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Amaç: Pediyatrik Yoğun Bakım Ünitesinde yatan bedensel hastalığı olan çocuklarda davranışsal-duygusal psikopatolojiler sıklıkla gelişmektedir. Fiziksel hastalığa eşlik eden bu ruhsal durumlar tedaviyi uyumu bozarak olumsuz sonuçlara yol açabilmektedir. Bu çalışmada çocuk yoğun bakım ünitemizde kritik hastalık nedeniyle izlenen hastalar için son 3 yıl içinde istenen çocuk psikiyatri konsultasyonlarının değerlendirilmesi amaçlanmıştır Gereç ve Yöntem: Çalışmamızda 2019-2022 yılları arasında Dr. Behçet Uz Çocuk Hastanesi Çocuk Yoğun Bakım ünitesinde izlenen çocuk psikiyatrisi konsültasyonu istenen hastaların verileri geriye dönük olarak taranmıştır. Hastaların demografik özellikleri, bedensel hastalık tanıları, konsültasyonların istenme nedenleri, konsültasyon sonucunda saptanan psikiyatrik tanılar ve bunun sonucunda tedavi uygulanıp uygulanmadığı, verilen bir tedavi olması durumunda hangi medikal tedavilerin tercih edildiği, psikiyatrik tedavi ve izlem sürecine ilişkin veriler kaydedilmiştir Bulgular: Üç yıllık sürede çocuk yoğun bakımda izlenen çocukların 118’i (%4,9) için psikiyatri konsültasyonu istenmiştir. Konsültasyon istenenlerin çoğu kızdır (%61,9) ve 12 yaş veya üzeri yaşta % 71,4 hasta bulunmaktadır. En sık konsültasyon isteme nedeni özkıyım girişimleri (%33,1) ve depresif görünüm (%25,5) olarak saptanmış olup en sık konulan tanı majör depresif bozukluk ve uyum bozukluğudur. Olguların %31’inde psikotrop ilaç başlanmış olup erkekler ve kızlar arasında anlamlı fark saptanmamıştır. Sonuç: Bu çalışma bedensel hastalığı olan kritik çocuk yoğun bakım hastalarında ruhsal hastalıkların sık görülmesine rağmen psikiyatri konsültasyonu istenme oranlarının düşük olduğunu saptamıştır. Bu durum yoğun bakım hekimlerinin belirtileri anlama ve değerlendirme konusunda hastaların bilinç durumları ve primer hastalıkları nedeniyle güçlükler yaşadığına işaret etmektedir. Bu nedenle çocuk psikiyatrisi ile birlikte multidisipliner bir yaklaşım izlemeleri ve işbirliği içinde olmaları hastanın tedaviye uyumunu arttırarak yatış sürelerini kısaltacaktır.

Background: Malnutrition, which occurs at the time of hospitalization or develops during follow-up, has a negative effect on patients in pediatric intensive care unit (PICU). In our study, we aimed to determine the malnutrition status at the time of hospitalization, the relationship of malnutrition status at hospitalization with mortality scores, as well as the changes in malnutrition status during hospitalization in PICU.Materials and Methods: Patients aged between 1 month and 18 years, who were hospitalized and followed up in PICU of our hospital for at least 7 days between January and June 2016, were included in our study. Pediatric Nutritional Risk Score (PNRS) scores were compared with Gomez and Waterlow scores when patients were discharged from the PICU. Results: Our study has included total 102 patients, weight loss was detected in 33 (32.3%) of the patients compared to hospitalization, while weight gain was detected in 44 (43.1%) patients. We detected newly developed malnutrition both at the time of admission and during the PICU follow-up. Patients with malnutrition at the time of discharge had a high PNRS score at admission. Conclusions: In conclusion, the malnutrition status and risk situations of patients should be determined and patient-specific nutritional strategies applied from the beginning of treatment in PICU., Amaç: Hastanede yatış sırasında ortaya çıkan veya izlem sırasında gelişen malnütrisyon, çocuk yoğun bakım ünitesindeki (ÇYBÜ) hastaları olumsuz etkilemektedir. Çalışmamızda, ÇYBÜ'nde yatış anındaki malnütrisyon durumunu, yatıştaki malnütrisyon durumunun mortalite skorları ile ilişkisini ve ÇYBÜ'nde yatışı sırasında malnütrisyon durumundaki değişiklikleri belirlemeyi amaçladık.Materyal ve Metod: Çalışmamıza Ocak-Haziran 2016 tarihleri arasında hastanemiz ÇYBÜ'nde yatarak en az 7 gün takip edilen 1 ay-18 yaş arası hastalar dahil edildi. Pediatrik Nutrisyonel Risk Skoru (PNRS), ÇYBÜ'nden taburcu olduklarında hesaplanan Gomez ve Waterlow skorları ile karşılaştırıldı.Bulgular: Çalışmamıza toplam 102 hasta dahil edilmiş olup, hastaların 33'ünde (%32.3) hastaneye yatışa göre kilo kaybı, 44'ünde (%43.1) kilo artışı saptanmıştır. Hem başvuru anında hem de ÇYBÜ takibinde yeni gelişen malnütrisyon saptandı. Taburculuk sırasında malnütrisyonlu olan hastaların başvuru sırasında yüksek PNRS skoru vardı.Sonuç: Çocuk yoğun bakım ünitesinde tedavinin başlangıcından itibaren hastaların malnütrisyon durumu ile risk durumları belirlenmeli ve hastaya özel beslenme stratejileri uygulanmalıdır.

