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Objective: In this study, we aimed to evaluate the effects of decompressive craniectomy (DC) on the brain death (BD) determination process in the pediatric intensive care unit (PICU). Materials and Methods: All children who were diagnosed with BD in the PICU between 2009 and 2020 were included in this study. Patient demographics, causative mechanisms, BD examinations, and ancillary tests used were recorded. The time intervals (from PICU admission to first BD examination, from first BD examination to BD diagnosis) and number of BD examinations were compared between patients with and without DC. Results: During the study period, 70 pediatric cases were diagnosed with BD among 513 total deaths (13.6%). Their median age was 54.5 months [interquartile range (IQR): 24-140]. Transcranial Doppler ultrasound (TCD) was performed in 66 patients (94.3%). The most common combination of ancillary tests was the apnea test and TCD combination, which was performed in 56 patients (80%). Thirty-four children (48.6%) experienced immediate surgery for DC. Patients with DC had a higher median number of BD examinations than patients without DC [3 (IQR: 2-3) vs. 2 (IQR: 1-2), P < .001]. The patients with DC had a longer time interval between the first examination and declaration of BD than patients without DC [45.5 hours (IQR: 21.7-91.7) versus 15 hours (IQR: 2-31.2), P < .006]. Conclusion: Decompressive craniectomy may complicate BD determination and cause challenges for brain death diagnosis based on cerebral flow imaging techniques. The lack of specific recommendations for this patient group in the guidelines causes a delayed diagnosis of BD.

Lupin beans are the yellow legume seeds of the genus Lupinus. They are traditionally eaten as a pickled snack in many countries. Bitter lupin beans have a high amount of alkaloids called lupanine. Because the alkaloid is responsible for anticholinergic toxidrome, the beans should pass a debittering process before consumption. Only few pediatric cases of lupin bean intoxication were reported. We present a 12-year-old boy who visited the emergency department for the unexpected onset of anticholinergic toxidrome.

Aim: Unforeseeable disasters such as earthquakes can lead to significant catastrophes. Early and effective treatment methods are life-saving in reducing post-earthquake mortality and morbidity. The aim of this study was to evaluate the treatment and outcomes of patients with crush injuries in the Izmir earthquake. Materials and Methods: Eight patients, 2 male, and 6 female were admitted to the intensive care unit. The medical records of these 8 crush injury patients were retrospectively reviewed. Results: Eight children rescued from rubble were admitted to the pediatric intensive care unit, and one of them died. The median age of the patients was 148.5 (range, 35 to 210) months and the median PRISM score was 4 (interquartile range 0-31). The median duration of being trapped under the rubble was 23 (range: 4 to 92) hours. Conclusion: Crush syndrome is a life-threatening event. The authors believe that early transportation and immediate intensive care therapy would have improved survival rates.

Introduction:In a minority of children after cardiovascular surgery may require prolonged mechanical ventilatory support and tracheostomy. We aim to describe indications, timing and, outcomes of the tracheostomy.Methods:A retrospective review of 12 children requiring tracheostomy after cardiac surgery between January 2010-December 2019 was performed. The patients’ characteristics, indications and timing for tracheostomy, and survival were reviewed.Results:After cardiac surgery, 12 (0.5%) of 2.459 patients with a median age at surgery of 210 days (interquartile range: 75-262 days) underwent tracheostomy. The median time between cardiac surgery and tracheostomy was 25 days (interquartile range: 15-47 days). Diaphragmatic paralysis was the most common (42%) indication for tracheostomy. Genetic syndrome or at least one non-cardiac morbidity was present in 41.6% of patients. The duration of mechanical ventilation was shorter in patients who had tracheostomy within 30 days compared with >30 days following intubation (30 vs. 60 days, p=0.035). The median length of pediatric intensive care unit stays after the tracheostomy was 41 days (range, 21-289 days). Among all patients with congenital heart surgery undergoing tracheostomy, 6 (50%) of 12 were decannulated after a median time of 179 days (range, 34-463 days). The operative mortality was 8.3% (1/12) and the overall mortality during the first year of follow-up was 8.3% (1/12).Conclusion:An early tracheostomy procedure may facilitates the weaning process and shorten the duration of positive pressure ventilation.

The short-acting β2 sympathomimetic amine salbutamol is very frequently used in the treatment of bronchospasm in patients with asthma and bronchiolitis. Tremor, hyperactivity, tachycardia, convulsion, hypomagnesemia, lactic acidosis, hyperglycemia, hypokalemia, hypotension, congestive heart failure, arrhythmia, and sudden cardiac arrest may occur in high-dose salbutamol use. Salbutamol use for suicidal purposes is very rare. In this article, an overview of salbutamol intoxication from a child who used 300 mg of salbutamol for suicide purposes and the approach to salbutamol poisoning in the accompanied by literature information were discussed.

Aim:During the coronavirus disease-2019 (COVID-19) pandemic, pediatric emergency department visits and pediatric intensive care unit (PICU) admissions were significantly decreased. This study aimed to evaluate the impact of prevention strategies on PICU admissions during the COVID-19 outbreak.Materials and Methods:We included all patients admitted to a PICU from March 15th to September 15th, 2020, and those admitted in the same period in 2019. Incidence rates ratios (IRR) between the 2019 and 2020 cohorts (IRR-1) and restriction periods (March 2020-June 2020) and post-restriction periods (July 2020-September 2020) (IRR-2) were computed using Poisson modelling according to the data distribution. We analyzed the number of PICU admissions and the patient characteristics.Results:A total of 437 patients from 465 admissions were included. In 2020, the number of PICU admissions significantly decreased by 65% compared to 2019 [0.355 (0.287-0.440)]. During the restriction period, the number of PICU admissions was significantly lower by 40.3% compared to the post-restriction period [0.597 (0.493-0.722)]. Lower respiratory tract infections (LRTIs) significantly decreased by 19% in the post-restriction period compared to the restriction period [0.811 (0.684-0.960)]. Cardiopulmonary arrests before PICU admission were significantly higher during the restriction period compared to the post-restriction period (15.5% vs 4.8%, p