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Factors such as increased metabolic needs and inadequate calorie and protein intake increase the risk of malnutrition in critically ill children admitted to the pediatric intensive care unit. This study aimed to determine the risk of malnutrition and associated clinical outcomes.Data from all patients aged 1 month to 18 years in 4 pediatric intensive care units in Adana, Turkey, were prospectively collected. Patient anthropometric data, the duration of mechanical ventilation, the length of stay in pediatric intensive care unit, 60-day mortality, nutritional status, and calorie and protein intake were recorded.A total of 111 patients were included in the study. There was a significant difference between survivor and non-survivor patients in terms of calorie and protein intake 48 hours after admission and protein intake on the seventh day after admission (P = .001, P = .000, and P = .003, respectively). No significant correlation was found between the length of pediatric intensive care unit stay, sepsis, and calorie intake in the first week. It was found that 1 g/kg/ day increase in protein intake on the seventh day of intensive care hospitalization decreased the risk of mechanical ventilation by 0.49 times (P = .035; sensitivity: 83.3%; specificity: 34.5%).Nutritional status should be evaluated fully in patients admitted to the pediatric intensive care unit and early detected malnutrition should be monitored closely to determine the need for early intervention. The risk of developing malnutrition is high in critically ill children. Providing the necessary energy and protein intake with nutritional therapy affects the clinical course in children with critical illness. Protein intake causes prolongation of mechanical ventilation time, delaying clinical recovery.

Aim:This study aimed to determine the knowledge level of nurses, emergency medical technicians, and paramedics about the basic and advanced life support guidelines in children.Materials and Methods:The study was conducted between July 2018 and August 2018, with 602 volunteer healthcare professionals, in Gaziantep of Turkey province of Turkey where the pediatric population is high. Following the 2015 guidelines of the American Heart Association, a questionnaire about basic and advanced life support in children and demographic data was administered. Statistical comparisons were made between the groups.Results:Of the 602 participants, 62% were male. The average age of the participants was 28.4 (minimum-maximum, 18-50) years. The basic and advanced knowledge scores of the nurses were lower than those of the emergency medical technicians and paramedics. Those who work in pediatric emergency departments and pediatric intensive care units, with 5-8 years of experience, and paramedics had high advanced life support scores and total knowledge scores. The basic life support knowledge scores and total knowledge scores of those with certification were good, but the advanced life support knowledge score was inadequate.Conclusion:The basic and advanced life support knowledge scores of the professionals were moderate, and the total knowledge scores of the nurses working in pediatric services were low. While basic life support knowledge scores of the paramedics and professionals working in emergency departments and child intensive care units were low, their advanced life support knowledge scores were high.

Introduction:The causes of intoxication can vary from country to country, from region to region within the same country and even in the same region over the years. In this study, the patients with intoxication diagnosis were evaluated in terms of their demographic characteristics, intoxication reasons and also the factors causing intensive care hospitalization in our pediatric intensive care unit (PICU).Methods:The study included 115 patients with intoxication diagnosis between one month and 18 years of age, who were followed up in PICU between January 2017 and December 2019.Results:The median age of the patients was 154 (interquartile range, 37-196) months and 51 patients (44%) were male. The median age of female patients and the patients who were hospitalized due to suicide attempt were higher (p

OBJECTIVE: Acute respiratory distress syndrome (ARDS) is a clinical picture that indicates severe acute hypoxemic respiratory insufficiency. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are convenient, uncomplicated, and inexpensive parameters that can be used in detecting the severity of the disease. The prognostic role of NLR and PLR in patients with pediatric ARDS is unknown. The aim of this study was to investigate if there was any relationship between initial hematological parameters and the stages of ARDS, duration of mechanical ventilation and the length of intensive care stay in pediatric ARDS. MATERIAL AND METHODS: Of 34 patients diagnosed with ARDS, 5 excluded, a total of 29 patients who were followed in our pediatric intensive care unit between 2016 and 2018 were retrospectively enrolled. Patients were retrospectively registered in terms of demographical features, disease severity scores (PIM2, PRISM III, PELOD scores), lymphocyte, neutrophil and platelet counts and NLR, PLR values in complete blood count during intensive care unit stay and on the day of discharge, the stages of ARDS, duration of mechanical and the length of intensive care stay. RESULTS: There was a significant relationship between NLR values and ARDS stages on the first day of the admittance (P = .003). There was a moderate correlation between NLR and PELOD scores on the day of admittance and it was statistically significant (r = 0.45, P = .026). There was no correlation between mechanical ventilation time and the length of intensive care stay and NLR-PLR values. Platelet-to-lymphocyte ratio was not identified as a prognostic factor in our study. CONCLUSION: In diagnosis of the severity of ARDS with severe acute hypoxemic respiratory insufficiency, NLR is a convenient and inexpensive parameter that can only be calculated by complete blood count.