Amaç: Mekanik ventilatörden ayrılması planlanan ve kendi solunumlarını tetikleyebilen aktif hastalarda özefageal basınç (Pes ), transpulmoner basınç (PL) ve zaman-basınç-ürününü (PTP) inceleyerek hastaların senkron veya asenkron oluşunun bu değerlere etkisini ortaya koymak. Gereç ve Yöntemler: Çalışmamıza mekanik ventilatörde izlenen ve kendi solunumunu tetikleyebilen, yakın zamanda mekanik ventilatörden ayrılması planlanan hastalar alınarak özefageal kateter yerleştirilmiş, ardından kateter dolum hacmi önce optimize ardından valide edilerek önce Pes ardından havayolu basıncından Pes’ın çıkarılmasıyla PL kayıt edilmeye başlanmıştır. Ventilatör üzerindeki kayıt cihazlarıyla hastaların mekanik ventilasyon parametreleri hem monitörizasyon değerleri hem de dalga formları olmak üzere kayıt altına alınmıştır. Daha sonra hasta başında klinisyen tarafından mekanik ventilasyon ayarları özefageal dalga formu referans alınarak yeniden düzenlenmiştir. Ardından bu hastaların dalga formları Matlab E2019a (Mathwoks, USA) yazılımı üzerinde incelenerek her soluk senkron-asenkron olarak işaretlenmiş ve asenkroni indeksi (AI) çıkarılmıştır. Buna göre hastanın asenkron ve senkron dönemleri tanımlanmış, aynı hastanın senkron ve asenkron dönemleri arasında ∆Pes, ∆PL, PTP-Pes, PTP-PL, PTP-Pes-dakika, PTP-PL-dakika değerleri yine Matlab yazılımı üzerinde hesaplanarak, senkron ve asenkron dönemler arasında bu değerlerin değişimleri SPSS istatistik programı ile incelenmiştir. Değişkenlerin dağılımının görsel ve analitik yöntemlerle (Shapiro-Wilk) incelenmesinin ardından istatiksel olarak gruplar arası farka bakılmıştır. Bulgular: Tüm hastaların senkron ve asenkron dönemleri kıyaslandığında senkron ve asenkron gruplar arasında, senkron grup lehine şu farklar bulunmuştur. ∆Peso [5,98 (3,55-9,08)] cmH2O, ∆PL [5 (2,7-7,25]cmH2O, ∆PTP-Peso [3,70 (2,81-4,6)]cmH2O*s, ∆PTP-PL [3,36 (1,39-4,18)]cmH2O*s, ∆PTP-Peso/dk [1,72 (1,02-2,67)]cmH2O*min , ∆PTP-PL/dk [1,25 (0,30-3,01)]cmH2O*min. Sonuç: Mekanik ventilatörden ayrılması planlanan ve kendi solunumunu tetikleyebilen aktif hastaların senkronizasyonunun hastaların ∆Peso, ∆Ptranspulmoner,PTP-Peso,PTP-Ptranspulmoner,PTP-Peso-dakika, PTP-Ptranspulmoner-dakika değerlerinde düşüşe yol açtığı yapılan istatistiki analizlerle de gösterilmiştir. Senkronizasyona dair bu bilgi litratürle korele edildiğinde, hastalarda Pes monitörizasyonu ve hastaların senkronizasyonu sözkonusu hastalarda oluşabilecek olan mekanik ventilasyon ilişkili akciğer hasarını önlemede ve dolayısıyla asenkroniye bağlı hastanede kalış süresi, ventilatörden ayırma başarısızlığı ve bunların sonucunda gelişebilecek olan mortalite ve morbiditeyi azaltmada faydalı olabilecek bir yöntemdir., Aim: To reveal the effect of synchronous or asynchronous patients on these values by examining the esophageal pressure (Pes ), transpulmonary pressure (PL), and time-pressure-product (PTP) in active patients who are planned to be weaned from the mechanical ventilator and can trigger their own respiration.Material and Methods: Patients who are monitored on a mechanical ventilator and who can trigger their own respiration, and who are planned to be separated from the mechanical ventilator in the near future, were taken and an esophageal catheter was inserted, then the catheter filling volume was first optimized and then validated, and PL was started to be recorded by removing Pes from the airway pressure. With the recording devices on the ventilator, the mechanical ventilation parameters of the patients were recorded as both monitoring values and waveforms. Then, the mechanical ventilation settings were rearranged by the clinician at the bedside with reference to the esophageal waveform. Then, the waveforms of these patients have examined on the Matlab E2019a (Mathworks, USA) software, and each breath was marked as synchronous-asynchronous and the asynchrony index (AI) was calculated. Accordingly, the asynchronous and synchronous periods of the patient were defined, and the values of ∆Pes, ∆PL, PTP-Pes, PTP-PL, PTP-Pes-minutes, PTP-PL-minutes between the synchronous and asynchronous periods of the same patient were calculated on Matlab software, and synchronous and The changes in these values between asynchronous periods were analyzed with the SPSS statistical program. After examining the distribution of the variables by visual and analytical methods (Shapiro-Wilk), the statistical difference between the groups was examined.Results: When the synchronous and asynchronous periods of all patients were compared, the following differences were found between the synchronous and asynchronous groups in favor of the synchronous group. ∆Peso [5.98 (3.55-9.08)] cmH2O, ∆PL [5 (2.7-7.25]cmH2O, ∆PTP-Peso [3.70 (2.81-4.6)) ]cmH2O*s, ∆PTP-PL [3.36 (1.39-4.18)]cmH2O*s, ∆PTP-Peso/min [1.72 (1.02-2.67)]cmH2O*min , ∆PTP-PL/min [1.25 (0.30-3.01)]cmH2O*min.Conclusion: It has also been shown by statistical analyzes that the synchronization of active patients who are planned to be weaned from mechanical ventilator and who can trigger their own respiration causes a decrease in the values of ∆Peso, ∆Ptranspulmonary, PTP-Peso,PTP-Ptranspulmonary, PTP-Peso-minute, PTP-Ptranspulmonary-minute. When this information about synchronization is correlated with the literature, Pes monitoring in patients and synchronization of patients prevent mechanical ventilation-related lung damage that may occur in these patients, and thus the duration of hospital stay due to asynchrony, failure to wean from the ventilator, and the consequences that may occur. It is a method that can be useful in reducing mortality and morbidity.

