Solunum yetmezliği nedeniyle mekanik ventilasyon desteği alan çocuklarda diyafram elektriksel aktivitesi takibinin ekstübasyon başarısını öngörme potansiyeli

ÖZETAmaç: Solunum yetmezliği nedeniyle mekanik ventilasyon desteği alan çocuklardagüvenilir ekstübasyon başarısı göstergesi bulunmamaktadır. Çalışmamızın amacı,ekstübasyon öncesi ve sonrası diyafram elektriksel aktivitesini (Edi) monitorizeederek ekstübasyon başarısını öngörmede yerini analiz etmektir.Gereç ve Yöntem: Çalışmamız, etik kurul onaylı (1400124188), BAPKO destekli(SAG-C-TUP-080415-0098), prospektif gözlemsel bir çalışmadır. MarmaraÜniversitesi Pendik Eğitim ve Araştırma Hastanesi, Pediatri Yoğun BakımÜnitesi’nde Ağustos 2014 ve Temmuz 2015 tarihleri arasında, solunum yetersizliğinedeniyle 48 saatin üzerinde invasif mekanik ventilasyon alan hastalar (0-18 yaş)çalışmaya alındı. Hastaların ekstübasyon öncesi ve sonrası vital bulguları, kesintisizEdi monitorizasyonu en az 24 saat kaydedildi. Önceden belirlenmiş aralıklarda kangazı takibi yapıldı. İstatistiksel analizlerde SPSS 17.0 programı kullanıldı.Bulgular: 25 hasta çalışmaya dahil edildi. Hastaların %44’ünde ekstübasyonbaşarısızdı. Kız hastalar erkeklere göre ekstübasyonda daha başarılı oldular(p=0,049). Ekstübasyon sonrası tüm hastalarda, medyan Edi maks değerleri 11’den20’ye arttı(p=0,0001). Ekstübasyon öncesi Edi değerlerinde ekstübasyon başarılı vebaşarısız grupta farklılık tespit edilmedi (p=0,622). Ekstübasyon başarısız grupta,post ekstübasyon pH’da düşme (7,29±0,12; p=0,003), CO2’de yükselme(59,6±21,42; p=0,015) ve SpO2’de düşme (95±5,69; p=0,024) gözlendi. Diğer kangazı parametreleri (HCO3, laktat) ve vital bulgularında (kalp hızı, solunum sayısı,kan basıncı) anlamlı değişiklik yoktu (p>0,05). Edi maks, başarılı ekstübasyonsonrası %150 artış gösterirken (med. 12a17), başarısız ekstübasyonda artış %250-300’e ulaştı (med.10a25). Bu fark istatistiksel anlamlı değildi (p=0,063). Edi değeri4 kat ve üzeri artan hastalarda ekstübasyon başarısızlıkla sonuçlandı (p=0,016).Hastaların medyan NVE (Vt/Edi) indeksleri karşılaştırıldığında, ekstübasyon başarılıgrupta daha yüksek (med.9,2 (IQR:5,4-23,1)), başarısız grupta daha düşük (med.8,2(IQR:4,2-18,4)) gözlendi (p=0,807). Ekstübasyon sonrası non-invasif mekanikviventilasyon desteği devam eden bir grup hastada Edi maks değerlerinde artış olmaklaberaber, istatiksel olarak anlamlı değildi (p=0,063).Sonuç: Diyafram elektriksel aktivitesi monitorizasyonu, bu az sayıda ve genişkomorbiditesi mevcut olan hasta grubumuzda, güvenilir bir ekstübasyon başarısıgöstergesi olarak tespit edilmemiştir. Ekstübasyon başarısız grupta Edi değerlerindeartış olmasına rağmen, bu farklılık istatistiksel anlamlı değildir. Edi’nin 4 kat üzeriartışı ekstübasyon başarısızlığını öngörebilir. Edi monitorizasyonunun, kısa bireğitim süreci sonrası uygulaması zor değildir. Daha fazla hasta ile ileri çalışmalaraaçık bir konudur.Anahtar Kelimeler: Diyafram elektriksel aktivitesi, ekstübasyon