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Rosenthal VD, Yin R, Brown EC, Lee BH, Rodrigues C, Myatra SN, Kharbanda M, Rajhans P, Mehta Y, Todi SK, Basu S, Sahu S, Mishra SB, Chawla R, Nair PK, Arjun R, Singla D, Sandhu K, Palaniswamy V, Bhakta A, Nor MBM, Chian-Wern T, Bat-Erdene I, Acharya SP, Ikram A, Tumu N, Tao L, Alvarez GA, Valderrama-Beltran SL, Jiménez-Alvarez LF, Henao-Rodas CM, Gomez K, Aguilar-Moreno LA, Cano-Medina YA, Zuniga-Chavarria MA, Aguirre-Avalos G, Sassoe-Gonzalez A, Aleman-Bocanegra MC, Hernandez-Chena BE, Villegas-Mota MI, Aguilar-de-Moros D, Castañeda-Sabogal A, Medeiros EA, Dueñas L, Carreazo NY, Salgado E, Abdulaziz-Alkhawaja S, Agha HM, El-Kholy AA, Daboor MA, Guclu E, Dursun O, Koksal I, Havan M, Ozturk-Deniz SS, Yildizdas D, Okulu E, Omar AA, Memish ZA, Janc J, Hlinkova S, Duszynska W, Horhat-Florin G, Raka L, Petrov MM, Jin Z. Incidence and risk factors for catheter-associated urinary tract infection in 623 intensive care units throughout 37 Asian, African, Eastern European, Latin American, and Middle Eastern nations: A multinational prospective research of INICC. Infect Control Hosp Epidemiol 2024; 45:567-575. [PMID: 38173347 DOI: 10.1017/ice.2023.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To identify urinary catheter (UC)-associated urinary tract infection (CAUTI) incidence and risk factors. DESIGN A prospective cohort study. SETTING The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries. PARTICIPANTS The study included 169,036 patients, hospitalized for 1,166,593 patient days. METHODS Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression. RESULTS Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower-middle-income countries (3.05); and with patients in public hospitals (5.89).The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001). CONCLUSIONS CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
- International Nosocomial Infection Control Consortium, INICC Foundation, Miami, Florida, United States
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Eric Christopher Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | | | - Camilla Rodrigues
- Department of Microbiology, Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, India
| | | | - Prasad Rajhans
- Deenanath Mangeshkar Hospital and Research Center Erandwane Pune, Pune, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta the Medicity, Haryana, India
| | - Subhash Kumar Todi
- Department of Critical Care, Advanced Medicare Research Institute Hospitals, Kolkata, India
| | - Sushmita Basu
- Advanced Medicare Research Institute Mukundapur Unit, Kolkata, India
| | | | | | - Rajesh Chawla
- Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Rajalakshmi Arjun
- Department of Critical Care, Kerala Institute of Medical Sciences Health, Trivandrum, India
| | | | - Kavita Sandhu
- Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | | | - Arpita Bhakta
- Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd-Basri Mat Nor
- Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia
| | - Tai Chian-Wern
- Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | | | | | - Aamer Ikram
- Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - Nellie Tumu
- Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Lili Tao
- Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | | | | | | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | | | | | | | | | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
| | | | | | | | | | | | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Oguz Dursun
- Akdeniz University Medical School, Antalya, Turkey
| | - Iftihar Koksal
- Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Merve Havan
- Ankara University Faculty of Medicine, Ankara, Turkey
| | | | | | - Emel Okulu
- Ankara University Faculty of Medicine Childrens Hospital NICU, Ankara, Turkey
| | - Abeer Aly Omar
- Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, the Kingdom of Saudi Arabia
| | - Jarosław Janc
- 4th Clinical Military Hospital, Wroclaw, Poland, Europe
| | - Sona Hlinkova
- Faculty of Health, Catholic University in Ruzomberok, Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
| | - Wieslawa Duszynska
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - George Horhat-Florin
- University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | - Lul Raka
- National Institute For Public Health, Prishtina, Kosovo
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
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2
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Rosenthal VD, Jin Z, Brown EC, Dongol R, De Moros DA, Alarcon-Rua J, Perez V, Stagnaro JP, Alkhawaja S, Jimenez-Alvarez LF, Cano-Medina YA, Valderrama-Beltran SL, Henao-Rodas CM, Zuniga-Chavarria MA, El-Kholy A, Agha H, Sahu S, Mishra SB, Bhattacharyya M, Kharbanda M, Poojary A, Nair PK, Myatra SN, Chawla R, Sandhu K, Mehta Y, Rajhans P, Abdellatif-Daboor M, Chian-Wern T, Gan CS, Mohd-Basri MN, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Villegas-Mota I, Aleman-Bocanegra MC, Bat-Erdene I, Carreazo NY, Castaneda-Sabogal A, Janc J, Hlinkova S, Yildizdas D, Havan M, Koker A, Sungurtekin H, Dinleyici EC, Guclu E, Tao L, Memish ZA, Yin R. Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach. Am J Infect Control 2024; 52:580-587. [PMID: 38154739 DOI: 10.1016/j.ajic.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden. METHODS We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs. RESULTS During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P < .001), 5.34 in the 3rd month (RR = 0.35; 95% CI = 0.32-0.38; P < .001), and 2.23 in the 17 to 29 months (RR = 0.15; 95% CI = 0.13-0.17; P < .001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR = 0.84; P = .0013) at 17 to 29 months. CONCLUSIONS The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Infection Prevention, INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric C Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Reshma Dongol
- Department of Infection Prevention, Grande International Hospital, Kathamandu, Nepal
| | - Daisy A De Moros
- Department of Infection Prevention, Hospital Del Nino Dr Jose Renan Esquivel De Panama, Panama, Panama
| | - Johana Alarcon-Rua
- Department of Infection Prevention, Clinica Sebastian De Belalcazar, Cali, Colombia
| | - Valentina Perez
- Department of Biological Sciences, Florida International University, Miami, Fl, USA
| | - Juan P Stagnaro
- Department of Infection Prevention, Instituto Central De Medicina, Provincia De Buenos Aires, La Plata, Argentina
| | - Safaa Alkhawaja
- Department of Infection Prevention, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Yuliana A Cano-Medina
- Department of Infection Prevention, Instituto Del Corazon De Bucaramanga, Bogota, Colombia
| | - Sandra L Valderrama-Beltran
- Department of Infection Prevention, Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
| | - Claudia M Henao-Rodas
- Department of Infection Prevention, Fundacion Hospital San Jose De Buga, Guadalajara De Buga, Colombia
| | - Maria A Zuniga-Chavarria
- Department of Infection Prevention, Hospital Clinica Biblica, San Jose De Costa Rica, Costa Rica
| | - Amani El-Kholy
- Department of Infection Prevention, Dar Alfouad Hospital 6th Of October City, 6th Of October City, Egypt
| | - Hala Agha
- Department of Infection Prevention, Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
| | - Suneeta Sahu
- Department of Infection Prevention, Apollo Hospital Bhubaneswar, Bhubaneswar, India
| | - Shakti B Mishra
- Department of Infection Prevention, IMS And SUM Hospital, Bhubaneswar, India
| | - Mahuya Bhattacharyya
- Department of Infection Prevention, Advanced Medicare Research Institute Dhakuria Unit, Kolkata, India
| | - Mohit Kharbanda
- Department of Infection Prevention, Desun Hospital & Heart Institute Kolkata, Kolkata, India
| | - Aruna Poojary
- Department of Infection Prevention, Breach Candy Hospital Trust, Mumbai, India
| | - Pravin K Nair
- Department of Infection Prevention, Holy Spirit Hospital, Mumbai, India
| | - Sheila N Myatra
- Department of Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Chawla
- Department of Infection Prevention, Indraprastha Apollo Hospital Delhi, New Delhi, India
| | - Kavita Sandhu
- Department of Infection Prevention, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Yatin Mehta
- Department of Critical Care, Medanta The Medicity, New Delhi, India
| | - Prasad Rajhans
- Department of Infection Prevention, Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | | | - Tai Chian-Wern
- Department of Infection Prevention, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Chin Seng Gan
- Department of Infection Prevention, University Malaya Medical Centre Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Mat Nor Mohd-Basri
- Department of Infection Prevention, International Islamic University Malaysia Department Of Anesthesia And Critical Care, Kuantan, Malaysia
| | - Guadalupe Aguirre-Avalos
- Department of Critical Care, Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico
| | - Blanca E Hernandez-Chena
- Department of Infection Prevention, Hospital General Regional 6 De Ciudad Madero, Madero, Mexico
| | - Alejandro Sassoe-Gonzalez
- Department of Infection Prevention, Hospital Regional De Alta Especialidad De Ixtapaluca, Ixtapaluca, Mexico
| | - Isabel Villegas-Mota
- Department of Infection Prevention, Instituto Nacional De Perinatologia Unidad De Cuidados Intensivos Neonatales, Mexico City, Mexico
| | - Mary C Aleman-Bocanegra
- Department of Infection Prevention, Hospital San José De Monterrey Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ider Bat-Erdene
- Department of Infection Prevention, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Nilton Y Carreazo
- Department of Infection Prevention, Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | - Sona Hlinkova
- Department of Infection Prevention, Catholic University In Ruzomberok Faculty Of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
| | - Dincer Yildizdas
- Department of Infection Prevention, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
| | - Merve Havan
- Department of Infection Prevention, Ankara University Faculty Of Medicine, Ankara, Turkey
| | - Alper Koker
- Department of Infection Prevention, Akdeniz University Medical School, Antalya, Turkey
| | - Hulya Sungurtekin
- Department of Infection Prevention, Pamukkale University Hospital, Denizli, Turkey
| | - Ener C Dinleyici
- Department of Infection Prevention, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ertugrul Guclu
- Department of Infection Prevention, Sakarya University Training And Research Hospital, Sakarya, Turkey
| | - Lili Tao
- Department of Infection Prevention, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziad A Memish
- Department of Infection Prevention, King Saud Medical City, Ministry of Health, Riyadh, Arabia
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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3
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Zirek F, Tekin MN, Bayav S, Gurbanov A, Havan M, Fitoz S, Kendirli T, Çobanoğlu N. Diagnosis of interstitial lung disease after surgery in an adolescent. Pediatr Pulmonol 2024. [PMID: 38651921 DOI: 10.1002/ppul.27014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Fazılcan Zirek
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merve Nur Tekin
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Secahattin Bayav
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merve Havan
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Suat Fitoz
- Department of Radiology, Division of Pediatric Radiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatrics, Division of Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nazan Çobanoğlu
- Department of Pediatrics, Division of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Şahin S, Botan E, Gün E, Yüksel MF, Süt NY, Kartal AT, Gurbanov A, Kahveci F, Özen H, Havan M, Yıldırım M, Şahap SK, Bektaş Ö, Teber S, Fitoz S, Kendirli T. Correlation between early computed tomography findings and neurological outcome in pediatric traumatic brain injury patients. Neurol Sci 2024:10.1007/s10072-024-07511-x. [PMID: 38622450 DOI: 10.1007/s10072-024-07511-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. Head computed tomography (CT) is frequently utilized for evaluating trauma-related characteristics, selecting treatment options, and monitoring complications in the early stages. This study assessed the relationship between cranial CT findings and early and late neurological outcomes in pediatric TBI patients admitted to the pediatric intensive care unit (PICU). The study included children aged 1 month to 18 years who were admitted to the PICU due to TBI between 2014 and 2020. Sociodemographic data, clinical characteristics, and cranial CT findings were analyzed. Patients were categorized based on their Glasgow Coma Scale (GCS) score. Of the 129 patients, 83 (64%) were male, and 46 (36%) were female, with a mean age of 6.8 years. Falls (n = 51, 39.5%) and in-vehicle traffic accidents (n = 35, 27.1%) were the most common trauma types observed. Normal brain imaging findings were found in 62.7% of the patients, while 37.3% exhibited intracranial pathology. Hemorrhage was the most frequent CT finding. Severe TBI (n = 26, p = 0.032) and mortality (n = 9, p = 0.017) were more prevalent in traffic accidents. The overall mortality rate in the study population was 10.1%. In children with TBI, cranial CT imaging serves as an essential initial method for patients with neurological manifestations. Particularly, a GCS score of ≤ 8, multiple hemorrhages, diffuse cerebral edema, and intraventricular bleeding are associated with sequelae and mortality.