The aim of this study was to determine the association between the use of intravenous N-acetylcysteine (NAC) and hepatic healing in pediatric intensive care unit (PICU) patients with non-acetaminophen-induced hepatic injury, except for acute liver failure.The data of patients who received intravenous NAC as adjuvant therapy for transaminase levels more than sixfold normal values during their PICU stay between 2010 and 2014 were retrospectively collected from the medical records database. The patients who did not receive NAC with elevated transaminase levels during their PICU stay between 2014 and 2018 were also collected as the standard of care (SOC) cohort.More than 50% of the liver injuries were secondary to acute hypoxia, hypotension, sepsis, and inflammation. The median number of elevated transaminase period (ETP) days of the NAC and SOC groups were 5 (IQR: 4) and 4 (IQR: 4), respectively (p = 0.17). There was no significant difference between the groups in terms of minimum and maximum laboratory values during ETP. There was no significant difference in terms of ETP and maximum ALT levels between the NAC and SOC groups in the hypoxia-hypotension subgroup.This study did not show an association between indirect measures of hepatic healing and post-insult use of NAC in pediatric liver injury in the PICU setting.

Introduction: In this study, we aimed to discuss the transfusion-associated costs in view of transfusion practice in the pediatric intensive care unit (PICU) by considering previously well-defined indications of blood transfusions and the evidence-based evaluation for transfusion decision-making in pediatric patients. Materials and Methods: During a year period (January 2017-December 2017) 76 patients, receiving transfusion with blood components along the stay in PICU were included in the study. Transfusion associated costs and total costs for healthcare services for children treated in PICU was collected by using Hospital Information System. Transfusion-associated costs depending on the supplies (such as sets for blood transfusion and apheresis), immunohematological tests and blood transfusion procedures were considered individually and the cost of transfusion was estimated for each patient which was proportioned to the total cost of healthcare services consequently. Results: The proportion of transfusion-associated cost to total cost of healthcare services was found as 3,24%. The medians for hospital cost and transfusion associated cost were 5478.76 euros (IQR=11280.02) and 130.57 euros (IQR=354.86), respectively. A significant strong positive corelation between numbers of transfusions and hospitalization cost of PICU was detected (r:0.674, p

INTRODUCTION In mechanically ventilated patients, driving pressure (ΔP) represents the dynamic stress applied to the respiratory system and is related to ICU mortality. An evolution of the Adaptive Support Ventilation algorithm (ASV® 1.1) minimizes inspiratory pressure in addition to minimizing the work of breathing. We hypothesized that ASV 1.1 would result in lower ΔP than the ΔP measured in APV-CMV (controlled mandatory ventilation with adaptive pressure ventilation) mode with physician-tailored settings. The aim of this randomized crossover trial was therefore to compare ΔP in ASV 1.1 with ΔP in physician-tailored APV-CMV mode. METHODS Pediatric patients admitted to the PICU with heterogeneous-lung disease were enrolled if they were ventilated invasively with no detectable respiratory effort, hemodynamic instability, or significant airway leak around the endotracheal tube. We compared two 60-min periods of ventilation in APV-CMV and ASV 1.1, which were determined by randomization and separated by 30-min washout periods. Settings were adjusted to reach the same minute ventilation in both modes. ΔP was calculated as the difference between plateau pressure and total PEEP measured using end-inspiratory and end-expiratory occlusions, respectively. RESULTS There were 26 patients enrolled with a median age of 16 (9-25 [IQR]) months. The median ΔP for these patients was 10.4 (8.5-12.1 [IQR]) and 12.4 (10.5-15.3 [IQR]) cmH2O in the ASV 1.1 and APV-CMV periods, respectively (p

