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Objectives: In this context, the objective of this study is to investigate the effect of variations in the neutrophil/lymphocyte ratio on the length of post-operative intensive care unit (ICU) stay in cases that were diagnosed with transposition of the great arteries (TGA) and who subsequently underwent arterial switch operation (ASO). Methods: This study was conducted with newborns that were diagnosed with TGA, followed up in the pediatric cardiac ICU, and who underwent ASO between January 1, 2021 and December 31, 2021. Variations in neutrophil-lymphocyte ratio (NLR) were recorded before and after the operation (day 1, 2, and 3). The primary endpoint was deemed as the prolonged post-operative ICU stay. For the purposes of this study, a prolonged post-operative ICU stay (PCILOS) was defined as a post-operative ICU stay that falls within the 25th percentile of the lengths of stay with the most extended durations. Results: The patient group comprised 45 patients. The median age of the patients was 3 (interquartile range [IQR] 2-7) days, and the median operation weight was 3000 (IQR 2800-3100) grams. Of the patients included in the study, 51% were male, and 49% were female. Median duration on a mechanical ventilator, the median length of ICU stay, and median length of hospital stay were 48 (IQR 24-96) hours, 6 (IQR 5-12) days, and 12 (IQR 10-16) days, respectively. PCILOS duration was determined as >8 days. Four (8.8%) patients died in the early period. Pre-operative NLR values of >1.5 and post-operative day-3 NLR values of >2.1 were found to be strong predictors of PCILOS. Conclusion: The findings of this study suggest that high NLR values in the pre-operative and early post-operative period in patients that were diagnosed with TGA and who underwent ASO were good predictors of prolonged ICU stays. [ABSTRACT FROM AUTHOR]

Objective: In this retrospective study, we aimed to evaluate the compatibility of endotracheal tube (ETT) size used during surgery with tracheal diameter measured by computed tomography(CT) and classic formulas in children who underwent CT imaging preoperatively due to surgical indications. Methods: The study included preoperatively CT scanned, 0-3 year-old patients who were operated due to congenital heart diseases between June 1-October 1, 2018.Using the CT scans, transverse and anteroposterior tracheal diameters were measured from the subglottic level. As these diameters reflect the external diameter of the ETT, the inner diameter-which corresponds the ETT size-was calculated using a correction formula. Besides, Cole’s formula was used to calculate the ETT size for each child, and the tube sizes used during surgeries were obtained from anesthesia charts.ETT sizes were compared. Results: 43 patients (22 girls [51.2%],21 boys [48.8%]) were included.The mean age was 10.5±9.6 months. 18 patients (41.9%) had cyanotic, 25 patients (58.1%) had acyanotic heart disease.Mean corrected transverse and anteroposterior tracheal diameters at CT images were 4.35±0.69mm and 4.30±0.71 mm, respectively. The mean diameter calculated by Cole’s formula was 4.22±0.20 mm. The mean tube size used during surgeries was 4.37±0.60 mm. There was no statistically significant difference between the tube sizes used during the surgeries and the corrected transverse tracheal diameters from CT measurements (p>0.05). But the tube sizes used during the surgeries found significantly larger than the diameters obtained by Cole’s formula (p<0.05). Conclusion: In 0-3 years of age pediatric patients who undergo a congenital heart surgery,corrected tracheal transverse diameter measured by CT is more effective,reliable and less invasive than classic formulas for determining appropriate ETT size. [ABSTRACT FROM AUTHOR]

Difficult airway, in other means having problems during tracheal intubation, is quite common in daily practice. When a unknown or unexpected difficult airway is faced, rapid intervention and appropriate management of the situation is life-saving. In this case report a patient who needed re-intubation due to respiratory distress caused by crusts in trachea during ICU follow-up after cardiac valve surgery. The process of unexpected difficulty in re-intubation was managed effectively by rapid and appropriate approach. [ABSTRACT FROM AUTHOR]