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Affiliation(s)
- Süleyman Şahin
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey.
| | - Edin Botan
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Merve Feyza Yüksel
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Nurşah Yeniay Süt
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Ayşe Tuğba Kartal
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Anar Gurbanov
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Merve Havan
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Miraç Yıldırım
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Seda Kaynak Şahap
- Department of Pediatric Radiology, Ankara University Medical School, Çocuk Radyoloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Ömer Bektaş
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Serap Teber
- Department of Pediatric Neurology, Ankara University Medical School, Çocuk Nöroloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Suat Fitoz
- Department of Pediatric Radiology, Ankara University Medical School, Çocuk Radyoloji Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care Unit, Ankara University Medical School, Çocuk Yoğun Bakım Bilim Dalı, Ankara Üniversitesi Tıp Fakültesi Çocuk Sağlığı Ve Hastalıkları A.B.D. Cebeci, Ankara, Turkey
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5
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Rosenthal VD, Jin Z, Yin R, Sahu S, Rajhans P, Kharbanda M, Nair PK, Mishra SB, Chawla R, Arjun R, Sandhu K, Rodrigues C, Dongol R, Myatra SN, Mohd-Basri MN, Chian-Wern T, Bhakta A, Bat-Erdene I, Acharya SP, Alvarez GA, Moreno LAA, Gomez K, da Jimenez-Alvarez LF, Henao-Rodas CM, Valderrama-Beltran SL, Zuniga-Chavarria MA, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Aleman-Bocanegra MC, Villegas-Mota MI, De Moros DA, Castaneda-Sabogal A, Carreazo NY, Alkhawaja S, Agha HM, El-Kholy A, Abdellatif-Daboor M, Dursun O, Okulu E, Havan M, Yildizdas D, Deniz SSO, Guclu E, Hlinkova S, Ikram A, Tao L, Omar AA, Elahi N, Memish ZA, Petrov MM, Raka L, Janc J, Horhat-Florin G, Medeiros EA, Salgado E, Dueñas L, Coloma M, Perez V, Brown EC. Assessing the impact of a multidimensional approach and an 8-component bundle in reducing incidences of ventilator-associated pneumonia across 35 countries in Latin America, Asia, the Middle East, and Eastern Europe. J Crit Care 2024; 80:154500. [PMID: 38128216 DOI: 10.1016/j.jcrc.2023.154500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal. METHODS We implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods. RESULTS 174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58-0.65; P < 0.001); 13.97 at the 3rd month (RR = 0.49; 95% CI = 0.46-0.52; P < 0.001); 14.44 at the 4-15 month (RR = 0.51; 95% CI = 0.48-0.53; P < 0.001); 11.40 at the 16-27 month (RR = 0.41; 95% CI = 0.38-0.42; P < 0.001), and to 9.68 at the 28-39 month (RR = 0.34; 95% CI = 0.32-0.36; P < 0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (p < 0.0001) during the 28th to 39th months after implementation of the intervention. CONCLUSIONS This intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Prasad Rajhans
- Deenanath Mangeshkar Hospital and Research Center Erandwane Pune, Pune, India
| | | | | | | | - Rajesh Chawla
- Indraprastha Apollo Hospital Delhi, New Delhi, India
| | | | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Camilla Rodrigues
- Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Mat Nor Mohd-Basri
- International Islamic University Malaysia, Department of Anesthesia and Critical Care, Kuantan, Malaysia
| | - Tai Chian-Wern
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Arpita Bhakta
- University Malaya Medical Centre, Department of Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Hala Mounir Agha
- Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
| | | | | | - Oguz Dursun
- Akdeniz University Medical School, Antalya, Turkey
| | - Emel Okulu
- Ankara University Faculty of Medicine Childrens Hospital NICU, Ankara, Turkey
| | - Merve Havan
- Ankara University Faculty of Medicine, Ankara, Turkey
| | | | | | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Sona Hlinkova
- Catholic University in Ruzomberok Faculty of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
| | - Aamer Ikram
- Armed Forces Institute of Urology, Rawalpindi, Pakistan
| | - Lili Tao
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Abeer Aly Omar
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
| | | | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria
| | - Lul Raka
- National Institute for Public Health, Prishtina, Kosovo
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | - George Horhat-Florin
- University of Medicine and Pharmacy Victor Babes Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | | | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Monica Coloma
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Valentina Perez
- Department of Biological Sciences, Florida International University, Miami, Fl, USA
| | - Eric Christopher Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Havan M, Tunç A. A Severe Degreaser Poisoning Treated Successfully with Extracorporeal Therapies in an Adolescent. When Should Charcoal Hemoperfusion Take Priority. Klin Padiatr 2024. [PMID: 38211620 DOI: 10.1055/a-2207-3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Merve Havan
- Pediatric Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ali Tunç
- Division of Pediatric Critical Care, Mersin İl Sağlık Müdürlüğü, Mersin, Turkey
- Division of Pediatric Intensive Care Unit, Mersin Il Saglik Mudurlugu, Mersin, Turkey
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7
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Rosenthal VD, Yin R, Nercelles P, Rivera-Molina SE, Jyoti S, Dongol R, Aguilar-De-Moros D, Tumu N, Alarcon-Rua J, Stagnaro JP, Alkhawaja S, Jimenez-Alvarez LF, Cano-Medina YA, Valderrama-Beltran SL, Henao-Rodas CM, Zuniga-Chavarria MA, El-Kholy A, Agha HM, Sahu S, Anusandhan SO, Bhattacharyya M, Kharbanda M, Poojary A, Nair PK, Myatra SN, Chawla R, Sandhu K, Mehta Y, Rajhans P, Zand F, Abdellatif-Daboor M, Tai CW, Gan CS, Mat Nor MB, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Villegas-Mota I, Aleman-Bocanegra MC, Bat-Erdene I, Carreazo NY, Castaneda-Sabogal A, Janc J, Belskiy V, Hlinkova S, Yildizdas D, Havan M, Koker A, Sungurtekin H, Dinleyici EC, Guclu E, Tao L, Memish ZA, Jin Z. International Nosocomial Infection Control Consortium (INICC) report of health care associated infections, data summary of 45 countries for 2015 to 2020, adult and pediatric units, device-associated module. Am J Infect Control 2024:S0196-6553(23)00879-9. [PMID: 38185380 DOI: 10.1016/j.ajic.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Reporting on the International Nosocomial Infection Control Consortium study results from 2015 to 2020, conducted in 630 intensive care units across 123 cities in 45 countries spanning Africa, Asia, Eastern Europe, Latin America, and the Middle East. METHODS Prospective intensive care unit patient data collected via International Nosocomial Infection Control Consortium Surveillance Online System. Centers for Disease Control and Prevention/National Health Care Safety Network definitions applied for device-associated health care-associated infections (DA-HAI). RESULTS We gathered data from 204,770 patients, 1,480,620 patient days, 936,976 central line (CL)-days, 637,850 mechanical ventilators (MV)-days, and 1,005,589 urinary catheter (UC)-days. Our results showed 4,270 CL-associated bloodstream infections, 7,635 ventilator-associated pneumonia, and 3,005 UC-associated urinary tract infections. The combined rates of DA-HAIs were 7.28%, and 10.07 DA-HAIs per 1,000 patient days. CL-associated bloodstream infections occurred at 4.55 per 1,000 CL-days, ventilator-associated pneumonias at 11.96 per 1,000 MV-days, and UC-associated urinary tract infections at 2.91 per 1,000 UC days. In terms of resistance, Pseudomonas aeruginosa showed 50.73% resistance to imipenem, 44.99% to ceftazidime, 37.95% to ciprofloxacin, and 34.05% to amikacin. Meanwhile, Klebsiella spp had resistance rates of 48.29% to imipenem, 72.03% to ceftazidime, 61.78% to ciprofloxacin, and 40.32% to amikacin. Coagulase-negative Staphylococci and Staphylococcus aureus displayed oxacillin resistance in 81.33% and 53.83% of cases, respectively. CONCLUSIONS The high rates of DA-HAI and bacterial resistance emphasize the ongoing need for continued efforts to control them.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA; Department of Infection Prevention, INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | | | - Sara E Rivera-Molina
