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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.

Moyamoya disease etiology is an undetermined vasculopathy and is mainly thought to affect the Internal Carotid Artery and Wills circle. An 8-month-old patient without any underlying disease was referred to our hospital with sudden extreme right hemiparesis. There was no evidence of meningeal irritation in the neurological examination, decreased tonus on the right side, strength in the upper right extremity 3/5 and strength in the lower right extremity 2/5, deep tendon reflexes were exaggerated. Cranial brain tomography angiography showed in both distal internal cerebral arteries and branches and a significantly curvy appearance, with similar changes present in the veins forming the Willis circle. Low molecular weight heparin, acetylsalicylic acid, and levetiracetam were started. On the fifth day of follow-up, motor activity in the lower right extremity returned to normal. The power loss of 2/5 in the upper right extremity was continuing. The patient was then transferred to a center with Moyamoya surgery, which may be needed. This case highlights the importance of considering Moyamoya disease as a classical etiologies of acute ischemic strokes in children. It also highlights the rare presentation among the Turkish population and the use of neurovascular imaging techniques to facilitate the diagnosis of Moyamoya diseas

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 (

An increasing number of pediatric patients with dilated cardiomyopathy (DCMP) undergo mechanical circulatory support (MCS), as a bridge to heart transplantation. Gastrointestinal complications in this population are rare, and the treatment is challenging. Patients with DCMP frequently present with heart failure symptoms, such as tachycardia, hypotension, respiratory distress, cyanosis, weak peripheral pulses, and inadequate feed. Rarely, gastrointestinal symptoms, such as nausea and ascites, may be noted if biventricular failure develops. Here we present a case of a 14-year-old girl with severe intractable diarrhea and malnutrition after being diagnosed with DCMP. After extracorporeal cardiopulmonary resuscitation, she was bridged to a long-term left ventricular assist device support. Her recovery was complicated with intractable diarrhea and malnutrition, which were critical. Thus, this case study aimed to emphasize that pediatric patients with DCMP having persistent diarrhea and malnutrition can be successfully treated with MCS.

Traumatic optic neuropathy (TON) is characterized by impaired visual function due to acute damage to the optic nerve injury related to the trauma. The predictive incidence of TON in children and adolescence is 0.7-2.5% after blunt or penetrating head injuries. Orbital trauma is often accompanied by head injury and is the most common cause of unilateral vision loss. Here, we present a case of 11-year-old child who had the complaint of vision loss in the right eye and developed TON after a motor vehicle accident. The intubated patient was admitted to the pediatric intensive care unit after trauma and was operated due to epidural hemorrhage. Visual loss was detected during follow-up and orbital computed tomography revealed multiple fractures in the orbital walls and magnetic resonance imaging showed effusion of the optic nerve sheath and contrast enhancement of the optic nerve. Clinical and imaging findings suggested TON and as there was no indication for surgery, pulse steroid treatment was given for 5 days. With this treatment, the patient's vision loss and clinical findings improved significantly.In conclusion, TON should be considered in patients with a head injury and post-traumatic vision loss. High-dose steroids should be considered in suitable patients.

Adenovirus is a non-enveloped, double-stranded DNA virus that can cause infections in the upper and lower respiratory tract, conjunctiva, and gastrointestinal tract. Adenovirus infections are usually mild but may cause mortality and morbidity, especially in immunocompromised patients. Cidofovir may be used to treat adenovirus. Cidofovir is an antiviral with a virostatic effect, especially effective for adenovirus and herpes virus. In this case report, we present a 15-year-old patient with adenovirus-induced severe acute respiratory distress syndrome, who was referred to us for renal failure and successfully treated with cidofovir.

Botulism is a rare but potentially life-threatening neuroparalytic syndrome caused by the action of a neurotoxin caused by the bacterium Clostridium botulinum. Early diagnosis and early treatment is important. In cases where botulism occurs sporadically, there is a need for easily applicable and rapid methods for diagnosis. The patient was admitted to the emergency department with complaints of dysarthria and sleepiness at the age of 7 years. During follow-up, bilateral ptosis, nystagmus, facial asymmetry, double vision and dysphagia developed. Electroneuromyography (ENMG) was performed in our case. It was evaluated as compatible with botulismus. Antitoxin treatment was performed. Six hours after the end of the antitoxin infusion, the ocular findings regressed, swallowing function improved, and dysarthric speech improved. Inconclusion, ENMG is found to be helpful in treatment decisions before toxin detection. Although toxin cannot be detected in patients, ENMG findings play an important role in the diagnosis of botulism.