başarısı, pediatri.ABSTRACTObjective: There is no reliable predictor for extubation success for children whorequire mechanical ventilation due to respiratory failure at present. The aim of thisstudy is to record the diaphragm electrical activity (Edi) during pre- and postextubation period, and analyze whether Edi monitoring could predict extubationsuccess.Methods: This was a prospective observational study with institutional ethics(1400124188) and BAPKO (SAG-C-TUP-080415-0098) grant approval. Patients (0-18 years) who required intubation and invasive mechanical ventilation due torespiratory failure over 48 hours in the pediatric intensive care unit of the MarmaraUniversity Pendik Training and Research Hospital between August 2014 and July2015 were eligible. Vital signs, continuous Edi values of the patients are recordedbefore and after extubation for minimum of 24 hours. Blood gases were obtained atpredetermined intervals. Statistical analyses were performed via 17.0 SPSS program.Results: 25 patients were included in this study. Extubation failed in 44% ofpatients. Females were more successfull than male patients at extubation (p=0,049).Median Edi max values increased from 11 to 20 after extubation in all patients(p=0,0001). There was no difference in pre-extubation Edi levels between patientswho failed and succeeded in extubation (p=0,622). Patients who failed extubationhad significantly lower pH (7,29±0,12; p=0,003), higher CO2 (59,6±21,42; p=0,015)and lower SpO2 (95±5,69; p=0,024) after extubation.There was no significant changein vital signs (heart rate, respiration rate, blood pressure) and other blood gasparameters (HCO3, lactat); (p>0,05). Edi max levels increased by 150% (med.12a17) after a successful extubation, whereas the levels increased by 250-300%(med.10a25) in patients who failed. On the other hand the difference was notsignificant (p=0,063). All patients who had at least 4 fold increment of Edi valueafter the extubation failed (p=0,016). Median NVE (Vt/Edi) index was higher insuccessful patients (med.9,2 (IQR:5,4-23,1)) compared to patients who failed theextubation (med.8,2 (IQR:4,2-18,4)) ; (p=0,807). In the subgroup of patients, whoviiiwere supported with non-invasive ventilation after extubation, Edi max values hadincreased after extubation, although this did not reach statistical significance(p=0,063).Conclusion: Diaphragm electrical activity monitoring has not been found a reliablepredictor of the extubation success in our small sample of patients with mixeddiagnoses and comorbidities. Although patients who failed had higher Edi levelscompared to successfully extubated patients, the difference was not significantstatistically. Increased Edi by 4 fold predicted failure. Diaphragmatic electricalactivity monitoring is not difficult, it can be easily performed after a short learningperiod. Further studies with larger sample size would be helpful.Keywords: Diaphragm electrical activity, extubation success, pediatrics