- Department of Infection Prevention, Hospital Maria Especialidades Pediátricas, Tegucigalpa, Honduras
| | - Somani Jyoti
- Department of Infection Prevention, National University Hospital, Singapore, Singapore
| | - Reshma Dongol
- Department of Infection Prevention, Grande International Hospital, Kathamandu, Nepal
| | - Daisy Aguilar-De-Moros
- Department of Infection Prevention, Hospital Del Nino Dr Jose Renan Esquivel De Panama, Panama, Panama
| | - Nellie Tumu
- Department of Infection Prevention, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Johana Alarcon-Rua
- Department of Infection Prevention, Clinica Sebastian De Belalcazar, Cali, Colombia
| | - Juan P Stagnaro
- Department of Infection Prevention, Instituto Central De Medicina, Provincia De Buenos Aires, La Plata, Argentina
| | - Safaa Alkhawaja
- Department of Infection Prevention, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Yuliana A Cano-Medina
- Department of Infection Prevention, Instituto Del Corazon De Bucaramanga, Bogota, Colombia
| | - Sandra L Valderrama-Beltran
- Department of Infection Prevention, Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
| | - Claudia M Henao-Rodas
- Department of Infection Prevention, Department of Infection Prevention, Fundacion Hospital San Jose De Buga, Guadalajara De Buga, Colombia
| | - Maria A Zuniga-Chavarria
- Department of Infection Prevention, Hospital Clinica Biblica, San Jose De Costa Rica, Costa Rica
| | - Amani El-Kholy
- Department of Infection Prevention, Dar Alfouad Hospital 6th Of October City, 6th Of October City, Egypt
| | - Hala Mounir Agha
- Department of Infection Prevention, Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
| | - Suneeta Sahu
- Department of Infection Prevention, Apollo Hospital Bhubaneswar, Bhubaneswar, India
| | - Siksha O Anusandhan
- Department of Infection Prevention, IMS And SUM Hospital, Bhubaneswar, India
| | - Mahuya Bhattacharyya
- Department of Infection Prevention, Advanced Medicare Research Institute Dhakuria Unit, Kolkata, India
| | - Mohit Kharbanda
- Department of Infection Prevention, Desun Hospital & Heart Institute Kolkata, Kolkata, India
| | - Aruna Poojary
- Department of Microbiology, Breach Candy Hospital Trust, Mumbai, India
| | - Pravin K Nair
- Department of Infection Prevention, Holy Spirit Hospital, Mumbai, India
| | - Sheila N Myatra
- Department of Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Chawla
- Department of Infection Prevention, Indraprastha Apollo Hospital Delhi, New Delhi, India
| | - Kavita Sandhu
- Department of Infection Prevention, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Yatin Mehta
- Department of Critical Care, Medanta The Medicity, New Delhi, India
| | - Prasad Rajhans
- Department of Infection Prevention, Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Farid Zand
- Department of Infection Prevention, Nemazee Hospital Shiraz University Of Medical Sciences, Shiraz, Iran
| | | | - Chian-Wern Tai
- Department of Infection Prevention, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Chin S Gan
- Department of Infection Prevention, University Malaya Medical Centre Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Mohd-Basri Mat Nor
- Department of Infection Prevention, International Islamic University Malaysia Department Of Anesthesia And Critical Care, Kuantan, Malaysia
| | - Guadalupe Aguirre-Avalos
- Department of Critical Care, Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico
| | - Blanca E Hernandez-Chena
- Department of Infection Prevention, Hospital General Regional 6 De Ciudad Madero, Madero, Mexico
| | - Alejandro Sassoe-Gonzalez
- Department of Infection Prevention, Hospital Regional De Alta Especialidad De Ixtapaluca, Ixtapaluca, Mexico
| | - Isabel Villegas-Mota
- Department of Infection Prevention, Instituto Nacional De Perinatologia Unidad De Cuidados Intensivos Neonatales, Mexico City, Mexico
| | - Mary C Aleman-Bocanegra
- Department of Infection Prevention, Hospital San José De Monterrey Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ider Bat-Erdene
- Department of Infection Prevention, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Nilton Y Carreazo
- Department of Infection Prevention, Hospital De Emergencias Pediatricas, Lima, Peru
| | | | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | - Vladislav Belskiy
- Department of Infection Prevention, Privolzhskiy District Medical Center, Nizhniy Novgorod, Russia
| | - Sona Hlinkova
- Department of Infection Prevention, Catholic University In Ruzomberok Faculty Of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
| | - Dincer Yildizdas
- Department of Infection Prevention, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
| | - Merve Havan
- Department of Infection Prevention, Ankara University Faculty Of Medicine, Ankara, Turkey
| | - Alper Koker
- Department of Infection Prevention, Akdeniz University Medical School, Antalya, Turkey
| | - Hulya Sungurtekin
- Department of Infection Prevention, Pamukkale University Hospital, Denizli, Turkey
| | - Ener C Dinleyici
- Department of Infection Prevention, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ertugrul Guclu
- Department of Infection Prevention, Sakarya University Training And Research Hospital, Sakarya, Turkey
| | - Lili Tao
- Department of Infection Prevention, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziad A Memish
- Department of Infection Prevention, King Saud Medical City, Ministry of Health, Riyadh, Arabia
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
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8
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Jin Z, Yin R, Brown EC, Shukla B, Lee BH, Abdulaziz-Alkhawaja S, Magray TA, Agha HM, El-Sisi A, Ali El-Kholy A, Bayani V, Daboor MA, Ruzzieh MA
A, Guclu E, Olmez-Gazioglu E, Dursun O, Kara TT, Koksal I, Eroglu A, Havan M, Kendirli T, Ozturk Deniz SS, Aktas G, Yildizdas D, Horoz OO, Okulu E, Kostekci YE, Omar AA, Memish ZA, Rosenthal VD. Prospective Cohort Study of Incidence and Risk Factors for Catheter-associated Urinary Tract Infections in 212 Intensive Care Units of Nine Middle Eastern Countries. Oman Med J 2023; 38:e571. [PMID: 38283207 PMCID: PMC10822129 DOI: 10.5001/omj.2023.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/02/2023] [Indexed: 01/30/2024] Open
Abstract
Objectives To identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in nine Middle Eastern countries. Methods We conducted a prospective cohort study between 1 January 2014 and 2 December 2022 in 212 intensive care units (ICUs) of 67 hospitals in 38 cities in nine Middle Eastern countries (Bahrain, Egypt, Jordan, Kuwait, Lebanon, Morocco, Saudi Arabia, Turkey, and the UAE). To estimate CAUTI incidence, we used the number of UC days as denominator and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: patient sex, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, hospitalization type, ICU type, facility-ownership, country income level classified by World Bank, and time period. Results Among 50 637 patients hospitalized for 434 523 patient days, there were 580 cases of acquired CAUTIs. The pooled CAUTI rate per 1000 UC days was 1.84. The following variables were independently associated with CAUTI: age, rising risk 1.0% yearly (adjusted odds ratio [aOR] = 1.01, 95% CI: 1.01-1.02; p < 0.0001); female sex (aOR = 1.31, 95% CI: 1.09-1.56; p < 0.0001); LOS before CAUTI acquisition, rising risk 6.0% daily (aOR = 1.06, 95% CI: 1.05-1.06; p < 0.0001); and UC/DU ratio (aOR = 1.11, 95% CI: 1.06-1.14; p < 0.0001). Patients from lower-middle-income countries (aOR = 4.11, 95% CI: 2.49-6.76; p < 0.0001) had a similar CAUTI risk to the upper-middle countries (aOR = 3.75, 95% CI: 1.83-7.68; p < 0.0001). The type of ICU with the highest risk for CAUTI was neurologic ICU (aOR = 27.35, 95% CI: 23.03-33.12; p < 0.0001), followed by medical ICU (aOR = 6.18, 95% CI: 2.07-18.53; p < 0.0001) when compared to cardiothoracic ICU. The periods 2014-2016 (aOR = 7.36, 95% CI: 5.48-23.96; p < 0.001) and 2017-2019 (aOR = 1.15, 95% CI: 3.46-15.61; p < 0.001) had a similar risk to each other, but a higher risk compared to 2020-2022. Conclusions The following CAUTI RFs are unlikely to change: age, sex, ICU type, and country income level. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.
