Objective: Acute respiratory failure is the most common reason for hospitalization to pediatric intensive care units. Invasive and non-invasive respiratory support methods are used for the treatment ...of patients with acute respiratory failure findings. The aim of this study is to evaluate the effectiveness of high flow nasal cannula (HFNC) oxygen therapy in pediatric intensive care. Method: This retrospective observational study was conducted between February 2017 and January 2018 in pediatric intensive care unit of Bahçeşehir Liv Hospital, İstinye University Faculty of Medicine. Patients aged between 1 month and 18 years, who received HFNC oxygen therapy for respiratory support in the pediatric intensive care unit, were included in the study. Results: HFNC therapy was received by 67 patients during one year of the study. 58.2% of the patients were male. The mean age of the patients was 37.2 months (R, 1-192), and their average body weight was 11.8 kg (R, 2.8-50). 65.7% of patients had an underlying disease. The most underlying disease was neurological disease with the rate of 35.8%. 94% of our patients received HFNC therapy due to acute respiratory failure, 3% due to acute heart failure and 3% due to shock. 40.3% of our patients received HFNC therapy due to pneumonia, 16.4% due to bronchopneumonia, 14.9% due to bronchiolitis, and 11.9% due to postextubation. 71.6% of patients receiving HFNC therapy improved their clinical findings without intubation. After HFNC therapy, there was a statistically considerable decrease in the respiratory rate, heart rate and retraction of the patients. HFNC therapy failure rates were statistically significantly higher in patients with underlying disease and especially in those with cardiac disease. Conclusion: As a result, it is known that HFNC therapy has been used effectively in children in recent years, and it provides improvement in vital findings and blood gas parameters. In our study, 71.6% of our patients benefited from HFNC therapy.
Diabetic ketoacidosis (DKA) is the most serious hyperglycemic emergency in patients with type I diabetes mellitus and is associated with significant morbidity and mortality. DKA may be a ...life-threatening condition due to severe clinical and biological impairments and treatment-associated complications cerebral edema, acute respiratory failure, acute renal failure (ARF), hypokalemia, hypophosphatemia. The development of ARF with rhabdomyolysis is a rare but potentially lethal disorder in children with DKA with an estimated mortality of about 50%. Continuous renal replacement therapy is commonly used in intensive care units to provide renal replacement and fluid management. We successfully treated a 13-year-old boy with continuous venovenous hemodiafiltration, who had been diagnosed with severe DKA, complicated with hypophosphatemia-induced acute respiratory failure, rhabdomyolysis and ARF, persistent acidosis, and coma.
Yaman A. Severe Rhabdomyolysis and Acute Renal Failure Treated by Continuous Venovenous Hemodiafiltration in a Child with Diabetic Ketoacidosis. Indian J Crit Care Med 2022;26(1):136-138.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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.
Isolated remethylation defects are rare inherited diseases caused by a defective remethylation of homocysteine to methionine, preventing various essential methylation reactions to occur. Patients ...present with a systemic phenotype, which can especially affect the central and peripheral nervous systems leading to epileptic encephalopathy, developmental delay and peripheral neuropathy. Respiratory failure has been described in some cases, caused by both central and peripheral neurological involvement. In published cases, the genetic diagnosis and initiation of appropriate therapy were rapidly performed following respiratory failure and led to a rapid recovery of respiratory insufficiency within days. Here, we present two infantile‐onset cases of isolated remethylation defects, cobalamine (Cbl)G and methylenetetrahydrofolate reductase (MTHFR) deficiencies, which were diagnosed after several months of respiratory failure. Disease modifying therapy based on hydroxocobalamin and betaine was initiated and shows a progressive improvement and enabled weaning off respiratory support after 21 and 17 months in CblG and MTHFR patients respectively. We show that prolonged respiratory failure responds to conventional therapy in isolated remethylation defects, but can require a sustained period of time before observing a full response to therapy.