Solunum yetmezliği nedeniyle mekanik ventilasyon desteği alan çocuklarda diyafram elektriksel aktivitesi takibinin ekstübasyon başarısını öngörme potansiyeli

Amaç: Solunum yetmezliği nedeniyle mekanik ventilasyon desteği alan çocuklarda güvenilir ekstübasyon başarısı göstergesi bulunmamaktadır. Çalışmamızın amacı, ekstübasyon öncesi ve sonrası diyafram elektriksel aktivitesini (Edi) monitorize ederek ekstübasyon başarısını öngörmede yerini analiz etmektir. Gereç ve Yöntem: Çalışmamız, etik kurul onaylı (1400124188), BAPKO destekli (SAG-C-TUP-080415-0098), prospektif gözlemsel bir çalışmadır. Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Pediatri Yoğun Bakım Ünitesi’nde Ağustos 2014 ve Temmuz 2015 tarihleri arasında, solunum yetersizliği nedeniyle 48 saatin üzerinde invasif mekanik ventilasyon alan hastalar (0-18 yaş) çalışmaya alındı. Hastaların ekstübasyon öncesi ve sonrası vital bulguları, kesintisiz Edi monitorizasyonu en az 24 saat kaydedildi. Önceden belirlenmiş aralıklarda kan gazı takibi yapıldı. İstatistiksel analizlerde SPSS 17.0 programı kullanıldı. Bulgular: 25 hasta çalışmaya dahil edildi. Hastaların %44’ünde ekstübasyon başarısızdı. Kız hastalar erkeklere göre ekstübasyonda daha başarılı oldular (p=0,049). Ekstübasyon sonrası tüm hastalarda, medyan Edi maks değerleri 11’den 20’ye arttı(p=0,0001). Ekstübasyon öncesi Edi değerlerinde ekstübasyon başarılı ve başarısız grupta farklılık tespit edilmedi (p=0,622). Ekstübasyon başarısız grupta, post ekstübasyon pH’da düşme (7,29±0,12; p=0,003), CO2’de yükselme (59,6±21,42; p=0,015) ve SpO2’de düşme (95±5,69; p=0,024) gözlendi. Diğer kan gazı parametreleri (HCO3, laktat) ve vital bulgularında (kalp hızı, solunum sayısı, kan basıncı) anlamlı değişiklik yoktu (p>0,05). Edi maks, başarılı ekstübasyon sonrası %150 artış gösterirken (med. 12a17), başarısız ekstübasyonda artış %250- 300’e ulaştı (med.10a25). Bu fark istatistiksel anlamlı değildi (p=0,063). Edi değeri 4 kat ve üzeri artan hastalarda ekstübasyon başarısızlıkla sonuçlandı (p=0,016). Hastaların medyan NVE (Vt/Edi) indeksleri karşılaştırıldığında, ekstübasyon başarılı grupta daha yüksek (med.9,2 (IQR:5,4-23,1)), başarısız grupta daha düşük (med.8,2 (IQR:4,2-18,4)) gözlendi (p=0,807). Ekstübasyon sonrası non-invasif mekanik vi ventilasyon desteği devam eden bir grup hastada Edi maks değerlerinde artış olmakla beraber, istatiksel olarak anlamlı değildi (p=0,063). Sonuç: Diyafram elektriksel aktivitesi monitorizasyonu, bu az sayıda ve geniş komorbiditesi mevcut olan hasta grubumuzda, güvenilir bir ekstübasyon başarısı göstergesi olarak tespit edilmemiştir. Ekstübasyon başarısız grupta Edi değerlerinde artış olmasına rağmen, bu farklılık istatistiksel anlamlı değildir. Edi’nin 4 kat üzeri artışı ekstübasyon başarısızlığını öngörebilir. Edi monitorizasyonunun, kısa bir eğitim süreci sonrası uygulaması zor değildir. Daha fazla hasta ile ileri çalışmalara açık bir konudur. Anahtar Kelimeler: Diyafram elektriksel aktivitesi, ekstübasyon başarısı, pediatri. ABSTRACT Objective: There is no reliable predictor for extubation success for children who require mechanical ventilation due to respiratory failure at present. The aim of this study is to record the diaphragm electrical activity (Edi) during pre- and post extubation period, and analyze whether Edi monitoring could predict extubation success. Methods: This was a prospective observational study with institutional ethics (1400124188) and BAPKO (SAG-C-TUP-080415-0098) grant approval. Patients (0- 18 years) who required intubation and invasive mechanical ventilation due to respiratory failure over 48 hours in the pediatric intensive care unit of the Marmara University Pendik Training and Research Hospital between August 2014 and July 2015 were eligible. Vital signs, continuous Edi values of the patients are recorded before and after extubation for minimum of 24 hours. Blood gases were obtained at predetermined intervals. Statistical analyses were performed via 17.0 SPSS program. Results: 25 patients were included in this study. Extubation failed in 44% of patients. Females were more successfull than male patients at extubation (p=0,049). Median Edi max values increased from 11 to 20 after extubation in all patients (p=0,0001). There was no difference in pre-extubation Edi levels between patients who failed and succeeded in extubation (p=0,622). Patients who failed extubation had significantly lower pH (7,29±0,12; p=0,003), higher CO2 (59,6±21,42; p=0,015) and lower SpO2 (95±5,69; p=0,024) after extubation.There was no significant change in vital signs (heart rate, respiration rate, blood pressure) and other blood gas parameters (HCO3, lactat); (p>0,05). Edi max levels increased by 150% (med. 12a17) after a successful extubation, whereas the levels increased by 250-300% (med.10a25) in patients who failed. On the other hand the difference was not significant (p=0,063). All patients who had at least 4 fold increment of Edi value after the extubation failed (p=0,016). Median NVE (Vt/Edi) index was higher in successful patients (med.9,2 (IQR:5,4-23,1)) compared to patients who failed the extubation (med.8,2 (IQR:4,2-18,4)) ; (p=0,807). In the subgroup of patients, who viii were supported with non-invasive ventilation after extubation, Edi max values had increased after extubation, although this did not reach statistical significance (p=0,063). Conclusion: Diaphragm electrical activity monitoring has not been found a reliable predictor of the extubation success in our small sample of patients with mixed diagnoses and comorbidities. Although patients who failed had higher Edi levels compared to successfully extubated patients, the difference was not significant statistically. Increased Edi by 4 fold predicted failure. Diaphragmatic electrical activity monitoring is not difficult, it can be easily performed after a short learning period. Further studies with larger sample size would be helpful. Keywords: Diaphragm electrical activity, extubation success, pediatrics