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Affiliation(s)
- Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Eric Christopher Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | - Bhavarth Shukla
- Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | | | | | | | - Hala Mounir Agha
- Department of Critical Care, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Amal El-Sisi
- Department of Critical Care, Cairo University Specialized Pediatric Hospital, Cairo, Egypt
| | - Amani Ali El-Kholy
- Department of Critical Care, Dar Alfouad Hospital, 6th of October City, Egypt
| | - Victor Bayani
- Department of Critical Care, Dar Alfouad Hospital, 6th of October City, Egypt
| | | | | | - Ertugrul Guclu
- Department of Critical Care, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Esra Olmez-Gazioglu
- Department of Critical Care, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Oguz Dursun
- Department of Critical Care, Akdeniz University Medical School, Antalya, Turkey
| | - Tuğçe Tural Kara
- Department of Critical Care, Akdeniz University Medical School, Antalya, Turkey
| | - Iftihar Koksal
- Department of Critical Care, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Ahmet Eroglu
- Department of Critical Care, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Merve Havan
- Department of Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Gizem Aktas
- Department of Critical Care, Pamukkale University Hospital, Denizli, Turkey
| | - Dincer Yildizdas
- Department of Critical Care, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
| | - Ozden Ozgur Horoz
- Department of Critical Care, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
| | - Emel Okulu
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
- Department of Critical Care, Salmaniya Medical Center, Manama, Bahrain
| | - Yasemin Ezgi Kostekci
- Neonatal Intensive Care Unit, Children’s Hospital, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Abeer Aly Omar
- Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait
| | - Ziad A. Memish
- Department of Infection Control, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
- International Nosocomial Infection Control Consortium Foundation, Miami, USA
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Kahveci F, Karaçoban G, Çelik NA, Gurbanov A, Uçmak H, Özen H, Balaban B, Botan E, Dikmen N, Havan M, Gökhan Ramoğlu M, Eyileten Z, Uçar T, Kendirli T. Venovenous Versus Venoarterial Extracorporeal Membrane Oxygenation: Pediatric Acute Respiratory Distress Syndrome. Turk Arch Pediatr 2023; 58:600-606. [PMID: 37818844 PMCID: PMC10724726 DOI: 10.5152/turkarchpediatr.2023.23025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/16/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE This study aimed to compare the efficacy, complication, and mortality of patients who were supported by venovenous (VV) extracorporeal membrane oxygenation (ECMO) and venoarterial (VA) ECMO for pediatric acute respiratory distress syndrome (PARDS). MATERIALS AND METHODS This study is a single-center, retrospective cohort study between 2014 and 2022. We evaluated to indication of ECMO support, ECMO type, patients' demographic features, complications, and children's outcomes supported by ECMO for PARDS. RESULTS Twenty-two patients with PARDS, 12 (54%) with VV, and 10 (46%) with VA ECMO were selected. The median number of days to be intubated before ECMO cannulation was 5 (0-16) days. The distribution of intubated days before the patients underwent ECMO was as follows: 0-1 days, 7 (31.8%) patients; 2-3 days, 2 (9.1%) patients; 4-7 days, 7 (31.8%) patients; 8-14 days, 5 (22.8%) patients; >14 days, 1 (4.5%) patient. The median ECMO cannulation day after admission to the pediatric intensive care unit was 3 (range, 1-9) days in the VV ECMO patient group, whereas it was 8 (range, 0-19) days in the VA ECMO group (P = .02). Considering hospital survival, 4 (45%) patients who underwent double-lumen VV ECMO, 1 (33%) patient who underwent VV ECMO, and 3 (30%) patients who supported by VAECMO survived. There was no difference between the groups in terms of hospital discharge rates. CONCLUSION The highest survival rate was found in the VV ECMO patient group established with double-lumen cannulas, similar to the literature. There was no difference in mortality between the groups whose intubation time before ECMO was 14 days or less.
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Affiliation(s)
- Fevzi Kahveci
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Gülçin Karaçoban
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Ayça Çelik
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Edin Botan
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Dikmen
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Gökhan Ramoğlu
- Division of Pediatrics, Department of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Eyileten
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tayfun Uçar
- Division of Pediatrics, Department of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatrics, Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
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Köstekci YE, Kendirli T, Gün E, Uçmak H, Demirtaş F, Havan M, Köse E, Okulu E, Eminoğlu FT, Erdeve Ö, Atasay B, Arsan S. Evaluation of the efficacy and associated complications of regional citrate anticoagulation in neonates: experience from a fourth level neonatal intensive care unit. Eur J Pediatr 2023; 182:4897-4908. [PMID: 37597047 DOI: 10.1007/s00431-023-05162-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023]
Abstract
Continuous kidney replacement therapy (CKRT) use has increased in recent years, but anticoagulation is a challenge for neonates. Regional citrate anticoagulation (RCA) is rarely preferred in neonates because of citrate accumulation (CA) and metabolic complications. We aimed to demonstrate the efficacy and safety of RCA in neonates. We retrospectively analyzed the medical records of 11 neonates treated with RCA-CKRT between 2018 and 2023. The initial dose of RCA was 2.1-3 mmol/l, and then, its dose was increased according to the level of ionized calcium (iCa+2) in the circuit and patients. The total/iCa+2 ratio after-treatment > 2.5 was indicated as CA. We evaluated to citrate dose, CA, circuit lifespan, and dialysis effectivity. The median gestational age was 39 (36.4-41.5) weeks, the median body weight (BW) was 3200 (2400-4000) grams, and the mean postnatal age was 4 (2-24) days. The most common indication for CKRT was hyperammonemia (73%). All neonates had metabolic acidosis and hypocalcemia during CKRT. Other common metabolic complications were hypophosphatemia (90%), hypokalemia (81%), and hypomagnesemia (63%). High dialysate rates with a median of 5765 ml/h/1.73 m2 allowed for a rapid decrease in ammonia levels to normal. Four patients (36.3%) had CA, and seven (63.7%) did not (non-citrate accumulation, NCA). Mean BW, median postnatal age, biochemical parameters, coagulation tests, and ammonia levels were similar between the CA and NCA groups. Low pH, low HCO3, high lactate, and SNAPPE-II scores could be associated with a higher T/iCa ratio. CONCLUSION RCA was an efficient and safe anticoagulation for neonates requiring CKRT. Metabolic complications may occur, but they could be managed with adequate supplementation. WHAT IS KNOWN • Continuous kidney replacement therapy (CKRT) has become popular in recent years due to its successful treatment of fluid overload, electrolyte imbalance, metabolic acidosis, multi-organ failure, and hyperleucinemia/hyperammonemia associated with inborn errors of metabolism. • The need for anticoagulation is the major difficulty in neonatal CKRT. In adult and pediatric patients, regional citrate anticoagulation has been shown to be effective. WHAT IS NEW • RCA is an effective and safe anticoagulation method for neonates who require CKRT. • Electrolyte imbalances and metabolic acidosis could be managed with adequate supplementation and appropriate treatment parameters such as citrate dose, blood flow rate, and dialysate flow rate.
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Affiliation(s)
- Yasemin Ezgi Köstekci
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, 06590, Mamak, Ankara, Turkey.
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ferhan Demirtaş
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, 06590, Mamak, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Engin Köse
- Division of Pediatric Metabolism, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emel Okulu
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, 06590, Mamak, Ankara, Turkey
| | - Fatma Tuba Eminoğlu
- Division of Pediatric Metabolism, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ömer Erdeve
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, 06590, Mamak, Ankara, Turkey
| | - Begüm Atasay
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, 06590, Mamak, Ankara, Turkey
| | - Saadet Arsan
- Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, 06590, Mamak, Ankara, Turkey
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11
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Ulgen Tekerek N, Dursun O, Asilioglu Yener N, Yildizdas D, Anıl AB, Kendirli T, Koker A, Karalok S, Aksoy A, Kinik Kaya E, Ekinci F, Incecik F, Olgac Dundar N, Durak F, Botan E, Havan M, Sahin S, Duman O, Haspolat S. Posttraumatic epilepsy in critically ill children with traumatic brain injury. Childs Nerv Syst 2023; 39:3207-3214. [PMID: 37480521 DOI: 10.1007/s00381-023-06087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The aim of this study was to determine the clinical, laboratory, and radiological factors related with posttraumatic epilepsy (PTE). METHODS The study is a multicenter descriptive cross-sectional cohort study. Children who followed up for TBI in the pediatric intensive care unit between 2014 and 2021 were included. Demographic data and clinical and radiological parameters were recorded from electronic case forms. All patients who were in the 6-month posttraumatic period were evaluated by a neurologist for PTE. RESULTS Four hundred seventy-seven patients were included. The median age at the time of trauma was 66 (IQR 27-122) months, and 298 (62.5%) were male. Two hundred eighty (58.7%) patients had multiple traumas. The mortality rate was 11.7%. The mean duration of hospitalization, pediatric intensive care unit hospitalization and mechanical ventilation, Rotterdam score, PRISM III score, and GCS at admission were higher in patients with epilepsy (p < 0.05). The rate of epilepsy was higher in patients with severe TBI, cerebral edema on tomography and clinical findings of increased intracranial pressure, blood transfusion in the intensive care unit, multiple intracranial hemorrhages, and intubated patients (p < 0.05). In logistic regression analysis, the presence of intracranial hemorrhage in more than one compartment of the brain (OR 6.13, 95%CI 3.05-12.33) and the presence of seizures (OR 9.75, 95%CI 4.80-19.83) were independently significant in terms of the development of epilepsy (p < 0.001). CONCLUSIONS In this multicenter cross-sectional study, intracranial hemorrhages in more than one compartment and clinical seizures during intensive care unit admission were found to be independent risk factors for PTE development in pediatric intensive care unit patients with TBI.