Background and aim Point-of-care ultrasound imaging of the inferior vena cava distensibility index is a potential indicator for determining fluid overload and dehydration in the mechanically ventilated patients. Data on inferior vena cava distensibility index and inferior vena cava distensibility variability are limited in mechanically ventilated pediatric patients. That is why our aim in this study was to measure inferior vena cava distensibility index and to obtain mean values in pediatric patients, ventilated in the operating room before the ambulatory surgical procedure started. Materials and methods This crosssectional study was performed between February 2019 and February 2020. Ultrasonographic measurements were performed in a total of 125 children. Results In a period of 13 months, the measurements were performed in a total of 125 children, of which 120 (62.5% male) met the criteria and were included in the study. Overall inferior vena cava distensibility index (%): mean ± SD: 6.8 ± 4.0, median (min–max): 5.7 (1.4–19.6), IQR: 3.8–8.7. Overall inferior vena cava distensibility variability (%): mean ± SD: 6.5 ± 3.7, median (min–max): 5.5 (1.4–17.8), IQR: 3.7–8.4. Conclusion Our study is the largest series of children in the literature in which inferior vena cava distensibility index measurements were investigated.

The assessment of the volume status in critically ill paediatric patients in intensive care units is vitally important for fluid therapy management. The most commonly used parameter for detecting volume status is still central venous pressure (CVP); however, in recent years, various kinds of methods and devices are being used for volume assessment in intensive care units.We aimed to evaluate the relationship between CVP, the global end-diastolic index (GEDI), and ultrasound measurements of the collapsibility and distensibility indices of the inferior vena cava (IVC) in paediatric patients undergoing Pulse index Contour Cardiac Output (PiCCO) monitoring.Fifteen patients receiving PiCCO monitoring were prospectively included in the study. Forty-nine PiCCO measurements were evaluated, and simultaneous CVP values were noted. After each measurement, IVC collapsibility (in spontaneously breathing patients) and distensibility (in mechanically ventilated patients) indices were measured with bedside ultrasound.The mean age was 93.2 ± 61.3 months. Significant and negative correlations of the GEDI were found with the IVC collapsibility index (in spontaneously breathing patients) and the IVC distensibility index (in mechanically ventilated patients) (r = -0.502, p 0.001; r = -0.522, p = 0.001, respectively). A significant and weakly positive correlation was found between the GEDI and CVP (r = 0.346, p = 0.015), and a significant and negative correlation was found between the IVC collapsibility index and CVP (r = -0.482, p = 0.03). The correlation between the IVC distensibility index and CVP was significant and negative (r = -0.412, p = 0.04).The use of PiCCO as an advanced haemodynamic monitoring method and the use of bedside ultrasound as a noninvasive method are useful to evaluate the volume status in critically ill paediatric patients in intensive care. These methods will gradually come to the fore in paediatric intensive care.

Rapid assessment of cerebral dysfunction is crucial for the management of patients in intensive care units. The Glasgow Coma Scale (GCS) evaluates eye, verbal, and motor responses, but is insufficient to effectively evaluate patients on mechanical ventilation, or who are unable to speak. The Full Outline of Unresponsiveness (FOUR) score includes additional information such as brainstem reflexes and respiratory status to provide a more complete clinical assessment. In this study, we aimed to compare the FOUR score with GCS in the assessment of patients with coma. This prospective study included patients between 1 month and under 18 years of age, who were hospitalized in the pediatric intensive care unit due to risk of coma or ongoing impairment of consciousness between May 2018 and June 2019. Information regarding FOUR scores, GCS values, patient demographics, duration of hospitalization, requirement for mechanical ventilation, and patient comorbidities were recorded and analyzed. Among the 80 patients included in the study, a statistically significant correlation was found between (low) GCS and FOUR scores during admission, and mortality and requirement for mechanical ventilation. Monitoring the level of consciousness is important in pediatric intensive care units and may be predictive of the course and disease outcome. Similar to the GCS, the FOUR score is a good indicator for predicting mortality and requirement for mechanical ventilation.

