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Introduction: Recently, some centers have used extubation during extracorporeal membrane oxygenation (ECMO) to eliminate barotrauma and volutrauma as a lung rest strategy. This study aims to demonstrate the use of extubation during ECMO in children. Methods: This retrospective study was conducted from January 1, 2015, to April 1, 2023, in our pediatric intensive care unit. Results: In this study, we presented six cases that were extubated during ECMO support. In addition, we followed 130 pediatric patients on ECMO in the same period. Two patients were primarily diagnosed with cardiomyopathy, one with myocarditis, two with congenital heart defect, and one with necrotizing pneumonia. The median age of patients was 99 (interquartile range 25-75) (16.5-192) months, and all were male. Venoarterial ECMO was connected to 4 patients, and venovenous ECMO was connected to 2 patients. Six patients were extubated during ECMO on the 5th, 12th, 3rd, 4th, 3rd and 14th days of their treatment, respectively. While the patients were extubated, three of them were supported by biphasic positive airway pressure, one was supported by nasal continuous positive airway pressure, and two were provided with supplementary oxygen. Three patients were extubated under ECMO and discharged. Conclusion: The risk of mechanical ventilation related complications such as volutrauma and barotrauma could minimized in patients extubated under ECMO. In addition, sedatives, analgesics, and muscle relaxant related complications such as delirium, muscle weakness, or prolonged ventilation could reduced via awake ECMO.

Introduction: Various perioperative problems occur in patients operated on brain tumors. While many studies focused on the long-term effects of surgery, few focused on the perioperative period. The aim of this study to evaluate clinical and laboratory features and determining the factors which are effecting the outcome in operated patients for brain tumors our pediatric intensive care unit (PICU). Methods: Patients who underwent intracranial tumor surgery in the PICU during the eight-year period were retrospectively screened. Results: Seventy-four patients were included in the study, mean age was 60 (1.5-192) months, and supratentorial tumors were detected in 41 (55.4%) patients. The median length of stay (LOS) in PICU of the patients was 5 (1-150) days. When supratentorial tumor localization, ventriculoperitoneal shunt presence, central venous catheter related bloodstream infection, ventilator-associated pneumonia and other infections were evaluated, a statistically significant difference was found between the two groups when patients’ LOS in the PICU is evaluated in 2 groups of more than 15 days (77%) and less than 15 days (23%). In the postoperative period, diabetes insipidus (DI) in 12 (16%), septicemia in 9 (12%), shunt infection in 8 (10%), hydrocephalus in 7 (9%), seizures in 5 (6%), cranial nerve palsy in 5 (6%) in patients. Conclusion: Neurological sequelae increased with younger age and were more common in patients with infratentorial tumors. While a relationship was found between delta sodium and DI in the postoperative first 4 days, without relationship was found with neurological sequelae.

Introduction: Thiamin deficiency, which is an overlooked but important cause of lactic acidosis, can lead to several clinical symptoms, including neuropathy, cardiogenic shock, and death, even though it can be easily treated in critically ill children. Methods: A single-center, retrospective cohort study conducted between March 2020 and March 2022. Results: Twenty-two patients were included in the study. The mean age was 26.5 (range, 1-214) months. The median thiamin dose was 50 (range, 3-100) milligrams and the mean thiamin treatment duration was 4 (range, 1-16) days. The mean length of PICU when thiamin treatment was started was 8 (range, 2-177) days. Thiamin treatment was administered on the 2nd (1-5) day of lactic acidosis. The mean lactate values after thiamin treatment was 5.5 (range, 5-17) mmol/L at the 6th hour, 4.1 (range, 1.5-17) mmol/L at the 12th hour, 3.1 (1.4-20) mmol/L at the 24th hour, and 2.7 (range, 0.15-17) mmol/L at 48th hour. Eleven (50%) patients’ lactate levels decreased below 4 mmol/L at the 12th hour of thiamin treatment. Blood gas values before thiamin treatment, lactate decrease trends, thiamin treatments’ duration, and form, and patients’ risk factors were not statistically significant in the two groups by 28-day mortality. Conclusion: We believe that in patients with lactic acidosis not directly related to a circulatory disorder, low clinical suspicion and early thiamin treatment of lactic acidosis is the right approach in the absence of specific diagnostic tests.