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Affiliation(s)
- Nazan Ulgen Tekerek
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
- Akdeniz University Hospital, Dumlupınar Boulevard, Konyaalti, Antalya, 07059, Turkey.
| | - Oguz Dursun
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Nazik Asilioglu Yener
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Dincer Yildizdas
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ayşe Berna Anıl
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Katip Celebi University, İzmir, Turkey
| | - Tanil Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Alper Koker
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Selen Karalok
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ayşe Aksoy
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Elif Kinik Kaya
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Faruk Ekinci
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Faruk Incecik
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Nihal Olgac Dundar
- Division of Pediatric Neurology, Department of Pediatrics, Katip Celebi Faculty of Medicine, İzmir, Turkey
| | - Fatih Durak
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Katip Celebi University, İzmir, Turkey
| | - Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Intensive Care, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Suleyman Sahin
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ozgur Duman
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Senay Haspolat
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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12
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Misirlioglu M, Yildizdas D, Ekinci F, Ozgur Horoz O, Tumgor G, Yontem A, Talay MN, Kangin M, Tufan E, Kesici S, Yener N, Kinik Kaya HE, Havan M, Tunc A, Akçay N, Sevketoglu E, Durak F, Ozel Dogruoz A, Ozcan S, Perk O, Duyu M, Boyraz M, Uysal Yazici M, Ozturk Z, Çeleğen M, Bukulmez A, Kacmaz E, Cagri Dinleyici E, Dursun O, Koker A, Bayraktar S, Talip Petmezci M, Nabaliyeva A, Agin H, Hepduman P, Akkuzu E, Kendirli T, Ozen H, Topal S, Ödek Ç, Ozkale M, Ozkale Y, Atay G, Erdoğan S, Konca C, Yapici G, Arslan G, Besci T, Yilmaz R, Gumus M, Oto A, Dalkiran T, Mercan M, Çoban Y, Ipek S, Gungor S, Arslankoylu AE, Alakaya M, Sari F, Yucel A, Yazar A. Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey. Front Pediatr 2023; 11:1179721. [PMID: 37601138 PMCID: PMC10436004 DOI: 10.3389/fped.2023.1179721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/29/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Malnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies. Material and Method In this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined. Results Of the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024). Conclusion Timely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score.
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Affiliation(s)
- Merve Misirlioglu
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Dincer Yildizdas
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Faruk Ekinci
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Ozden Ozgur Horoz
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Gokhan Tumgor
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Ahmet Yontem
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - Mehmet Nur Talay
- Department of Pediatrics, Health Sciences University, Gazi Yasargil Training and Research Hospital, Diyarbakir, Türkiye
| | - Murat Kangin
- Department of Pediatric Intensive Care, Faculty of Medicine, Medipol University, Istanbul, Türkiye
| | - Erennur Tufan
- Department of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Selman Kesici
- Department of Pediatric Intensive Care, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Nazik Yener
- Department of Pediatric Intensive Care, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
| | - Hatice Elif Kinik Kaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Türkiye
| | - Merve Havan
- Department of Pediatric Intensive Care, Mersin City Training and Research Hospital, Mersin, Türkiye
| | - Ali Tunc
- Department of Pediatrics, Mersin City Training and Research Hospital, Mersin, Türkiye
| | - Nihal Akçay
- Department of Pediatric Intensive Care, University of Health Sciences Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | - Esra Sevketoglu
- Department of Pediatric Intensive Care, University of Health Sciences Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye
| | - Fatih Durak
- Department of Pediatric Intensive Care, İzmir Health Sciences University, Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Aysenur Ozel Dogruoz
- Department of Pediatric Intensive Care, İzmir Health Sciences University, Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Serhan Ozcan
- Department of Pediatric Intensive Care, Ankara City Hospital, Ankara, Türkiye
| | - Oktay Perk
- Department of Pediatric Intensive Care, Ankara City Hospital, Ankara, Türkiye
| | - Muhterem Duyu
- Department of Pediatric Intensive Care, Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| | - Merve Boyraz
- Department of Pediatric Intensive Care, Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| | - Mutlu Uysal Yazici
- Department of Pediatric Intensive Care, Health Sciences University Ankara, Dr. Sami Ulus Obstetrics Child Health and Diseases Training and Research Hospital, Ankara, Türkiye
| | - Zeynelabidin Ozturk
- Department of Pediatric Intensive Care, Health Sciences University Ankara, Dr. Sami Ulus Obstetrics Child Health and Diseases Training and Research Hospital, Ankara, Türkiye
| | - Mehmet Çeleğen
- Department of Pediatric Intensive Care, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Aysegul Bukulmez
- Department of Pediatric Gastroenterology, Faculty of Medicine, Hepatology and Nutrition, Afyonkarahisar Health Sciences University, Afyonkarahisar, Türkiye
| | - Ebru Kacmaz
- Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye
| | - Ener Cagri Dinleyici
- Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye
| | - Oguz Dursun
- Department of Pediatric Intensive Care, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Alper Koker
- Department of Pediatric Intensive Care, Faculty of Medicine, Akdeniz University, Antalya, Türkiye
| | - Suleyman Bayraktar
- Department of Pediatric Intensive Care, Sultangazi Haseki Training and Research Hospital, Istanbul, Türkiye
| | - Mey Talip Petmezci
- Department of Pediatric Intensive Care, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Türkiye
| | - Aygul Nabaliyeva
- Department of Pediatric Intensive Care, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Türkiye
| | - Hasan Agin
- Department of Pediatric Intensive Care, University of Health Sciences Izmir, Dr. Behcet Uz Child Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Pinar Hepduman
- Department of Pediatric Intensive Care, University of Health Sciences Izmir, Dr. Behcet Uz Child Diseases and Surgery Training and Research Hospital, Izmir, Türkiye
| | - Emine Akkuzu
- Department of Pediatric Intensive Care, Isparta City Hospital, Isparta, Türkiye
| | - Tanil Kendirli
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - Hasan Ozen
- Department of Pediatric Intensive Care, Faculty of Medicine, Ankara University, Ankara, Türkiye
| | - Sevgi Topal
- Department of Pediatric Intensive Care, Erzurum Regional Training and Research Hospital, ErzurumTürkiye
| | - Çağlar Ödek
- Department of Pediatric Intensive Care, Faculty of Medicine, Uludag University, Bursa, Türkiye
| | - Murat Ozkale
- Department of Pediatric Intensive Care, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Teaching and Medical Research Center, Adana, Türkiye
| | - Yasemin Ozkale
- Department of Pediatric Intensive Care, Faculty of Medicine, Baskent University, Adana Dr Turgut Noyan Teaching and Medical Research Center, Adana, Türkiye
| | - Gürkan Atay
- Department of Pediatric Intensive Care, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Seher Erdoğan
- Department of Pediatric Intensive Care, Umraniye Training and Research Hospital, Istanbul, Türkiye
| | - Capan Konca
- Department of Pediatric Intensive Care, Adiyaman Training and Research Hospital, Adiyaman, Türkiye
| | - Guler Yapici
- Department of Pediatric Intensive Care, Adiyaman Training and Research Hospital, Adiyaman, Türkiye
| | - Gazi Arslan
- Department of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Tolga Besci
- Department of Pediatric Intensive Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Türkiye
| | - Resul Yilmaz
- Department of Pediatric Intensive Care, Faculty of Medicine, Selcuk University, Konya, Türkiye
| | - Meltem Gumus
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Selcuk University, Konya, Türkiye
| | - Arzu Oto
- Department of Pediatric Intensive Care, University of Health Sciences Bursa High Specialization Hospital, Bursa, Türkiye
| | - Tahir Dalkiran
- Department of Pediatric Intensive Care, Necip Fazil City Hospital, Kahramanmaras, Türkiye
| | - Mehmet Mercan
- Department of Pediatrics, Necip Fazil City Hospital, Kahramanmaras, Türkiye
| | - Yasemin Çoban
- Department of Pediatric Intensive Care, Faculty of Medicine, Mugla University, Mugla, Türkiye
| | - Sevcan Ipek
- Department of Pediatric Intensive Care, Faculty of Medicine, Sutcu Imam University, Kahramanmaras, Türkiye
| | - Sukru Gungor
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Sutcu Imam University, Kahramanmaras, Türkiye
| | - Ali Ertug Arslankoylu
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Mehmet Alakaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Ferhat Sari
- Department of Pediatric Intensive Care, Faculty of Medicine, Hatay Mustafa Kemal University, Hatay, Türkiye
| | - Aylin Yucel
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Türkiye
| | - Abdullah Yazar
- Department of Pediatric Intensive Care, Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Türkiye
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13
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Öztürk M, Botan E, Gün E, Baskin AK, İslamoğlu C, Erkol GH, Havan M, Çakmak FH, Haskoloğlu Ş, İleri T, İnce E, Doğu F, Ertem M, İkinciogullari A, Kendirli T. The Determining Factors for Outcome of Pediatric Intensive Care Admitted Children After Stem Cell Transplantation. J Pediatr Hematol Oncol 2023; 45:e768-e772. [PMID: 36706283 DOI: 10.1097/mph.0000000000002610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/07/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Requiring pediatric intensive care unit (PICU) admission relates to high mortality and morbidity in patients who received hematopoietic stem cell transplantation (HSCT). In this study, we aimed to evaluate the indications for PICU admission, treatments, and the determining risk factors for morbidity and mortality in patients who had allogeneic HSCT from various donors. MATERIALS AND METHODS In this retrospective study, we enrolled to patients who required the PICU after receiving allogeneic HSCT at our Pediatric Bone Marrow Transplantation Unit between 2005 and 2020. We evaluated to indication to PICU admission, applications, mortality rate, and the determining factors to outcomes. RESULTS Thirty-three (7%) patients had 47 PICU admissions and 471 patients underwent bone marrow transplantation during 16-year study period. Also, 14 repeated episodes were registered in 9 different patients. The median age of PICU admitted patients was 4 (0.3 to 18) years and 29 (62%) were male. The main reasons for PICU admission were a respiratory failure, sepsis, and neurological event in 20, 8, and 7 patients, respectively. The average length of PICU stay was 14.5 (1 to 80) days, 14 (43%) of patients survived and the mortality rate was 57%. Multiple organ failure ( P =0.001), need for respiratory support ( P =0.007), inotrope agents ( P =0.001), and renal replacement therapy ( P =0.013) were found as significant risk factors for mortality. CONCLUSIONS Allogeneic HSCT recipients need PICU admission because of its related different life-threatening complications. But there is a good chance of survival with quality PICU care and different advanced organ support methods.
