rates, especially in children. Treatment of poisoning with these drugs includes administration of atropine, glucagon, calcium and inotropic agents as clinically needed; and newer approaches like hyperinsulinemic euglycemia and intravenous lipid emulsion therapies. We herein present two refractory cases of calcium channel blocker and beta blocker poisoning that underwent hyperinsulinemic euglycemia and intravenous lipid emulsion interventions. CASE.1 A 17-year-old female patient has been brought to our setting unconscious and recalcitrantly hypotensive and bradycardic after taking 8 tablets of 90 mg diltiazem hydrochloride and 5 tablets of 500 mg paracetamol + 30 mg caffeine. The patient was given saline, atropine, repeating doses of calcium gluconate, dopamine, noradrenaline, hyperinsulinemic euglycemia treatment, hemodiafiltration, and lipid administration. She achieved a full recovery during follow-up, and was discharged with cure. CASE.2 A 17-year-old girl, who developed an unresponsive hypotension after ingesting 12 tablets of 12.5 mg carvedilol, 6 - 7 tablets of 450 mg diosmin + 50 mg hesperidin, and 6-7 tablets of 10 mg metoclopramide HCl, was treated with saline, glucagon, calcium gluconate, dopamine, noradrenaline, and administration of hyperinsulinemic euglycemia and lipid. The patient responded well to the treatment, and was discharged with cure. The newer treatment modality of lipid emulsion has been reported to achieve promising results by several reports in the literature; however, there are a limited number of published cases regarding its use in children. Further studies to assess the pediatric utilization of these treatment approaches are needed

Burnout of Nurses Working in a University Hospital and the Effect of Social Support

Purpose: In this study, levels of burnout in nurses working in Cukurova University Faculty of Medicine and perceived social support systems and to examine the factors that affect burnout. Material and Methods: Socio-demographic data collection form for this purpose, Maslach Burnout Inventory, Multidimensional Scale of Perceived Social Support 403 nurses applied. Results: According to the results obtained from the nurses social support systems are adequate but moderate emotional exhaustion (EE) and depersonalization (D) were live. In terms of personal achievement, it is concluded their high levels of burnout. Nurses working in night mode of operation of the data evaluated EE and D were higher mean scores than the other groups, and statistically significant (p = 0.001). Conclusion: Nurses perceived social support, burnout was found to affect. In particular sub-group of friend support and burnout was determined that the most important social support. [Cukurova Med J 2014; 39(4.000): 752-764

Noninvasive ventilation in cancer children with acute respiratory failure

WOS: 000398493700005Objective: To establish the effectiveness of noninvasive ventilation in cancer children with acute respiratory failure. Methods: The data of 33 cancer patients were obtained prospectively from six different pediatric intensive care units in Turkey between the years of 2012 and 2013. Results: The diagnosis was leukemias in 25 (75.8%), lymphomas in 3 (9.1%) and other solid tumors in 5 (15.1%) patients. Pneumonia in 12 (36.3%) and sepsis in 15 (45.4%) patients were seen as the common reasons of respiratory failure. The mean PaO2/ FiO2 ratios were (164.22 +/- 37.24) and (126.80 +/- 42.73) in noninvasive ventilation success and failure group, respectively. Noninvasive ventilation was successful in 18 (54.5%) patients. The failure group consisted of 15 patients required intubation. A total of 14 (42.4%) patients died. The clinical outcome in terms of success and failure was meaningful statistically (P = 0.0 00 1). Conclusions: Our results could encourage the use of noninvasive ventilation in children with cancer who develop acute respiratory failure. It should be considered as a useful therapeutic approach to avoid endotracheal intubation