Introduction: The discharge rates of newborns dependent on medical technology and in need of palliative care have increased. Specialized care units aimed to reduce patient load in neonatal intensive care units (NICU), and increase the quality of home care. In our country, there are few specialized care units for these patients. This study aimed to determine the characteristics of patients who were hospitalized in NICU and transferred to pediatric intensive care unit (PICU) due to continuing care. Methods: The data of patients who were hospitalized in NICU between January 1, 2008 and July 31, 2022 and transferred to PICU were analyzed. Results: Twenty (51%) of 39 patients were male, 46% had congenital anomaly(s), 33% had neurometabolic diseases. Fourty-nine percent (n=19) of patients died during PICU stay, 2.6% (n=1) died after discharge. Demographic findings of died and survived patients were similar. Ninety percent of patients received invasive respiratory support (IRS) for a median of 43 days during NICU, 97% received IRS for a median of 31 days during PICU. Percutaneous endoscopic gastrostomy (PEG) and tracheostomy were performed 31%, and 51% of patients, respectively. The median length of stay in NICU and PICU were 55 days and 37 days, respectively. The discharged patients had a higher rate of PEG or tracheostomy (p

Objective: Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment option providing cardiopulmonary support when standard therapies prove insufficient for reversible diseases. The mean objective of this study was to evaluate our center’s experience with ECMO following pediatric cardiac surgery. Materials and Methods: This retrospective study was conducted in our pediatric intensive care unit (PICU) between November 2014 and March 2021 and included patients who received ECMO following cardiac surgery. Results: Over the 7-year period, 324 patients underwent cardiac surgery, of which 24 (7.4%) required ECMO support. Among them, 13 (54.2%) were female, with a median age of 16.0 (2.0- 208) months and a median weight of 7.0 (3.5-70) kg. The mean vasoactive inotrope score (VIS) was 53.9 ± 44.5. Atrioventricular septal defect repair was the most common surgical procedure (n = 8/24, 41.6%). The primary indication for ECMO was low cardiac output syndrome (LCOS) in 14 (58.3%) patients. The median duration of ECMO support was 6.0 (1.0-46.0) days. Nonsurvivors had significantly higher Pediatric Risk Score of Mortality (PRISM) III scores (P = .014) and VIS scores during the pre-ECMO period (P = .004). Early or late neurological complications developed in 12 (50%) patients, with significant differences in lactate levels and pH levels preECMO between those with and without neurological complications (P = .01, P = .02, respectively). We successfully decannulated 16 (66.6%) patients, with a final survival rate of 12 (50%). Conclusion: ECMO plays a crucial role in providing pre- and post-cardiac surgery support for children. LCOS remains the main indication, and high PRISM III and VIS scores are valuable predictors of outcomes.

Introduction:The choice of anticoagulation in continuous renal replacement therapy (CRRT) is very important for circuit life and bleeding complications. The primary outcome of our study was circuit lifespan. Secondary outcomes, we aimed to identify metabolic complications.Methods:This retrospective study was conducted in our pediatric intensive care unit between November 2019 and March 2021.Results:The study included 35 patients, 19 with regional citrate anticoagulation (RCA) and 16 with heparin anticoagulation (HA). The patient’s pediatric risk of mortality III score was similar in both groups (p=0.76); also, p-SOFA score was higher in the RCA group and was significant [(HA: 6.43±5.24, RCA: 10.21±3.96, p=0.024)]. 100 hemofilter were used in all therapies (total CRRT times 4115.50 h), 43 in HA and 57 in the RCA group. Median circuit life and total CRRT duration were longer for RCA [(33.0; 3.0-168.0) (30.5; 9.0-520.0) (14.0; 0.75-285.0) (94.0; 11.0-394.0) (p=0.043\0.021)] than for HA. Hypocalcemia was detected 9/19 in the RCA and 4/16 in the HA (p=0.021). HA was preferred in 3 patients and RCA in 4 patients who needed ECMO simultaneously with CRRT. The most common reason for circuit change in RCA groups is patient-related and clotting in the heparin group. Mortality rates were not the same in both groups (p=0.012).Conclusion:Citrate 18/0 has better safety and efficacy with a long filter life and easily manageable systemic complications. In addition, anticoagulation with RCA may be preferred in patients monitored with ECMO and in need of CRRT.

