BACKGROUND:Colistin is active against most multidrug-resistant, aerobic Gram-negative bacteria. Because of the reported nephrotoxicity during the first years of use of colistin, there were concerns ...of its use in pediatrics where there was limited experience The aim of this study is to document the clinical characteristics and outcomes of use of colistin in pediatric patients at a pediatric intensive care unit in Turkey.
METHODS:We reviewed the medical and laboratory records of 29 critically ill children who were treated with colistin for 38 courses between January 2011 and December 2011 at the Department of Pediatric Intensive Care Unit in Ankara University Medical School, Turkey.
RESULTS:The median age was 17 months (range 3–217 months). Male-to-female ratio was 1:1.37. Ventilator-associated pneumonia (21 courses) was the leading diagnosis followed by catheter-related blood stream infection (6 courses), bacteremia (4 courses), ventriculoperitoneal shunt infection, peritonitis and pneumonia (1 course). The most commonly isolated microorganisms were Acinetobacter baumanni, Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia marcescens, Stenotrophomonas maltophilia, and Enterobacter cloacae. Two colistin formulations were used. Colimycin (Kocak Farma) was used in 21 colistin treatment episodes. The median dosage of colistin in this group was 5.0 mg/kg/d (2.3–5.6 mg/kg/d). Colomycin (Forest Laboratories) was used in 17 colistin treatment episodes. The median dosage of colistin in the second group was 75,000 International Unit/kg/d (50,000–80,000 International Unit/kg/d). Thirty colistin treatment episodes (79%) had a good or partial clinical response and 8 (21%) had a poor clinical response. Of the 8 colistin treatment episodes with poor clinical response, 3 were in the Colimycin group and 5 were in the Colomycin group. Ten patients died. There was no evidence of neurotoxicity in this study. Nephrotoxicity was observed in 1 patient but was not attributed to colistin because the patient had multiorgan failure at the same time.
CONCLUSIONS:This study in a small cohort of patients suggests that the use of colistin in severe nosocomial infections caused by multidrug-resistant Gram-negative bacteria is well-tolerated and efficacious.
A 13‐year‐old girl who had been on home parenteral nutrition for 6 months has been presented with multifocal atrial tachycardia and atrial fibrillation. Echocardiography and multislice computed ...tomography showed fat accumulation on the interatrial septum. Lipomatous hypertrophy of the interatrial septum has never been reported in children.
Introduction:The aim of this study was to investigate demographic, epidemiologic, and clinical characteristics of cases admitted to pediatric intensive care unit (PICU) for poisoning.Methods:Cases ...with poisoning admitted to PICU between January 1, 2015 and June 30, 2016 were evaluated retrospectively.Results:Ninety two cases were enrolled in this study. The mean age was 63.65±59.1 months and 73.9% of the cases were under 5 years of age. Fifty five point four percent of the cases were male. Of the poisoning cases, 82.6% were accidental and 14.1% were suicidal. Seventy seven point two percent of the cases were drug related and 18.3% of them were multi-drug poisonings. Central nervous system drugs were the most frequently (24.2%) ingested drugs. The most common cause of non-drug poisonings were pesticide and insecticides (42.8%). The median duration of time from ingestion to admission to the pediatric emergency department was 60 (10-2880) minutes. Of the cases, 31.5% were symptomatic. Gastric lavage and activated charcoal were performed in 65.2% and 72.8% of the cases, respectively. Continuous venovenous hemodiafiltration was performed in 3 cases. The mean time of PICU and hospital stay were 19.53±14.37 and 35.91±29.46 hours, respectively. During the study period, one case died due to acute poisoning of alpha-lipoic acid.Conclusion:Pediatric poisonings are among the most common reasons for referrals to emergency department, admission to hospital and represent a preventable cause of morbidity and mortality. Parental education about prevention of poisoning and keeping drugs and household products out of children’s reach is important because most of the poisonings occur at home with drugs and household products. Recognition of epidemiologic and clinical characteristics of pediatric poisoning by healthcare providers is also important for rapid diagnosis and treatment.