Objective: Acute respiratory failure is the most common reason for hospitalization to pediatric intensive care units. Invasive and non-invasive respiratory support methods are used for the treatment ...of patients with acute respiratory failure findings. The aim of this study is to evaluate the effectiveness of high flow nasal cannula (HFNC) oxygen therapy in pediatric intensive care. Method: This retrospective observational study was conducted between February 2017 and January 2018 in pediatric intensive care unit of Bahcesehir Liv Hospital, Istinye University Faculty of Medicine. Patients aged between 1 month and 18 years, who received HFNC oxygen therapy for respiratory support in the pediatric intensive care unit, were included in the study. Results: HFNC therapy was received by 67 patients during one year of the study. 58.2% of the patients were male. The mean age of the patients was 372 months (R, 1-192), and their average body weight was 11.8 kg (R, 2.8-50). 65.7% of patients had an underlying disease. The most underlying disease was neurological disease with the rate of 35.8%. 94% of our patients received HFNC therapy due to acute respiratory failure, 3% due to acute heart failure and 3% due to shock. 40.3% of our patients received HFNC therapy due to pneumonia, 16.4% due to bronchopneumonia, 14.9% due to bronchiolitis, and 11.9% due to postextubation. 71.6% of patients receiving HFNC therapy improved their clinical findings without intubation. After HFNC therapy, there was a statistically considerable decrease in the respiratory rate, heart rate and retraction of the patients. HFNC therapy failure rates were statistically significantly higher in patients with underlying disease and especially in those with cardiac disease. Conclusion: As a result, it is known that HFNC therapy has been used effectively in children in recent years, and it provides improvement in vital findings and blood gas parameters. In our study, 71.6% of our patients benefited from HFNC therapy. Keywords: High flow nasal cannula oxygen therapy, pediatric intensive care, respiratory failure Amac: Cocuk yogun bakim unitelerine yatisin en sik nedeni akut solunum yetmezligidir. Akut solunum yetmezligi bulgulari olan hastalara tedavi amacli invazif ve non-invazif solunum destek yontemleri kullanilmaktadir. Bu calismanin amaci cocuk yogun bakimda yuksek akisli nazal kanul oksijen (YANKO) tedavisinin etkinligini degerlendirmektir. Yontem: Bu retrospektif gozlemsel calisma, Subat 2017 ile Ocak 2018 tarihleri arasinda Istinye Universitesi Tip Fakultesi, Bahcesehir Liv Hastanesi, Cocuk Yogun Bakim Unitesi'nde gerceklestirilmistir. Bir ay ile 18 yas arasinda cocuk yogun bakim unitesinde solunum destegi amaciyla yuksek akisli nazal kanul oksijen tedavisi alan hastalar calismaya alindi. Bulgular: Bir yillik calisma suresi icerisinde 67 hastamiz YANKO tedavisi aldi. Hastalarin %58,2'si erkekti. Hastalarin ortalama yaslari 37,2 ay (R, 1-192), ortalama vucut agirliklari 11,8 kg (R, 2,8-50) idi. Hastalarin %65,7'sinde altta yatan bir hastalik vardi. En sik altta yatan hastalik %35,8 ile norolojik hastalik grubu olusturuyordu. Hastalarimizin %94'u akut solunum yetmezligi, %3'u akut kalp yetmezligi ve %3'u sok nedeniyle YANKO tedavisi aldi. Hastalarimizin %40,3'u pnomoni, %16,4'u bronkopnomoni, %14,9'u bronsiolit, %11,9'u ekstubasyon sonrasi akut solunum yetmezligi nedeniyle YANKO tedavisi aldi. YANKO tedavisi alan hastalarin %71,6'si entube olmadan klinik bulgulari duzeldi. YANKO sonrasi hastalarin solunum sayisi, kalp hizi, retraksiyon duzeylerinde istatistiksel olarak anlamli dusus saptandi. Altta yatan hastaligi olan ve ozellikle kardiyak hastaligi olanlarda YANKO tedavisi basarisizlik oranlari istatistiksel olarak anlamli yuksek bulundu. Sonuc: Sonuc olarak, son yillarda YANKO tedavisinin cocuklarda etkin bir sekilde kullanildigi, vital bulgular ve kan gazi parametrelerinde duzelme sagladigi bilinmektedir. Calismamizda hastalarimizin %71,6'si YANKO tedavisinden fayda gordu. Anahtar kelimeler: Cocuk yogun bakim, solunum yetmezligi, yuksek akisli nazal kanul oksijen tedavisi
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.
Although immediate extubation in the operating room following pediatric liver transplantation can be safe and beneficial for select patients, many surgeons and anesthesiologists are still cautious. ...The study aimed to evaluate the safety and efficiency of immediate extubation in the operating room following pediatric liver transplantation.
Sixty-four pediatric liver transplant recipients were included in this retrospective study. Patients were divided into 2 groups: immediate extubation (IE) (those who were extubated in the operating room) and delayed extubation (DE) (those who were extubated in the intensive care unit). Preoperative, intraoperative, and postoperative variables were recorded.
Although a total of 19 (29.7%) patients were extubated in the pediatric intensive care unit (group DE), 45 (70.3%) were extubated in the operating room at the end of surgery (group IE). The use of fresh frozen plasma and platelets was statistically higher in group DE (P = .017 and P = .002, respectively). Duration of anesthesia and length of stay in the pediatric intensive care unit was statistically longer in group DE (P = .020 and P = .0001, respectively). Three (15.8%) patients required reintubation in group DE and 2 (4.4%) in group IE. Hospital stay was statistically longer in group DE (P = .012).
The current study demonstrated that immediate extubation in the operating room after surgery for pediatric patients who have undergone liver transplantation was safe. The duration of anesthesia and the intraoperative use of blood products such as platelet and fresh frozen plasma can effectively decide immediate extubation.
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