Introduction:Providing support for early enteral nutrition reduces the severity and complications of the disease, shortening the length of stay in the intensive care unit and affecting the patients positively. Although there is not enough evidence about when to start feeding in intensive care patients, it is recommended to start feeding within 24-48 hours with hemodynamically stable condition. Conditions such as surgery, sepsis and trauma increase the energy needs of patients. The aim of this study was to determine the first enteral nutrition time of patients with trauma followed up in the pediatric intensive care unit.Methods:The cases followed up between July 2018 and June 2019 in our pediatric intensive care unit due to trauma were examined. The demographic, clinic findings and first enteral nutrition hours of the patient were recorded retrospectively. Intensive care and hospitalization times, trauma mechanisms and affected organ systems were evaluated with intensive care and trauma scores.Results:A total of 49 patients with trauma were included in the study. The ages of the patients were minimum 6 months and maximum 17 years. Thirty eight (77.6%) of the patients were male. There were 31 patients (63.2%) fed within the first 24 hours of admission to intensive care unit and 14 (28.6%) patients fed within 24-48 hours, and the number of patients with an initial enteral nutrition time over 48 hours was 4 (8.2%). The reason for not being fed within the first 48 hours was the requirement of an abdominal surgery after trauma. The length of hospital stay of those who started feeding within the first 24 hours was shorter (p=0.009).Conclusion:It is of importance to provide nutritional support in critically ill children with trauma in the intensive care unit, as in other patient groups. If there is no contraindication in terms of nutrition, patients should be fed as early as possible, the enteral route should be preferred, and the sufficiency of the calories given should be frequently evaluated.

Airway secretions may increase in intubated patients due to the impaired mucociliary clearance, impaired cough reflex, abnormal glottic function, insufficient moisturizing, and respiratory tract infections. As with any intervention, patients should be cautiously monitored for possible complications during the endotracheal suctioning. Procedure-related changes in the cerebral and somatic tissue oxygenation, hemodynamics, and oxygen saturation can be observed in these patients. It is important to ensure maintenance of tissue oxygenation during these and other interventions performed in critically ill children. The aim of this study was to investigate the effects of the endotracheal suctioning on tissue oxygenation in patients undergoing mechanical ventilation in the pediatric intensive care unit. Cerebral and somatic near-infrared spectroscopy (NIRS) monitoring were performed noninvasively using standardized NIRS equipment as a means of monitoring regional tissue oxygenation. Vital signs, level of sedation, pain scores, and somatic and cerebral tissue oxygenation values of mechanically ventilated patients were recorded prospectively 5 minutes before, during, and after endotracheal suctioning. Cerebral NIRS measurements did not exhibit any statistically significant changes during endotracheal suctioning. Somatic NIRS levels changed significantly before, during, and after endotracheal suctioning and remained low throughout the procedure. Endotracheal suctioning is an invasive intervention that facilitates clearance of tracheal secretions and maintenance of the oxygenation and ventilation. The maintenance of the tissue oxygenation should be documented during these and other interventions performed on critically ill children. Somatic NIRS is a useful tool for monitoring tissue oxygenation during such procedures.

A 5.5-month-old girl, who had no known disease, was checked by her mother after sleep, and was found in her bed while she was unconscious and bleeding from her nose. History, physical examination, laboratory results, chest x-ray and clinical findings were thought to be compatible with postobstructive pulmonary edema. The patient was started with reservoir, non-breathing oxygen 15 L/min and empiric sulperazone. Her clinical findings improved within 24-48 hours and oxygen therapy was discontinued. On the 3rd day of treatment, she was transferred to the general child service for follow-up and continuation of the treatment. Postobstructive pulmonary edema in children is a rare but urgent and life-threatening condition. Early diagnosis and treatment is life-saving, maintaining the airway and ensuring oxygenation is the main goal., Özgeçmişinde bilinen bir hastalığı olmayan 5,5 aylık kız hasta uyku sonrası annesi tarafından kontrol edilirken yatağında yüzüstü baygın şekilde burnundan kan gelirken bulunmuş idi. Öykü, fizik muayene, laboratuvar sonuçları, akciğer grafisi ve klinik bulgularının negatif basınçlı pulmoner ödemle uyumlu düşünüldü. Hastaya rezervuarlı geri solumasız oksijen 15 L/dk ve ampirik sulperazon başlandı. Takibinde 24-48 saat içinde klinik bulguları düzeldi ve oksijen tedavisi kesildi. Tedavinin 3. Gününde takip ve tedavinin devamı için genel çocuk servisine devredildi. Çocuklarda negatif basınçlı pulmoner ödem nadir görülen fakat acil ve hayatı tehdit edebilen bir durumdur. Erken tanı ve tedavinin hayat kurtarıcı olup, hava yolunun korunup, oksijenasyonun sağlanması temel hedeftir.