Introduction: Subacute sclerosing panencephalitis (SSPE) is a chronic, progressive, and degenerative infection of the central nervous system caused by measles virus. The first aim of this study was ...to assess the demographic and epidemiological characteristics of SSPE patients admitted to pediatric intensive care unit (PICU). The second aim was to determine the thoughts of their parents about home care. Methods: Patients with SSPE, who were admitted to our PICU between January 1, 2015 and June 30, 2015, were evaluated retrospectively. Results: Fourteen patients were admitted to the PICU for a total of 16 episodes. Ten (71%) patients were male and 4 (29%) were female. Male-to-female ratio was 2.5. The mean age of the patients was 16.25±1.14 years. Thirteen patients had received their first measles vaccine at the age of 9 months. Ten (71.4%) patients had measles infection at a later time after the vaccination and one (7.1%) patient had measles before vaccination. The mean age at the time of measles infection was 23.81±15.67 months. The mean age at the time of first symptoms was 8.64±3.33 years and the mean duration of latent period was 5.72±2.96 years. Thirteen (81.3%) patients were admitted to the PICU with pneumonia and respiratory failure, 1 (6.2%) was admitted with sepsis, and 2 (12.5%) patients were admitted with neurological problems. None of the parents accepted home care in the study period. Frequent power cuts (80%), poor housing and home conditions (70%), poverty (60%), worries of the parents about home care (60%), and household crowding (50%) were their reasons for not accepting home care. Conclusion: Patients with SSPE may require PICU admission and long PICU stays for respiratory failure and neurologic problems. Palliative care units may be an option when home care is not possible for these patients.
Introduction: The aim of this study was to determine the frequency
of central line-associated bloodstream infections, risk factors, their
relationship with catheter insertion location, and the effect ...of central
line-associated bloodstream infections on mortality and pediatric
intensive care unit (PICU) length of stay.
Methods: This was a prospective, observational and cohort study,
carried out between November 2009 and February 2011. During
this period, all the patients who had central-line were monitored for
central line-associated bloodstream infection.
Results: In the study period, 275 patients were admitted to our PICU.
The frequency of invasive device usage was 38.9% (107) for central
venous catheter, 38.2% (105) for mechanical ventilation, 53.3%
(147) for urinary catheter, and 11.3% (32) for artery line. Central lineassociated
bloodstream infection was detected in 16 (14.8%) of the
patients and 23 central line-associated bloodstream infection attacks
were observed. There were 14 central line-associated bloodstream
infection attacks in 1.000 central venous catheter usage days. There
were 168 patients without central venous catheter and 4 (2.4%) of
them had blood stream infection. Thirty-six patients died and the
mortality rate was 13%. Five of these patients (13.8%) died due to
central line-associated bloodstream infection, 27 (25%) of them had
central venous catheter and 9 (6%) of them did not (p=0.001).
Conclusion: In conclusion, central line-associated bloodstream
infection is one of the serious healthcare-associated infections, and
it is an important cause of morbidity and mortality in PICUs.
Kurt F, Kendirli T, Gündüz RC, Kesici S, Akça H, Şahin Ş, Kalkan G, Derbent M, Tuygun N, Ödek Ç, Gültekin-Keser A, Oğuz S, Polat E, Derinöz O, Tekin D, Tekşam Ö, Bayrakcı B, Suskan E. Outcome of ...out-of-hospital cardiopulmonary arrest in children: A multicenter cohort study. Turk J Pediatr 2018; 60: 488-496. 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.
OBJECTIVESThe objectives of this study were to determine the causes, location of cardiopulmonary arrest (CPA) in children, and demographics of cardiopulmonary resuscitation (CPR) in Turkish pediatric ...emergency departments and pediatric intensive care units (PICUs) and to determine survival rates and morbidities for both in-hospital and out-of-hospital CPA.
METHODSThis multicenter descriptive study was conducted prospectively between January 15 and July 15, 2011, at 18 centers (15 PICUs, 3 pediatric emergency departments) in Turkey.