Evaluation of possible COVID-19 reinfection in children: A multicenter clinical study

Background: Although it was originally unknown whether there would be cases of reinfection of coronavirus disease 2019 (COVID-19) as seen with other coronaviruses, cases of reinfection were reported from various regions recently. However, there is little information about reinfection in children. Methods: In this study, we aimed to investigate the incidence and clinical findings of reinfection in pediatric patients who had recovered from COVID-19. We retrospectively evaluated all patients under 18 years of age with COVID-19 infection from a total of eight healthcare facilities in Turkey, between March 2020 and July 2021. Possible reinfection was defined as a record of confirmed COVID-19 infection based on positive reverse transcription-polymerase chain reaction (RT-PCR) test results at least 3 months apart. Results: A possible reinfection was detected in 11 out of 8840 children, which yielded an incidence of 0.12%. The median duration between two episodes of COVID-19 was 196 (92–483) days. When initial and second episodes were compared, the rates of symptomatic and asymptomatic disease were similar for both, as was the severity of the disease (p = 1.000). Also, there was no significant difference in duration of symptoms (p = 0.498) or in hospitalization rates (p = 1.000). Only one patient died 15 days after PCR positivity, which resulted in a 9.1% mortality rate for cases of reinfection in pediatric patients. Conclusion: We observed that children with COVID-19 were less likely to be exposed to reinfection when compared with adults. Although the clinical spectrum of reinfection was mostly similar to the first episode, we reported death of a healthy child during the reinfection

Antibiotic associated diarrhea in outpatient pediatric antibiotic therapy

Background: Antibiotic-associated diarrhea is one of the most frequent side effects of antimicrobial therapy. We assessed the epidemiological data of antibiotic-associated diarrhea in pediatric patients in our region. Methods: The prospective multi-center study included pediatric patients who were initiated an oral antibiotic course in outpatient clinics and followed in a well-established surveillance system. This follow-up system constituded inclusion of patient by the primary physician, supply of family follow-up charts to the family, passing the demographics and clinical information of patient to the Primary Investigator Centre, and a close telephone follow-up of patients for a period of eight weeks by the Primary Investigator Centre. Results: A result of 758 cases were recruited in the analysis which had a frequency of 10.4% antibiotic-associated diarrhea. Among the cases treated with amoxicillin-clavulanate 10.4%, and cephalosporins 14.4% presented with antibiotic-associated diarrhea. In the analysis of antibiotic-associated diarrhea occurrence according to different geographical regions of Turkey, antibiotic-associated diarrhea episodes differed significantly (p = 0.014), particularly higher in The Eastern Anatolia and Southeastern Anatolia. Though most commonly encountered with cephalosporin use, antibiotic-associated diarrhea is not a frequent side effect. Conclusion: This study on pediatric antibiotic-associated diarrhea displayed epidemiological data and the differences geographically in our region

SARS-CoV-2 seropositivity among pediatric health care personnel just after the first peak of pandemic: A nationwide surveillance.

BACKGROUND: COVID-19 pandemic affected every single person on earth one way or the other. The healthcare personnel were no exception, their responsibilities as well as their risks being immense. METHODS: 4927 healthcare personnel all working in pediatric units at 32 hospitals from seven different regions of Turkey enrolled to the study to determine the seroprevalence of SARS Co-V-2 after the first peak wave. Point of care serologic lateral flow rapid test kit for IgM/IgG was used (Ecotest CE Assure Tech. Co. Ltd.). Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed. RESULTS: Nearly 6.1% of healthcare personnel were found to be seropositive for SARS Co-V- 2. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19 co-worker increased the likelihood of infection. The least and the most experienced personnel affected more. Most of the seropositive healthcare personnel (68%) did not have any suspicion that they had COVID-19 previously. CONCLUSIONS: Health surveillance for healthcare personnel involving routine point-of-care nucleic acid testing as well as monitoring PPE adherence would be important strategies to protect healthcare personnel from COVID-19 and to reduce nosocomial SARS-CoV-2 transmission