Background Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA. Methods This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis. Results The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, and creatinine levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P

Introduction:This study aims to evaluate bronchoscopy’s indications and clinical results in patients who underwent bronchoscopy during their stay in the pediatric intensive care unit (PICU).Methods:This study was carried out retrospectively in PICU between April 2019, and October 2021. The diagnoses of the patients, the reasons for bronchoscopy, where and by whom bronchoscopy was performed, complications related to bronchoscopy, and the contribution of bronchoscopy to diagnosis and treatment were determined.Results:Thirty-seven patients underwent bronchoscopy. The median age was 20 (7-126) months. The children comprised 17 females (45.9%). We performed bronchoscopy in 17 (45.9%) patients in the PICU and in 20 (54.1%) patients in the operating room. Pediatric intensive care physicians, 13 (35.1%) performed fifteen (40.5%) of bronchoscopy procedures pediatric pulmonologists and 9 (24.3%) pediatric surgeons. Nine patients underwent rigid bronchoscopy, 28 patients underwent flexible bronchoscopy. The median bronchoscopy time was 10 minutes (7.5-15). Bronchomalacia was found in 5 of the patients and tracheomalacia in 2 of them. Three patients (8.1%) had extraluminal airway compression. Bronchoscopy was performed in six patients due to foreign body aspiration. In 13 patients, peak inspiratory pressure and positive end-expiratory pressure of mechanical ventilation were decreased after the bronchoscopy procedure. During the bronchoscopy procedure, desaturation showed in 19 patients, bleeding in 4 patients, bradycardia in 4 patients, and short-term cardiac arrest in 3 patients. Three patients with cardiac arrest were patients who underwent rigid bronchoscopy. The median PICU length of stay was 52 days. There were no bronchoscopy-related deaths, but 9 patients died due to their primary disease.Conclusion:Bronchoscopy is a method that can be performed in PICU, both at the bedside and the operating room, to identify pathological changes in the airway in critical patients and to remove foreign bodies and life-threatening plugs in the airway. Its use for emergency or diagnostic purposes is increasing in PICUs.

One of the most common health problems today is volatile substance abuse and toxic gas inhalation. Butane gas, also known as lighter gas, is increasingly used because it causes euphoria, pleasure and joy among adolescents. The most important reasons for this situation are the fact that it is cheap and easy to obtain, and at the same time the legal audit is not very serious. In this article, two adolescent male patients who were followed up in our pediatric intensive care unit after lighter gas inhalation are presented. The first case was discharged, and the second case died despite extracorporeal cardiopulmonary resuscitation due to cardiac arrest during admission to our hospital from another center. In our study, it was aimed to draw attention to the fact that butane gas inhalation, which has been increasingly common in childhood, is responsible for significant morbidity and mortality.

Purpura fulminans (PF) is a rare but fatal thrombotic disease caused by microvascular thrombosis due to coagulation disorder. Necrosis can progress to muscle and bone tissue contributing to late mortality and morbidity. A healthy 4-month-old girl and a 7-month-old girl had previously admitted to our intensive care unit with severe PF due to meningococcemia. Both patients had a severe and critical period in the pediatric intensive care unit and were supported with extracorporeal treatments. We opened colostomy for perineal infection because of large and deep skin lesions. In addition, we waited for a full auto-amputation involving all extremities instead of early surgical amputation. Both survived and acceptable limb function and some mobilization capacity were preserved. In conclusion, we think that early colostomy in severe perineal infections and autoamputation options in severe extremity involvement should be preferred in order to get better results.

Background Pediatric intensive care units (PICUs), where children with critical illnesses are treated, require considerable manpower and technological infrastructure in order to keep children alive and free from sequelae. Methods In this retrospective comparative cohort study, hospital records of patients aged 1 month to 18 years who died in the study PICU between January 2015 and December 2019 were reviewed. Results A total of 2,781 critically ill children were admitted to the PICU. The mean±standard deviation age of 254 nonsurvivors was 64.34±69.48 months. The mean PICU length of stay was 17 days (range, 1–205 days), with 40 children dying early (

Summary: Background: To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries. Methods: Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression. Findings: 557 patients (median age, 8 years; 24% 2 years old. Interpretation: We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19. Funding: None.