Background The number of studies evaluating delirium and its frequency in critically ill infants, children, and adolescents is increasing day by day. The primary objective of this study was to evaluate all patients hospitalized in our pediatric intensive care unit (PICU) in terms of pediatric delirium, to determine the frequency and risk factors of pediatric delirium. Patients and methods The patients included in this study had been hospitalized in the PICU between November 1, 2018, and August 31, 2019, and were followed up for more than 48 hours. Results Delirium was detected in 14 patients (9.9%) through regular evaluations. The Pediatric Index of Mortality 2 (PIM2) scores and the length of stay in the PICU were higher in patients with delirium (p = 0.03 and p = 0.01, respectively). The use of respiratory support, sedation-analgesia, vasoactive and corticosteroid treatments, and physical restraints were higher in patients with delirium and were statistically significant (p

Introduction:The aim of this study was to determine the frequency of patients with critical illness polyneuropathy/myopathy followed by mechanical ventilator in the intensive care unit, and to determine the risk factors associated with this condition and discuss them with the literature.Methods:This study was performed retrospectively (August 2012 to August 2017), at a tertiary university hospital in Turkey. A total of 31 patients who were on mechanical ventilation and diagnosed with polyneuropathy/myopathy by electroneuromyography (ENMG) during pediatric intensive care unit follow-up were included in the study. Data were collected from patient files and computer system. Demographic characteristics of the patients, causes of hospitalization, underlying disease, length of the pediatric intensive care unit and hospital stay, length of mechanical ventilation, and treatment modalities were recorded. Patients without respiratory support and patients on mechanical ventilation without ENMG procedures were excluded.Results:A total of 31 patients were included in the study. Myopathy was present in 5/31 (16.1%) and polyneuropathy in 26/31 (83.9%) patients. Respiratory distress/failure was the most common cause of respiratory support (n=10, 32.3%) and the second most common cause was post cardiac surgery (n=9, 29%). The diagnosis of 18 (58%) patients were sepsis and 2 (6.4%) patients had multiple organ failure. The mean duration of mechanical ventilation was 27.4±14.1 days, length of pediatric intensive care unit stay was 41.5±24 days, length of hospital stay was 57.5±27.5 days. Mortality was observed in 5 (16.1%) of 31 patients.Conclusion:Critical illness polyneuropathy and myopathy in intensive care practice is a condition with increasing frequency and importance. Increased attention to this matter allows to take the necessary preventions, early recognition and to make the appropriate approach.

Background/aim Intraabdominal hypertension is a common clinical condition with high mortality and morbidity in pediatric intensive care units. The aim of this study was to test the feasibility of regional tissue oxygenation (rSO2) measurement using near-infrared spectroscopy and to assess the correlation between rSO2 and perfusion markers of intraabdominal hypertension in high-risk pediatric patients. Materials and method In this prospective observational cohort study in a tertiary pediatric intensive care unit in Cukurova University Faculty of Medicine, a total of 31 patients who were admitted between May 2017 and May 2018 with a risk of intraabdominal hypertension were included. Mesenteric and renal rSO2 measurements were taken and correlations with other tissue perfusion markers including mean arterial pressure, pH, lactate, intraabdominal pressure, abdominal perfusion pressure, mixed venous oxygen saturation, vasoactive inotropic score were assessed. Intraabdominal pressure was measured as ≥10 mmHg in 15 patients (48.3%) and these patients were defined as the group with intraabdominal hypertension. Results In the group with intraabdominal hypertension, mixed venous oxygen saturation was lower (P = 0.024), vasoactive inotropic score was higher (P = 0.024) and the mean abdominal perfusion pressure value was lower (P = 0.014). In the ROC analysis, the mesenteric rSO2 measurement was the best parameter to predict intraabdominal hypertension with area under the curve of 0.812 (P = 0.003) 95% CI [0.652–0.973]. Conclusion Monitoring of mesenteric rSO2 is feasible in patients at risk for intraabdominal hypertension. Moreover, both mesenteric regional oxygen and perfusion markers may be used to identify pediatric patients at risk for intraabdominal hypertension.