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Affiliation(s)
| | - Edin Botan
- Division of Pediatric Critical Care Medicine
| | - Emrah Gün
- Division of Pediatric Critical Care Medicine
| | | | | | - Gül Hatice Erkol
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Critical Care Medicine
| | - Fatih Hasan Çakmak
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Talia İleri
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif İnce
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Figen Doğu
- Department of Pediatric Allergy and Immunology
| | - Mehmet Ertem
- Department of Pediatric Hematology and Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
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14
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Bozan G, Pérez-Brocal V, Aslan K, Kiral E, Sevketoglu E, Uysal Yazici M, Azapagasi E, Kendirli T, Emeksiz S, Dursun O, Yildizdas D, Anil AB, Akcay N, Kihtir HS, Havan M, Ulgen Tekerek N, Ekinci F, Kilic O, Moya A, Dinleyici EC. Analysis of Intestinal and Nasopharyngeal Microbiota of Children with Meningococcemia in Pediatric Intensive Care Unit: INMACS-PICU Study. Diagnostics (Basel) 2023; 13:1984. [PMID: 37370879 DOI: 10.3390/diagnostics13121984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/02/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Microbiota composition might play a role in the pathophysiology and course of sepsis, and understanding its dynamics is of clinical interest. Invasive meningococcal disease (IMD) is an important cause of community-acquired serious infection, and there is no information regarding microbiota composition in children with meningococcemia. In this study, we aimed to evaluate the intestinal and nasopharyngeal microbiota composition of children with IMD. Materials and Methods: In this prospective, multi-center study, 10 children with meningococcemia and 10 age-matched healthy controls were included. Nasopharyngeal and fecal samples were obtained at admission to the intensive care unit and on the tenth day of their hospital stay. The V3 and V4 regions of the 16S rRNA gene were amplified following the 16S Metagenomic Sequencing Library Preparation. Results: Regarding the alpha diversity on the day of admission and on the tenth day at the PICU, the Shannon index was significantly lower in the IMD group compared to the control group (p = 0.002 at admission and p = 0.001, on the tenth day of PICU). A statistical difference in the stool samples was found between the IMD group at Day 0 vs. the controls in the results of the Bray-Curtis and Jaccard analyses (p = 0.005 and p = 0.001, respectively). There were differences in the intestinal microbiota composition between the children with IMD at admission and Day 10 and the healthy controls. Regarding the nasopharyngeal microbiota analysis, in the children with IMD at admission, at the genus level, Neisseria was significantly more abundant compared to the healthy children (p < 0.001). In the children with IMD at Day 10, genera Moraxella and Neisseria were decreased compared to the healthy children. In the children with IMD on Day 0, for paired samples, Moraxella, Neisseria, and Haemophilus were significantly more abundant compared to the children with IMD at Day 10. In the children with IMD at Day 10, the Moraxella and Neisseria genera were decreased, and 20 different genera were more abundant compared to Day 0. Conclusions: We first found alterations in the intestinal and nasopharyngeal microbiota composition in the children with IMD. The infection itself or the other care interventions also caused changes to the microbiota composition during the follow-up period. Understanding the interaction of microbiota with pathogens, e.g., N. meningitidis, could give us the opportunity to understand the disease's dynamics.
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Affiliation(s)
- Gurkan Bozan
- Pediatric Intensive Care Unit, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Turkey
| | - Vicente Pérez-Brocal
- Area of Genomics and Health, Foundation for the Promotion of Sanitary and Biomedical Research of Valencia Region (FISABIO-Public Health), 46020 Valencia, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBEResp), 28029 Madrid, Spain
| | - Kaan Aslan
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Turkey
| | - Eylem Kiral
- Pediatric Intensive Care Unit, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Turkey
| | - Esra Sevketoglu
- Pediatric Intensive Care Unit, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul 34147, Turkey
| | - Mutlu Uysal Yazici
- Pediatric Intensive Care Unit, Faculty of Medicine, Gazi University, Ankara 06500, Turkey
| | - Ebru Azapagasi
- Pediatric Intensive Care Unit, Faculty of Medicine, Gazi University, Ankara 06500, Turkey
| | - Tanil Kendirli
- Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara 06590, Turkey
| | - Serhat Emeksiz
- Pediatric Intensive Care Unit, Ankara City Hospital, Ankara 06800, Turkey
| | - Oguz Dursun
- Pediatric Intensive Care Unit, Faculty of Medicine, Akdeniz University, Antalya 07070, Turkey
| | - Dincer Yildizdas
- Pediatric Intensive Care Unit, Faculty of Medicine, Cukurova University, Adana 01790, Turkey
| | - Ayse Berna Anil
- Pediatric Intensive Care Unit, Faculty of Medicine, Izmir Katip Celebi University, Izmir 35620, Turkey
| | - Nihal Akcay
- Pediatric Intensive Care Unit, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul 34147, Turkey
| | - Hasan Serdar Kihtir
- Department of Pediatric Critical Care, Antalya Training and Research Hospital, University of Health Sciences, Antalya 07100, Turkey
| | - Merve Havan
- Pediatric Intensive Care Unit, Faculty of Medicine, Ankara University, Ankara 06590, Turkey
| | - Nazan Ulgen Tekerek
- Pediatric Intensive Care Unit, Faculty of Medicine, Akdeniz University, Antalya 07070, Turkey
| | - Faruk Ekinci
- Pediatric Intensive Care Unit, Faculty of Medicine, Cukurova University, Adana 01790, Turkey
| | - Omer Kilic
- Division of Pediatric Infectious Diseases, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Turkey
| | - Andres Moya
- Area of Genomics and Health, Foundation for the Promotion of Sanitary and Biomedical Research of Valencia Region (FISABIO-Public Health), 46020 Valencia, Spain
- Biomedical Research Networking Center for Epidemiology and Public Health (CIBEResp), 28029 Madrid, Spain
- Institute for Integrative Systems Biology (I2SysBio), University of Valencia and Spanish National Research Council (CSIC), 46010 Valencia, Spain
| | - Ener Cagri Dinleyici
- Pediatric Intensive Care Unit, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Turkey
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Havan M, Uçmak H, Kendirli T. Pediatric Ventilator Liberation Guideline: Should the T-Piece and Automatic Tube Compensation Be Ignored in the Spontaneous Breathing Trial? Am J Respir Crit Care Med 2023; 207:1404-1405. [PMID: 36930960 PMCID: PMC10595460 DOI: 10.1164/rccm.202302-0300le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Affiliation(s)
- Merve Havan
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
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16
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Kahveci F, Gurbanov A, Uçmak H, Ödemiş AS, Özen H, Balaban B, Botan E, Gün E, Havan M, Dikmen N, Ramoğlu MG, Uçar T, Eyileten Z, Akar AR, Kendirli T. Prolonged extracorporeal membrane oxygenation in pediatrics: How long did we wait? Perfusion 2023:2676591231172607. [PMID: 37137815 DOI: 10.1177/02676591231172607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND In this study, we aimed to evaluate the duration of extracorporeal membrane oxygenation (ECMO) and its effect on outcomes. Also, we sought to identify hospital mortality predictors and determine when ECMO support began to be ineffective. METHODS This was a single-center, retrospective cohort study conducted between January 2014 and January 2022. The prolonged ECMO (pECMO) cut-off point was accepted as 14 days. RESULTS Thirty-one (29.2%) of 106 patients followed up with ECMO had pECMO. The mean follow-up period of the patients who underwent pECMO was 22 (range, 15-72) days, and the mean age was 75 ± 72 months. According to the results of our heterogeneous study population, life expectancy decreased dramatically towards the 21st day. Hospital mortality predictors were determined in the logistic regression analysis in all ECMO groups in our study as high Pediatric Logistic Organ Dysfunction (PELOD) two score, continuous renal replacement therapy (CRRT) use, and sepsis. The pECMO mortality was 61.2% and the overall mortality was 53.0%, with the highest mortality rate in the bridge-to-transplant group (90.9%) because of lack of organ donation in our country. CONCLUSIONS In our study, the PELOD two score, presence of sepsis, and use of CRRT were found to be in the predictors of in-hospital ECMO mortality model. Considering the complications, in the COX regression model analysis, the factors affecting the probability of dying in patients followed under ECMO were found to be bleeding, thrombosis, and thrombocytopenia.
