Seizures in a Pediatric Intensive Care Unit: A Prospective Study

Background: The aim of the research is to determine the etiology and clinical features of seizures in critically ill children admitted to a pediatric intensive care unit (PICU). Methods: A total of 203 children were admitted from June 2013 to November 2013; 45 patients were eligible. Age ranged from 2 months to 19 years. Seizures were organized as epileptic or acute symptomatic. Pediatric risk of mortality score III, Glasgow coma scale, risk factors, coexistent diagnosis, medications administered before admission, type and duration of seizures, drugs used, requirement and duration of mechanical ventilation, length of stay and neuroimaging findings were collected as demographic data prospectively. Results: The male-female ratio was 0.8. Mean age was 5.4. The most common causes of seizures were acute symptomatic. Most frequent coexistent diagnosis was infectious diseases, and 53.3% had recurrent seizures. Medications were administered to 51.1% of the patients before admission. Seizures were focal in 21 (46.7%), generalized in 11 (24.4%) and 13 (28.9%) had status epilepticus. Intravenous midazolam was first-line therapy in 48.9%. Acute symptomatic seizures were usually new-onset, and duration was shorter. Epileptic seizures tended to be recurrent and were likely to progress to status epilepticus. However, type of seizures did not change severity of the disease. Also, laboratory test results, medications administered before admission, requirement and duration of ventilation, mortality and length of stay were not significant between epileptic/acute symptomatic patients. Conclusion: Seizures in critically ill children, which may evolve into status epilepticus, is an important condition that requires attention regardless of cause. Intensified educational programs for PICU physicians and international guidelines are necessary for a more efficient approach to children with seizures.WoSScopu

Effects of Hemodialysis on Thiol-Disulphide Homeostasis in Critically Ill Pediatric Patients with Acute Kidney Injury

Aim. To evaluate thiol/disulphide homeostasis as a new indicator of oxidative stress in AKI patients and to determine the effect of HD on antioxidant balance and oxidative stress through plasma thiols. Methods. This study was performed in patients aged between 12 months and 18 years prospectively who underwent hemodialysis due to AKI and were followed up for a year in a 22-bed tertiary pediatric intensive care unit. 20 patients and 39 controls were included. Results. No difference was present between the groups in terms of age and gender. Median values of plasma native thiol, total thiol, and percent thiol were significantly lower in AKI group both before and after dialysis when compared to control group. The median dynamic disulphide values were significantly lower in the AKI group of predialysis compared to the controls. When pre- and postdialysis values were compared, disulphide values were statistically higher after dialysis. When pre- and postdialysis native thiol, dynamic disulphide, total thiol, and percent thiol median values were compared, postdialysis values were significantly higher than the predialysis values. There was a positive correlation between albumin, total thiol, and native thiol values before dialysis in the patient group. Conclusion. AKI patients have low levels of thiol species showing the presence of oxidative stress and hemodialysis has a positive effect on thiol/disulphide balance. This new method may be an inexpensive and simple tool suitable for clinical studies and can be used in routine screening as a useful indicator to show oxidative stress

Factors Affecting Development Of Pneumothorax In Critically Ill Children: A 3-Year Study

Background: To determine the factors affecting the development of pneumothorax in critically ill children admitted to pediatric intensive care unit (PICU). Methods: This was a single-centered retrospective case control study comparing the clinical features of mechanically ventilated patients, who developed pneumothorax with matched control cases. Results: The study screened 2850 patients admitted to the PICU over a 3 year period. Among 1140 patients who were mechanically ventilated, 4.4% (n = 50) developed pneumothorax. Median age was 24 months. Patients with pneumothorax were found to have median pediatric risk of mortality (PRISM):26, Pediatric logistic organ dysfunction (PELOD):22 and multiorgan disfuction (MODS):3 whereas in the control group they were 15.5, 12, and 3, respectively. PRISM and PELOD were significantly higher in pneumothorax group. Pneumothorax was observed on the 11.6th day of mechanical ventilation (MV). Pneumothoraxwas mainly secondary to pneumonia (n=18, 36%) and MV-related reasons (n=13, 26%). The risk of pneumothorax was higher when P-mean was > 14 cmH(2)P and tidal volume (TV) was > 10 mL/kg (P < 0.05). The mean albumin level was 2.7 g/dL in the pneumothorax group compared with 3.6 g/dL in the control group (P < 0.001). The number of days on mechanical ventilator and the duration of hospital stay were statistically significant in pneumothorax group (P < 0.05). The mortality outcome was 44% (n=22) in the pneumothorax group compared with 6.7% (n = 2) in the control group (P < 0.001). Conclusions: Pneumothorax in critically ill children was related to increased morbidity, mortality and prolonged length of stay in hospital. Higher pediatric risk of mortality (PRISM) and Pediatric logistic organ dysfunction (PELOD) scores were associated with increased risk of pneumothorax. Hypoalbuminemia as a reflection of malnutrition status of patients might be a risk factor.WoSScopu

Stress induced gastrointestinal bleeding in a pediatric intensive care unit: which risk factors should necessitate prophilaxis?