Introduction:Central venous catheters are frequently used for intravenous applications and hemodynamic monitoring in pediatric intensive care units. In addition to the benefits of the catheters, they can lead to many complications such as catheter-related bloodstream infection (CRBI). One of the most important steps in the prevention of CRBI is nursing care. Here, we compared CRBI rates between standard dressing and chlorhexidine gluconate-impregnated dressing in our pediatric intensive care unit.Methods:A total of 144 patients, who underwent central venous catheter and hemodialysis catheter placement, were included in the study. The patients were divided into two groups as standard dressing and chlorhexidine gluconate-impregnated dressing. The diagnosis of CRBI and colonization was made using the diagnostic criteria of the Center for Disease Control and Prevention.Results:The total number of central catheter days was 3749 in our pediatric intensive care unit during the study period. The CRBI rate was 4.53/1000 central venous catheter days. In the whole group, the CRBI rate was 10.4% and colonization rate was 11.8%. CRBI was detected in 13 patients (12.3%) with standard dressing and 2 patients (5.1%) in the chlorhexidine gluconate-impregnated dressing group. There was no statistically significant difference in CRBI risk and catheter colonization between the groups (p=0.356 and p=0.616, respectively).Conclusion:The rate of CRBI and colonization in the chlorhexidine gluconate impregnated dressing group was found to be lower than in the standard dressing group although not statistically significant. We believe that studies with larger patient groups will contribute to the literature.

We aimed to investigate the rate of brain death (BD) determinations and organ donations (OD) in our tertiary pediatric intensive care unit (PICU), and to report the data on the demographic pattern and supplementary descriptive data on BD declarations.The study was designed as a retrospective, single-center, descriptive cohort study. We evaluated all children who were determined to meet the criteria for BD in our tertiary PICU between January 2011 and December 2020.During study period, BD was identified in 24 patients among 225 total deaths (10.7%). Their median age was 85 months (8-214) and the male-to-female ratio was 1 : 1. The most common diagnosis was meningoencephalitis in 25%, followed by traumatic intracranial hemorrhage (16.7%). The median time from admission to PICU until BD diagnosis was 6.5 days. The time from the first BD physical examination to the declaration of BD was 27.5 hours. There was no statistically important difference between donors and non-donors. The apnea test (AT) was the most performed ancillary method (100%), followed by electroencephalogram (EEG) (66.7%), and magnetic resonance angiography or computed tomography angiography (MRA/ CTA) (54.2%). Hyperglycemia developed in 79.2% of the cases, and 70.8% developed diabetes insipidus (DI). Five patients (20.8%) were organ donors in study group. In the study, 13 solid organ and 4 tissue transplantations were performed after OD.Awareness of the incidence and etiology may contribute to the timely diagnosis and declaration of brain death, and with the help of good donor care, may help in increasing OD rates in the pediatric population.

Candida urinary tract infections (UTIs) are common nosocomial infections among critically ill patients hospitalized in pediatric intensive care Units (PICU). We aimed to report outcomes of critically ill pediatric patients who received micafungin for hospital acquired Candida UTIs. We analyzed treatment success rates and success rates among different Candida species.This retrospective cohort study included patients who received micafungin for Candida UTI as first choice in our PICU between January 2017 and July 2018. Data, including demographic and clinical features, were retrospectively collected from medical files of the patients. Treatment efficacy was defined as resolution of clinical symptoms and a negative culture for Candida at day 14 after initiation of micafungin treatment.Twenty-four pediatric patients (median age 5.72 years, range, 2 months-16 years) were included in the present study. Fourteen (58.3%) patients had urinary catheters at the time of Candida isolation. Resolution of symptoms and a negative culture at day 3 of micafungin treatment were achieved in 17 (70.8%) and 14 (58.3%) patients, respectively. Moreover, 19 (79.2%) patients had a normal urine analysis and negative culture 14 days after initiation of micafungin treatment. Treatment responses did not statistically differ between Candida species.Micafungin is safe and efficacious in critically ill pediatric patients with Candida UTIs. Its efficacy in our pediatric population was as comparable to that observed in adult studies, therefore, it should be considered as an effective therapeutic option in Candida UTIs of critically ill pediatric patients.