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococcus (VRE) colonization and infections are important in the pediatric intensive care unit (PICU). This study aimed to investigate the effect of a 2% chlorhexidine gluconate (CHG) bath on VRE and CRE colonization. Materials and Methods: Skin bathing was performed every other day with 2% CHG as of April 2019. The frequency of CRE and VRE colonization pre and post-intervention was evaluated. Rectal swab samples were taken within 7 days before and after skin bathing with CHG. Besides, VRE and CRE spontaneously negation rates within 14 day periods were examined. Results: The number of CRE positive patients within the CHG group were detected as 10 (47.6%) before using CHG and as 8 (38%) after using (OR: 1.5, p= 0.131, 95% CI: 0.87-1.98). The number of VRE positive patients were detected within the CHG group as 15 (71.4%) before using CHG and as 10 (47.6%) after using (OR: 2.7, p= 0.044, 95% CI: 1.09-2.42). Also, when we compared the control group with the CHG group; there was no significant difference in CRE when comparing the negation rates (p= 0.804). There was a significant difference between the two groups in VRE (p= 0.048). Conclusion: It shows that performing skin bathing with 2% CHG every other day in the PICU significantly reduces VRE colonization but cannot decrease the risk of CRE colonization. We think that skin bathing with 2% CHG every other day in the PICU can be used as one of the resistant microorganism colonization and infection prevention methods.

Objective: Nitric oxide therapy is not routinely used in the treatment of pediatric acute respiratory distress syndrome (PARDS), but it is recommended to be used as an adjunctive therapy in some selected cases. In our study, we aimed to discuss patients with PARDS who were treated with inhaled nitric oxide (iNO) therapy. Methods: The data of patients who were hospitalized in the pediatric intensive care unit with a diagnosis of PARDS and received iNO treatment between January 2016 and January 2018 were retrospectively analyzed. Age, gender, length of stay, mortality, number of days on mechanical ventilation, use of vasoactive drugs, mortality scores, lactate levels, OI (oxygenation index), PaO2/FiO2, methemoglobin levels, iNO administration time, echocardiographic findings and underlying primary diseases were recorded. Results: It was determined that 9 patients who were followed up with the diagnosis of PARDS were given iNO treatment. Except for one patient, they were diagnosed with pneumonia developing on the basis of chronic disease and PARDS secondary to septic shock. Five patients died while receiving iNO therapy. Seven patients were ventilated with iNO in addition to conventional mechanical ventilation methods. Two patients who died were ventilated with HFOV (high frequency oscillatory ventilation). In 3 of 9 patients, inhaled nitric oxide treatment was successful. Conclusion: Although inhaled nitric oxide treatment is a known treatment used in different diseases, the level of its effect in PARDS patients continues to be investigated. We think that this treatment can be beneficial when applied in selected patients and experienced centers.