Sahin, Sanliay/0000-0001-8418-1889WOS: 000384945400004PubMed: 25263241BACKGROUND: The aim of this study was to determine the frequency and the risk factors of stress induced gastrointestinal bleeding (GIB) in critically ill children, and to investigate the effect of prophilaxis. The setting was a 14-beded, tertiary care PICU. METHODS: Records of 182 children admitted consecutively from December 2012 to May 2013 were retrospectively reviewed. 136 patients were eligible. The age ranged from 40 days to 18 years. Diagnosis, demographic data, risk factors, administration of prophilaxis, drugs used in medication, prescence and degree of GIB and complications were recorded. RESULTS: The male-female ratio was 1.3. Mean age was 5.9. Mean PRISM III score was 12.2 and 49.3% had PRISM Score >= 10. Most frequent diagnosis was infectious diseases. Sixtyone (44.9%) children received prophylaxis in which antacids was used in 28 (45.9%), sucralfate in 18 (29.5%), proton pomp inhibitors (PPIs) in 51 (83.6%) and 5 (8.2%) received H2 reseptor antagonist. The incidence of GIB was 15.4% (N.=21), in which 66.7% (N.=14) were mild, 23.8% (N.=5) were moderate, 4.8% (N.=1) was significant and 4.8% (N.=1) was massive. In children who received prophylaxis 17 (27.9%) cases developed GIB. Mechanical ventilation was found to be the only risk factor significantly associated with stress induced GIB. Also; mechanical ventilation and trauma was strongly significant (P= 10, renal and hepatic failure, hypotension, and heart failure/arrhythmia was found to be associated with the development of GIB in critically ill children (P= 10, renal and hepatic failure, hypotension, and heart failure/arrhythmia must be kept in mind as risk factors requiring attention in PICU setting

Outcome Of Out-Of-Hospital Cardiopulmonary Arrest In Children: A Multicenter Cohort Study

The aim of this study was to evaluate the demographic characteristics of children who experienced out-of-hospital cardiopulmonary arrest (CPA), and to assess the impact of the bystander cardiopulmonary resuscitation (CPR) on the survival rate of witnessed arrests and the effects of the arrest and CPR durations on the neurological outcomes. This multicenter, retrospective study included a total of 182 patients who underwent CPR for out-of-hospital CPA between January 2008 and December 2012 at six centers in Ankara, Turkey. The median [interquartile range (IQR)] age was 22 (5-54) months; 60.4% of the patients were males, and 44% were younger than one year of age. The witnessed arrest rate was 75.8% (138/182) and the rate of bystander CPR was 13.9% (13/93). In these patients the rate of the return of spontaneous circulation (ROSC) was higher (76.9%). Following resuscitation in the patients for whom the spontaneous circulation was able to be returned, the median (IQR) duration of arrest was 5 (1-15) min, while it was 15 (5-40) min for the remaining patients (p<0.001). The ROSC rate was 94.9% in patients who underwent CPR for less than 20 min and 22% in patients requiring CPR longer than 20 min (p<0.001). Survival to hospital discharge was 14.3%. Of these patients, 57.7% experienced neurological disability. The short duration of an arrest and the presence of CPR are both critical for survival. We suggest that a witness to the CPA, performing early and efficient CPR, yields better results.Wo

Outcome of out-of-hospital cardiopulmonary arrest in children: A multicenter cohort study

The aim of this study was to evaluate the demographic characteristics of children who experienced out-of-hospital cardiopulmonary arrest (CPA), and to assess the impact of the bystander cardiopulmonary resuscitation (CPR) on the survival rate of witnessed arrests and the effects of the arrest and CPR durations on the neurological outcomes. This multicenter, retrospective study included a total of 182 patients who underwent CPR for out-of-hospital CPA between January 2008 and December 2012 at six centers in Ankara, Turkey. The median {[}interquartile range (IQR)] age was 22 (5-54) months; 60.4\% of the patients were males, and 44\% were younger than one year of age. The witnessed arrest rate was 75.8\% (138/182) and the rate of bystander CPR was 13.9\% (13/93). In these patients the rate of the return of spontaneous circulation (ROSC) was higher (76.9\%). Following resuscitation in the patients for whom the spontaneous circulation was able to be returned, the median (IQR) duration of arrest was 5 (1-15) min, while it was 15 (5-40) min for the remaining patients (p<0.001). The ROSC rate was 94.9\% in patients who underwent CPR for less than 20 min and 22\% in patients requiring CPR longer than 20 min (p<0.001). Survival to hospital discharge was 14.3\%. Of these patients, 57.7\% experienced neurological disability. The short duration of an arrest and the presence of CPR are both critical for survival. We suggest that a witness to the CPA, performing early and efficient CPR, yields better results