Rhabdomyolysis (RML) is a clinical condition that results in the release of the cellular content into the circulation due to musculoskeletal damage caused by various causes. For this reason, emergency departments should recognize RML and start treatment without any delay. In this study, we present a case of secondary RML in a 14-year-old patient followed up with the diagnosis of subacute sclerosing panencephalitis. Respiratory and circulatory support was provided in the emergency unit and alkalization was started. All medications used by the patient were cut off. Hemodiafiltration treatment was performed in our intensive care unit. It was learned that the patient have used the senna plant regularly for five years because of constipation. It has been reported in the literature that the senna plant has toxic effects on the brain, liver, kidney, heart and muscle, and also may cause renal tubular necrosis, centrilobular hepatic necrosis and muscle fiber necrosis. In this case report, we aimed to emphasize that the senna plant sold by herbalists and used frequently by people may cause secondary RML which may be a life-threatening condition.

Purpose: Snake venom has serious cardiotoxic, neurotoxic, nephrotoxic effects. The neutrophil-to-lymphocyte ratio (NLR) is a new biomarker of inflammation and can be used as an indicator and prognositic marker of inflammation. In this study we aimed to analyze the association with clinical outcomes of pediatric patients with snakebite envenomation, and NLR. Materials and Methods: A total of 61 pediatric patients with snakebite who admitted to a tertiary university hospital and a children’s hospital between July 2012 and July 2017 were included in the study. Demographic features, clinical findings and complications of snakebite, length of stay in hospital, NLR at admission (NLR1), and NLR at the twelfth hour (NLR2) and NLR at the discharge (NLR3) and mean platelet volume (MPV) were retrospectively reviewed and recorded. Results: There was a positive correlation between NLR1 and the length of hospital stay. We found that as the level of NLR1 increased, the length of hospitalization was prolonged. NLR1 level increased as the disease stage progressed, but it was not statistically significant. Our study showed that when the severity of the illness increased, the length of hospital stay was significantly prolonged. Conclusion: The study revealed a positive correlation with NLR and severity of the illness. We claim that NLR at admission can be a useful marker for predicting severe clinical course and prolonged hospital length of stay for pediatric patients with snake envenomation.

The aim of this study was to evaluate the Candida species, predisposing factors, antifungal treatment approaches, and clinical outcomes of invasive Candida infections (ICIs) in a tertiary pediatric intensive care unit (PICU). A retrospective study was performed from January 2008 to January 2019 including 102 children with ICIs who were admitted to a university hospital in southeastern Turkey. Positive blood cultures were detected in 43 (42.1%) patients, and positive urine cultures were detected in 59 (57.8%). According to our results, Candida albicans (42.2%) was the most common species for all isolates followed by C. parapsilosis (17.6%). In our patient population, non-albicans Candida species were dominant (57.8%) in all isolates. The most common facilitating factor in our study was the use of mechanical ventilator support (87.3%). The mortality rate of our patients with ICIs was 13.7%. Candida albicans was found to have the highest mortality rate among all Candida species (30.7%). When we compared patients with C. albicans and those with non-albicans Candida species in terms of risk factors, we detected a significant difference between the two groups for total parenteral nutrition use (p = 0.027). Fluconazole was the most preferred (58.8%) treatment option in our PICU for ICIs. Our results showed an increased trend in micafungin use in recent years. ICIs are a significant problem due to the high mortality and morbidity rates in critically ill pediatric patients in PICUs. In recent years, an increase in Candida infections caused by non-albicans Candida species has been reported. Multicenter prospective studies are needed to determine the risk factors for ICIs.