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Affiliation(s)
- Fevzi Kahveci
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aslı Samsa Ödemiş
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Dikmen
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Gökhan Ramoğlu
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tayfun Uçar
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Eyileten
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Rüçhan Akar
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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17
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Kahveci F, Coşkun MK, Uçmak H, Özen H, Gurbanov A, Balaban B, Dikmen N, Karagözlü S, Sarıcaoğlu MC, Botan E, Gün E, Havan M, Ramoğlu MG, Uçar T, Eyileten Z, Tutar E, Akar AR, Kendirli T. Hybrid extracorporeal membrane oxynegation in pediatric intensive care patients: A single center experience: More is better? Perfusion 2023:2676591231168537. [PMID: 37010553 DOI: 10.1177/02676591231168537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND The initial extracorporeal membrane oxygenation (ECMO) configuration is inefficient for patient oxygenation and flow, but by adding a Y-connector, a third or fourth cannula can be used to support the system, which is called hybrid ECMO. METHODS This was a single-center retrospective study consisting of patients receiving hybrid and standard ECMO in our PICU between January 2014 and January 2022. RESULTS The median age of the 12 patients who received hybrid ECMO and were followed up with hybrid ECMO was 140 (range, 82-213) months. The total median ECMO duration of the patients who received hybrid ECMO was 23 (8-72) days, and the median follow-up time on hybrid ECMO was 18 (range, 3-46) days. The mean duration of follow-up in the PICU was 34 (range, 14-184) days. PICU length of stay was found to be statistically significant and was found to be longer in the hybrid ECMO group (p = 0.01). Eight (67%) patients died during follow-up with ECMO. Twenty-eight-day mortality was found to be statistically significant and was found to be higher in the standard ECMO group (p = 0.03). The hybrid ECMO mortality rate was 66% (decannulation from ECMO). The hybrid ECMO hospital mortality rate was 75%. The standard ECMO mortality rate was 52% (decannulation from ECMO). The standard ECMO hospital mortality rate was 65%. CONCLUSIONS Even though hybrid ECMO use is rare, with increasing experience and new methods, more successful experience will be gained. Switching to hybrid ECMO from standard ECMO at the right time with the right technique can increase treatment success and survival.
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Affiliation(s)
- Fevzi Kahveci
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mert Kaan Coşkun
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Anar Gurbanov
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Dikmen
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Selen Karagözlü
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Edin Botan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Gökhan Ramoğlu
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tayfun Uçar
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Eyileten
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ercan Tutar
- Division of Pediatric Cardiology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Rüçhan Akar
- Department of Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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Havan M, Kendirli T, Parlar ÖT, Özcan S, Yahşi A, Erat T, Öcal D, Guriz H, Özdemir H, Karahan ZC, Çiftci E, İnce E. Clinical Management of a Pandrug-Resistant OXA-48 Klebsiella pneumoniae Infection in the Pediatric Intensive Care Unit. Microb Drug Resist 2023. [PMID: 36912811 DOI: 10.1089/mdr.2022.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is one of the serious forms of health care-associated infection. Pan-drug resistant (PDR) CRKP infections can cause severe infections. Mortality and treatment costs in the pediatric intensive care unit (PICU) are high. This study aims to share our experience regarding the treatment of oxacillinase (OXA)-48-positive PDR-CRKP infection in our 20-bed tertiary PICU with isolated rooms and 1 nurse for every 2-3 patients. Methods: Patient demographic characteristics, underlying diseases, previous infections, source of infection PDR-CRKP, treatment modalities, measures used, and outcomes were recorded. Findings: Eleven patients (eight men and three women) were found to have PDR OXA-48-positive CRKP. Because of the simultaneous detection of PDR-CRKP in three patients and the rapid spread of the disease, it was classified as a clinical outbreak, and strict infection control measures were taken. Combination therapy with double carbapenemase (meropenem and imipenem), amikacin, colistin, and tigecycline was used for treatment. The mean duration of treatment and isolation was 15.7 and 65.4 days, respectively. No treatment-related complication was observed, only one patient died, and the mortality rate was 9%. Conclusions: This severe clinical outbreak can be successfully treated with effective treatment with combined antibiotics and strict adherence to infection control measures. ClinicalTrial.gov ID: 28/01/2022 - 1/5.
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Affiliation(s)
- Merve Havan
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özgün Tutku Parlar
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serhan Özcan
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aysun Yahşi
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tuğba Erat
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Duygu Öcal
- Department of Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Haluk Guriz
- Department of Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Ceren Karahan
- Department of Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Ergin Çiftci
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erdal İnce
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
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19
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Gurbanov A, Çelik NA, Gurbanova L, Gün E, Botan E, Balaban B, Kahveci F, Özen H, Uçmak H, Çağlayan U, Havan M, Vatansever G, Tekin D, Kendirli T. Clinical and Laboratory Features and Factors Determining the Outcome in Poisoning Children in a Tertiary Pediatric Intensive Care Unit: Eleven Years of Experience. Turk Arch Pediatr 2023; 58:189-196. [PMID: 36856357 PMCID: PMC10081007 DOI: 10.5152/turkarchpediatr.2023.22206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate the characteristics of patients admitted to a pediatric intensive care unit for poisoning and the factors associated with their outcomes. MATERIALS AND METHODS Patients who were admitted to the pediatric intensive care unit for poisoning over the 11-year period between January 2010 and December 2020 were retrospectively analyzed. The patients' demographic characteristics, poisoning agent, whether the poisoning was unintentional or intentional (suicide attempt), clinical findings at admission, indication for hospitalization, antidote administered, and supportive and extracorporeal treatments were examined. RESULTS During the study period, poisonings accounted for 9.4% (436/4653) of pediatric intensive care unit admissions. Of these, 419 patients with complete records were included in the analysis. Drug poisonings accounted for 81.9% of cases (multiple drugs in 38.5%). The most common drug group was central nervous system drugs (47%). Of the symptomatic patients, 56.5% had central nervous system-related findings and 55% had gastrointestinal findings. Before pediatric intensive care unit admission, 52.7% of the patients received activated charcoal and 7.4% received antidote therapy. In the pediatric intensive care unit, 68.9% of patients received no medical treatment, while 71.5% of those who received medical treatment had organ involvement. Multivariate logistic regression analysis to predict whether patients will require treatment during the intensive care follow-up showed that antidote administration before pediatric intensive care unit admission was associated with the need for medical treatment (odds ratio: 25.6, 95% CI: 6.8-96, P < .05). Three patients died, and the mortality rate was 0.72%. CONCLUSION Childhood poisoning is a widespread and important problem. Effective management in pediatric emergency and intensive care units contributes to patient survival without sequelae.
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Affiliation(s)
- Anar Gurbanov
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nur Ayça Çelik
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Lala Gurbanova
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Edin Botan
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Burak Balaban
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fevzi Kahveci
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hasan Özen
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hacer Uçmak
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Utku Çağlayan
- Department of Pediatric Emergency Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Göksel Vatansever
- Department of Pediatric Emergency Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Deniz Tekin
- Department of Pediatric Emergency Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
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20
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Sık G, Inamlık A, Akçay N, Kesici S, Aygun F, Kendırlı T, Atay G, Sandal O, Varol F, Ozkaya PY, Duyu M, Bırbılen AZ, Ozcan S, Arslan G, Kangın M, Bayraktar S, Altug U, Anıl AB, Havan M, Yetımakman AF, Dalkıran T, Zengın N, Oto A, Kıhtır HS, Gırgın Fİ, Telhan L, Yıldızdas D, Yener N, Yukselmıs U, Alakaya M, Kılınc MA, Celegen M, Dursun A, Battal F, Sarı F, Ozkale M, Topal S, Kocaoglu C, Yazar A, Alacakır N, Odek C, Yaman A, Cıtak A. Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study. Pediatr Res 2023:10.1038/s41390-023-02518-0. [PMID: 36813951 PMCID: PMC9946280 DOI: 10.1038/s41390-023-02518-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. METHODS A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. RESULTS The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. CONCLUSIONS In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. IMPACT MIS-C is a life-threatening condition. Patients need to be followed up in the intensive care unit. Early detection of factors associated with mortality can improve outcomes. Determining the factors associated with mortality and length of stay will help clinicians in patient management. High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.