BACKGROUND Rhabdomyolysis; can occur due to toxic, infectious, metabolic, and genetic causes. Severe rhabdomyolysis may progress to several clinical manifestations such as cardiac arrest and may pose a risk of mortality if it is not treated timely. CASE In this article, we presented a 26-month-old patient who was admitted with an acute rhabdomyolysis attack and a venovenous hemodiafiltration (CVVHDF) was initiated on the 5th hour of hospitalization. Creatine kinase (CK) levels of the patient continued to increase (max: 943 452 IU/L) until the 5th day of treatment and hereafter began to decrease. As the common causes of rhabdomyolysis were excluded and the CK levels were the highest values reported in the literature, although, LPIN1 deficiency was the most suspected diagnosis, to facilitate the diagnostic procedures a whole-exome sequencing was performed. A homozygous [c.1696G > C p. (Asp566His)] mutation was detected on LPIN1 gene. This variant has not been described previously, however, when examined with programs such as SIFT and Mutation taster, it has been considered as pathogenic. CONCLUSION In the pediatric age group, especially in infants presenting with severe rhabdomyolysis, LPIN1 deficiency should also be considered; as early diagnosis and appropriate treatment may reduce mortality.

Objectives Data on the relationship between tracheotomy and ventilator-associated pneumonia (VAP) in children is very limited. We planned to evaluate the effect of tracheotomy on VAP rates in children. Materials and methods We evaluated patients who underwent tracheotomy during follow-up at the pediatric intensive care unit (PICU) of our hospital. Patients who were diagnosed as VAP at least once and followed by a mechanical ventilation (MV) for at least 30 days before and after tracheotomy were included in our study. The underlying diagnoses of the patients and the number of VAP diagnosis, VAP rates (VAP number x1000/day of MV) before and after tracheotomy were recorded. Logistic regression analysis was used to compare VAP rates before and following a tracheotomy. Results There were a total of 47 patients including 28 (59.6%) girls and 19 (40.4%) boys in our study. The duration of MV before tracheotomy was 74.9 ± 48.9 (31–295) days and after tracheotomy, it was 103.3 ± 102.8 (30–586) days. The number of VAP before tracheotomy was 0.9 ± 1.2 (0–8) and after tracheotomy, it was 0.6 ± 0.6 (0–3). The VAP rate before tracheotomy was 5.9 ± 6.3 (0–26.5) and the VAP rate after tracheotomy was 3.2 ± 3.8 (0–11.4). Ventilator-associated pneumonia rates were lower following tracheotomy (OR:0.91,95%CI:0.826–0.981,p = 0.017). Conclusion Tracheotomy decreased the VAP rate in children receiving long-term mechanical ventilatory support.

Purpose: The optimal scrubbing time for the disinfection of the surface of needleless connectors has not been determined. The evidence for successful needleless connector decontamination with 70% isopropyl alcohol ranges from 5 to 60 s. The aim of this prospective study was to identify colonization on the external surface of needleless connectors on central venous catheters and measure the efficiency of 15 s of scrubbing with 70% alcohol. Method: A total of 31 patients were included. Samples were collected adhering to aseptic no-touch technique policies. Two samples were collected from the injectable surface of the needleless connector with sterile sodium chloride 0.9% moistened and a dry swab from the same site. Then the surface was scrubbed with alcohol 70% for 15 s for disinfection and second couples of samples for the cultures were taken after disinfection. Findings: A total of 420 swabs were obtained. The number of colonization (equal or higher than 15 CFU/plate) was present on 21 of the needleless connectors (20.0%). Coagulase-negative staphylococci was responsible for all the colonization. After disinfection for 15 s, no isolation exceeding 1 CFU/plate was present. Conclusion: Scrubbing for 15 s with 70% alcohol was found to be successful at elimination of colonization of the surface of needleless connector even in high microorganism counts.