PubMedID: 30638664 Purpose: To the best of our knowledge, in the literature, there is no data regarding clinical utility of the abdominal perfusion pressure (APP) in critically ill children. Thus, in the present study, we aimed to investigate the clinical utility of APP in predicting of survival in critically ill children with IAH. Design: A prospective cohort study of patients between 1 month to 18 years who had risk for intra-abdominal hypertension from June 2013 to January 2014. Setting: Pediatric intensive care unit (PICU) at a tertiary university hospital. Patients: Thirty-five (16 female) PICU patients who had risk for the development of IAH were included. Serial intraabdominal pressure (IAP) and mean arterial pressure (MAP) measurements were performed. Abdominal perfusion pressure was calculated using the formula (MAP-IAP). Measurements and Main Results: Overall mortality rate was 49% (n = 17). The mortality rate in patients with IAP mean ? 10 mmHg (n = 27, 77%) was 55% (n = 15), while 53% (n = 16) in patients with IAP max ? 10 mmHg (n = 30, 86%) and 47% (n = 7) in patients with IAP min ? 10 mmHg (n = 15, 43%). Overall mean APP was 58 ± 20 mmHg. Logistic regression analysis revealed that decrease in minAPP was associated with increased risk for mortality (Odds ratio for each 1 mmHg decrease in APP was 1.052 [CI 95%, 1.006–1.100], p < 0.05). ROC curve analysis revealed that, in predicting mortality, area under curve for minAPP was 0.765. The optimal cut-off point for APP was obtained as 53 mmHg with the 77.8% sensitivity and 70.6% specificity using the IU method. Conclusions: Our findings showed that APP seems to be a useful tool in predicting mortality. Interventions to improve APP may be associated with better outcomes in critically ill PICU patients. Level of evidence: Level II. Type of study: Diagnostic. © 2018 Elsevier Inc.

Transfusion-associated acute lung injury (TRALI) is one of the complications seen due to transfusion. Hypoxemia and bilateral pulmonary infiltration in posteroanterior chest roentgenogram is seen in all cases during transfusion or within the first 6 hours; fever, hypotension, and pink frothy bleeding from endotracheal tube may also be seen. It can be seen following the administration of any blood product. The management strategies for TRALI include withholding the transfusion, positive pressure breathing support, and diuretics. There are few reported cases of TRALI occurring following donor granulocyte transfusion (DGT). In this article, we discuss two cases of TRALI following DGT transfusion.

BACKGROUND Measurement of the optic nerve sheath diameter (ONSD) with point-of-care ultrasound (POCUS) is a non-invasive and radiation-free technique that can be used to assess increased intracranial pressure (ICP). Ophthalmic artery and central retinal artery Doppler indices can be used like transcranial Doppler to evaluate increased ICP. This study aims to examine the diagnostic value of ONSD measurements and central retinal artery Doppler indices in the evaluation of pediatric patients with increased ICP. METHODS This was a prospective, case-controlled single center study. The study group was comprised of a total of 38 pediatric patients with increased ICP and the control group included 19 healthy children. Ophthalmic ultrasound was performed and ONSD and central retinal artery Doppler indices were measured. RESULTS The mean age of the study group was 80.84 ± 65.12 months. The mean ONSD was 5.9 ± 0.8 (3.6-8.1) mm in the study group and the mean resistive index (RI) was 0.71 ± 0.08 (min:0,55-max:1) and was significantly greater than the control group (p < 0.001 and p < 0.001, respectively). In terms of predicting increased ICP, the ONSD measurement was the strongest parameter, with its area under the curve: 0.767 (95 percent confidence interval: 0.68-0.85). In the study group, the cut-off value for ONSD was 5.8 mm (66 percent sensitivity, 100 percent specificity) and the cut-off value for RI was 0.68 (63 percent sensitivity, 83 percent specificity). CONCLUSIONS Point-of-care ultrasound is a noninvasive and important tool in pediatric intensive care units. Our study is significant as one of the few pediatric studies where central retinal artery Doppler indices are evaluated in addition to OSND, in patients with increased ICP.