RESULTSDuring the study period, 239 children had received CPR. Patients’ average age was 42.4 (SD, 58.1) months. The most common cause of CPA was respiratory failure (119 patients 49.8%). The location of CPA was the PICU in 168 (68.6%), hospital wards in 43 (18%), out-of-hospital in 24 (10%), and pediatric emergency department in 8 patients (3.3%). The CPR duration was 30.7 (SD, 23.6) minutes (range, 1–175 minutes) and return of spontaneous circulation was achieved in 107 patients (44.8%) after the first CPR. Finally, 58 patients (24.2%) were discharged from hospital; survival rates were 26% and 8% for in-hospital and out-of-hospital CPA, respectively (P = 0.001). Surviving patients’ average length of hospital stay was 27.4 (SD, 39.2) days. In surviving patients, 19 (32.1%) had neurologic disability.
CONCLUSIONPediatric CPA in both the in-hospital and out-of-hospital setting has a poor outcome.
Abstract Purpose To determine the efficiency of noninvasive mechanical ventilation (NIV) both in protection from intubation and in preventing reintubation of postextubation in patients in the ...pediatric intensive care unit (PICU). Methods A prospective observational study was conducted in a multidisciplinary 10-bed tertiary PICU of a university hospital. All patients were admitted to our unit from June 2012 to May 2014 and deemed to be candidates to receive continuous positive airway pressure or bilevel positive airway pressure. Measurements and Results We performed 160 NIV episodes in 137 patients. Their median age was 9 months (range, 1-240 months), and their median weight was 7.5 kg (range, 2.5-65 kg). Fifty-seven percent of patients were male. Noninvasive mechanical ventilation was successful in 70% (112 episodes) of patients. There was an underlying illness in 83.8% (134 episodes) of the patients. Bilevel positive airway pressure support was given to 57.5% (92 episodes) of the patients, whereas the remaining 42.5% (68 episodes) received continuous positive airway pressure support. Among the causes of respiratory failure in our patients, the most frequent were postextubation, pneumonia, bronchiolitis, atelectasia, and cardiogenic pulmonary edema. Sedation was applied in 43.1% of the episodes. Complications were detected in 29 episodes (18.1 %). The NIV failure group showed higher Pediatric Risk of Mortality III-24 score, shorter NIV duration, more frequent underlying disease, lower number fed, longer length of PICU stay, and hospital stay, and mortality was higher. Conclusions Noninvasive mechanical ventilation effectively and reliably reduced endotracheal intubation in the treatment of respiratory failure due to different clinical situations. Our results suggest that NIV can play an important role in PICUs in helping to avoid intubation and prevent reintubation. Although there were serious underlying diseases in most of our patients, such as immunosuppression, 70% avoided intubation with use of NIV.
This prospective, observational, single-center study aimed to determine the perioperative predictors of early extubation (<24 h after cardiac surgery) in a cohort of children undergoing cardiac ...surgery. Children aged between 1 month and 18 years who were consecutively admitted to pediatric intensive care unit after cardiac surgery for congenital heart disease between January 2012 and June 2014. Ninety-nine patients were qualified for inclusion during the study period. The median duration of mechanical ventilation was 20 h (range 1–480), and 64 patients were extubated within 24 h. Four of them failed the initial attempt at extubation, and the success rate of early extubation was 60.6 %. Older patient age (
p
= .009), greater body weight (
p
= .009), absence of preoperative pulmonary hypertension (
p
= .044), lower RACHS-1 category (OR, 3.8; 95 % CI 1.35–10.7;
p
< .05), shorter cardiopulmonary bypass (
p
= .008) and cross-clamp (
p
= .022) times, lower PRISM III-24 (
p
< .05) and PELOD (
p
< .05) scores, lower inotropic score (
p
< .05) and vasoactive-inotropic score (
p
< .05), and lower number of organ failures (OR, 2.26; 95 % CI 1.30–3.92;
p
< .05) were associated with early extubation. Our study establishes that early extubation can be accomplished within the first 24 h after surgery in low- to medium-risk pediatric cardiac surgery patients, especially in older ones undergoing low-complexity procedures. A large prospective multiple institution trial is necessary to identify the predictors and benefits of early extubation and to facilitate defined guidelines for early extubation.
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