Background The increased intracranial pressure (ICP) syndrome may emerge depending on many different neurological factors and the early diagnosis and treatment are important for the prevention of neurologic damage and related mortality. In recent years, the follow-up of increased ICP with non-invasive methods has been rising. In this study, our objective was to determine the significance and any possible correlation between Optic Nerve Sheath Diameter (ONSD) and Near Infrared Spectroscopy (NIRS) in children with increased ICP. Methods Patients who were hospitalized in our pediatric ICU at Çukurova University Medical Faculty between June 2018 and June 2019 due to the suspicion of increased ICP were included in this study. The demographic characteristics of patients, diagnosis at admission, results of the cranial CT and MRI examinations, and results of the simultaneous ONSD and NIRS measurements were recorded. Results A total of 36 patients were included in our study. With respect to the diagnosis, non-traumatic causes were at the forefront in 30 patients (83.3%), and the most common causes were meningoencephalitis (n = 9; 25%) and non-traumatic bleeding (n = 7; 19.4%). Six of the patients were under the age of one year (16.7%), and the mean values of ONSD and NIRS were 4.8 ± 0.7 mm and 71.1 ± 12.4% respectively in this group. Fourteen patients were in the one to ten year age group and the mean values of ONSD and NIRS were 6.1 ± 0.6 mm and 72.7 ± 9.3% respectively. Sixteen patients were over ten years of age (44.4%), and the mean values of ONSD and NIRS were 5.6 ± 0.7 mm and 74.2 ± 16% respectively. There was no correlation between the ONSD and NIRS values (r:0.307; p = 0.068). Conclusion Our study showed that ONSD measurements were helpful in children with increased ICP and reflected the increase in ICP. However, our study also demonstrated that ONSD was not in correlation with the NIRS monitoring. We believe that there is a need for further studies focused on the use of ONSD and NIRS in the monitoring of increased ICP.

Background Point-of-care ultrasound is commonly used in pediatric intensive care units in recent years. The aim of this study was to find an answer to the question `where are we now in Turkish pediatric intensive care units for point-of-care ultrasound use?`. Methods This was a multicenter, descriptive study in which we developed an online survey. We asked 45 questions about point-of-care ultrasound using fields and training status of clinicians in pediatric intensive care units. Results A total of 29 units responded to the questions completely. Of all included units 41.4% were in public hospitals, 6.9% in city hospitals (public-private partnership) and 51.7% in university hospitals. The most common use of point-of-care ultrasound was central venous catheter insertion. Lung ultrasound use rates for detection of pleural effusion, evaluation of pneumothorax, and diagnosis of pneumonia were 93.1%, 86.2%, and 34.5%, respectively. Critical care echocardiography use rate was 79.3%. In 89.7% of the units, intensive care specialists had been specifically trained for the use of point-of-care ultrasound. Conclusions Our study showed that point-of-care ultrasound was not only used for central venous catheterization but also for widespread fields in pediatric intensive care units. With an experienced team, it is possible to perform rapid, noninvasive and repeatable ultrasonographic assessment of patients. In our view point-of-care ultrasound is the new stethoscope of critical care physicians.

Background Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging global public health threat. As a reserve agent, colistin has been the drug of choice for the treatment of infections caused by CRE. The aim of this study was to determine the risk factors of carbapenem and colistin-resistant Enterobacteriaceae infections and to investigate the outcomes. Methods We conducted a retrospective study in a single university hospital between the years 2013 and 2017 including 150 patients with Enterobacteriaceae infections. Results Of 150 Enterobacteriaceae infections, 62 (41%) were carbapenem and 23 (15%) were colistin-resistant. Colistin resistance rates among Enterobacteriaceae species increased from 4% in 2014 to 25% in 2017. The inhospital mortality of the patients with colistin-resistant and with carbapenem-resistant infections were 39% (9/23) and 45% (28/62), respectively. Prior exposure to polyantibiotic therapy for Gram negative bacteria was found as a predictor of CRE (OR = 6.4; 95% CI 3.07-13.6; p = 0.001) infections. The median length of hospital stay prior to positive culture (OR = 1.02; 95%CI, 1.0-1.04; p = 0.003) and history of surgery during the admission (OR = 2.46; 95% CI 1.2-5.1; p = 0.005) were found as the predictors of CRE infections. Underlying necrotizing enterocolitis and/or short-bowel syndrome (OR=6.38; 95%CI 1.16-35; p = 0.033) and mechanical ventilation prior to index culture were found as predictors of colistin resistance (OR = 9.4; 95% CI 2-40.4; p = 0.004). Conclusions Recognizing the risk factors of carbapenem and colistin resistant Enterobacteriaceae infections is essential in order to conserve carbapenem and colistin since there are no new antibiotics to treat multidrugresistant Enterobacteriaceae infections.