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Affiliation(s)
- Guntulu Sık
- Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
| | - Aysegul Inamlık
- grid.411117.30000 0004 0369 7552Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Nihal Akçay
- grid.414177.00000 0004 0419 1043Department of Pediatric Intensive Care, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selman Kesici
- grid.14442.370000 0001 2342 7339Department of Pediatric Intensive Care, Hacettepe University, Ankara, Turkey
| | - Fatih Aygun
- grid.506076.20000 0004 1797 5496Department of Pediatric Intensive Care, İstanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Tanıl Kendırlı
- grid.7256.60000000109409118Department of Pediatric Intensive Care, Ankara University, Ankara, Turkey
| | - Gurkan Atay
- grid.417018.b0000 0004 0419 1887Department of Pediatric Intensive Care, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Sandal
- Department of Pediatric Intensive Care, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Fatih Varol
- grid.414850.c0000 0004 0642 8921Department of Pediatric Intensive Care, Sancaktepe Şehit Prof. MD İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Pınar Yazıcı Ozkaya
- grid.8302.90000 0001 1092 2592Department of Pediatric Intensive Care, Ege University, Izmir, Turkey
| | - Muhterem Duyu
- Department of Pediatric Intensive Care, Goztepe Prof. MD Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Ahmet Ziya Bırbılen
- Department of Pediatric Intensive Care, Gaziantep Cengiz Gökçek Gynecology and Pediatrics Hospital, Gaziantep, Turkey
| | - Serhan Ozcan
- grid.449874.20000 0004 0454 9762Department of Pediatric Intensive Care, Ankara Yıldırım Beyazıt University, Ankara Children’s Hospital, Ankara, Turkey
| | - Gazi Arslan
- grid.21200.310000 0001 2183 9022Department of Pediatric Intensive Care Unit, Dokuz Eylül University, Izmir, Turkey
| | - Murat Kangın
- Department of Pediatric Intensive Care, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Suleyman Bayraktar
- grid.413752.60000 0004 0419 1465Department of Pediatric Intensive Care, Sultangazi Haseki Training and Research Hospital, Istanbul, Turkey
| | - Umit Altug
- Department of Pediatric Intensive Care, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Ayşe Berna Anıl
- Department of Pediatric Intensive Care, Tepecik Training and Research Hospital, Izmır Katip Çelebi University, Izmir, Turkey
| | - Merve Havan
- Department of Pediatric Intensive Care, Mersin City Hospital, Mersin, Turkey
| | - Ayse Filiz Yetımakman
- grid.411105.00000 0001 0691 9040Department of Pediatric Intensive Care, Kocaeli University, Kocaeli, Turkey
| | - Tahir Dalkıran
- Department of Pediatric Intensive Care, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Neslihan Zengın
- grid.411688.20000 0004 0595 6052Department of Pediatric Intensive Care, Manisa Celal Bayar Unıversity, Manisa, Turkey
| | - Arzu Oto
- Department of Pediatric Intensive Care, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Hasan Serdar Kıhtır
- grid.413819.60000 0004 0471 9397Department of Pediatric Intensive Care, Antalya Training and Research Hospital, Antalya, Turkey
| | - Feyza İnceköy Gırgın
- grid.16477.330000 0001 0668 8422Department of Pediatric Intensive Care, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Leyla Telhan
- grid.411781.a0000 0004 0471 9346Department of Pediatric Intensive Care, Medipol University, Istanbul, Turkey
| | - Dincer Yıldızdas
- grid.98622.370000 0001 2271 3229Department of Pediatric Intensive Care, Cukurova University, Adana, Turkey
| | - Nazik Yener
- grid.411049.90000 0004 0574 2310Department of Pediatric Intensive Care, Samsun 19 Mayıs University, Samsun, Turkey
| | - Ufuk Yukselmıs
- grid.414850.c0000 0004 0642 8921Department of Pediatric Intensive Care, Kartal Dr Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Alakaya
- grid.411691.a0000 0001 0694 8546Department of Pediatric Intensive Care, Mersin University, Mersin, Turkey
| | - Mehmet Arda Kılınc
- Department of Pediatric Intensive Care, Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkey
| | - Mehmet Celegen
- Department of Pediatric Intensive Care, Afyonkarahisar Tarining and Research Hospital, Afyon, Turkey
| | - Adem Dursun
- grid.513116.1Department of Pediatric Intensive Care, Kayseri City Hospital, Kayseri, Turkey
| | - Fatih Battal
- grid.412364.60000 0001 0680 7807Department of Pediatric Intensive Care, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ferhat Sarı
- grid.14352.310000 0001 0680 7823Department of Pediatric Intensive Care, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Murat Ozkale
- grid.411548.d0000 0001 1457 1144Department of Pediatric Intensive Care, Dr Turgut NOYAN Hospital, Baskent University, Adana, Turkey
| | - Sevgi Topal
- Department of Pediatric Intensive Care, Erzurum Bölge Training and Research Hospital, Erzurum, Turkey
| | - Celebi Kocaoglu
- Department of Pediatric Intensive Care, Konya City Hospital, Konya, Turkey
| | - Abdullah Yazar
- grid.411124.30000 0004 1769 6008Department of Pediatric Intensive Care, Necmettin Erbakan University, Konya, Turkey
| | - Nuri Alacakır
- grid.411693.80000 0001 2342 6459Department of Pediatric Intensive Care, Trakya University, Edirne, Turkey
| | - Caglar Odek
- grid.34538.390000 0001 2182 4517Department of Pediatric Intensive Care, Bursa Uludağ University, Bursa, Turkey
| | - Ayhan Yaman
- grid.508740.e0000 0004 5936 1556Department of Pediatric Intensive Care, Istınye University Liv Hospital, Istanbul, Turkey
| | - Agop Cıtak
- grid.411117.30000 0004 0369 7552Department of Pediatric Intensive Care, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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Havan M, Kendirli T. Response to Letter to Editor. Pediatr Cardiol 2023; 44:504-505. [PMID: 36585994 DOI: 10.1007/s00246-022-03091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Merve Havan
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Tanıl Kendirli
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
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22
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Akcay N, Kihtir HS, Durak C, Kendirli T, Havan M, Kockuzu E, Bozan G, Sevketoglu E. Mortality Risk Factors Among Critically Ill Children With Acute COVID-19 in PICUs: A Multicenter Study From Turkish Pediatric Critical COVID-19 and MIS-C Study Group. Pediatr Infect Dis J 2022; 41:742-750. [PMID: 35703298 PMCID: PMC9359682 DOI: 10.1097/inf.0000000000003592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. METHODS A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. RESULTS Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. CONCLUSIONS This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality.
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Affiliation(s)
- Nihal Akcay
- From the Department of Pediatric Critical Care Medicine, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hasan Serdar Kihtir
- Division of Pediatric Critical Care Medicine University of Health Sciences Turkey, Antalya Training and Research Hospital, Antalya, Turkey
| | - Cansu Durak
- Department of Pediatric Critical Care Medicine, Istanbul University- Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Tanil Kendirli
- Department of Pediatric Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Division of Pediatric Critical Care Medicine, Mersin City Training and Research Hospital Mersin, Turkey
| | - Esra Kockuzu
- Division of Pediatric Critical Care Medicine, Dortcelik Children’s Hospital, Bursa, Turkey
| | - Gurkan Bozan
- Department of Pediatric Critical Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Esra Sevketoglu
- From the Department of Pediatric Critical Care Medicine, University of Health Sciences Turkey, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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23
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Özcan S, Gunes MSA, Havan M, Perk O, Azapağası E, Gün E, Botan E, Ergun E, Ates U, Kahilogullari G, Kendirli T. Comparison of pre-PICU and per-PICU interventions, clinical features and neurologic outcomes of motor vehicle collision trauma and other mechanisms of trauma in children. ULUS TRAVMA ACIL CER 2022; 28:456-463. [PMID: 35485520 PMCID: PMC10443131 DOI: 10.14744/tjtes.2022.86617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/27/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Motor vehicle collisions (MVCs) are the number one cause of death in the pediatric age group. The aim of this study was to determine the differences between MVCs and other trauma mechanisms (OTMs) in patients who were followed up at a pediatric intensive care unit (PICU). METHODS Data were retrospectively collected for pediatric trauma patients hospitalized at a third level PICU between 2014 and 2018. Patients have been divided into two groups as MVC and OTM. Demographic data, pre-PICU interventions (cardiopulmonary resuscitation, intubation, injury severity scores, time period before intensive care), intensive care interventions (invasive mechanical ventilation, non-invasive mechanical ventilation, need for surgery, type of surgery, need for transfusion, and inotrope therapy) were compared between two groups. Outcomes were evaluated by survival, discharge from hospital, Pediatric Cerebral Performance Cate-gory (PCPC) at discharge, tracheotomy presence, and amputation performed. RESULTS During the 5-year study period, 135 patients were hospitalized for trauma. The injured body regions were the head and neck (61.5%), abdomen and lumbar spine (39.4%), and extremities and pelvis (36.3%). Multiple trauma was mostly seen in the MVC trauma group (p=0.001). The need for invasive mechanical ventilation and inotrope therapy was greater in the MVC group (p=0.002, 0.001 respectively). One hundred and twenty-three patients (91.1%) survived. The mortality rate was higher in the MVC group (p=0.026). The PCPC results were better in the OTM group (p=0.017). CONCLUSION MVCs lead to more multiple trauma cases than OTMs. Invasive mechanical ventilation, inotropes, and other inten-sive care interventions were necessary much more often in MVC victims than in OTM patients.
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Affiliation(s)
- Serhan Özcan
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | | | - Merve Havan
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Oktay Perk
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Ebru Azapağası
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Emrah Gün
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Edin Botan
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Ergun Ergun
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Ufuk Ates
- Department of Pediatric Surgery, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Gokmen Kahilogullari
- Department of Neurosurgery, Ankara University Faculty of Medicine, Ankara-Turkey
| | - Tanıl Kendirli
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara-Turkey
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24
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Gökcan Öztürk A, Küçük ZE, Özcan S, Havan M, Gün E, Botan E, Kendirli T. Use of Therapeutic Plasma Exchange in the Pediatric Intensive Care Unit. Turk Arch Pediatr 2022; 57:186-192. [PMID: 35383013 PMCID: PMC9366156 DOI: 10.5152/turkarchpediatr.2022.21209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Objective: Therapeutic plasma exchange has been used as a primary or supportive treatment in many diseases in recent years and has achieved satisfactory results in lots of diseases in children. Therapeutic plasma exchange procedure is changing plasma component of a patient's blood with the new plasma as a replacement solution. The aim of this study is to share our experience of therapeutic plasma exchange on varying indications in critically ill children who were accepted to our pediatric intensive care unit. Materials and Methods: We conducted this study between December 2010 and February 2020, retrospectively. Patients’ data such as age, sex, indication, number of sessions, vascular access route, and type of replacement fluid used were obtained from medical records. Indications for therapeutic plasma exchange were classified according to the 2019 American Society for Apheresis categorization. The patient’s follow-up, clinical courses, therapeutic plasma exchange season count, complications, and outcome were evaluated according to each indications and their overall condition. Results: This study included a total of the 84 patients who underwent therapeutic plasma exchange, and their median (minimum-maximum) ages were 7.07 years (0.2-18), 57.1% were male (n = 48) and 42.9% were female (n = 36). A total of 463 sessions of therapeutic plasma exchange were performed in 84 patients. The most common indication was thrombocytopenia-associated multi-organ failure with sepsis (40.4%, n = 34) followed by liver failure/hepatic encephalopathy (28.5%, n = 24) and autoimmune encephalitis (9.5%, n = 8), and according to The American Society for Apheresis 2019 category, patients distributions were as follows: 15.4% of the patients were placed in category 1 (n = 13), 5.9% in category 2 (n = 5), 77.3% in category 3 (n = 65), and 1.1% in category 4 (n = 1). Therapeutic plasma exchange was combined to extracorporeal membrane oxygenation in 10 patients (11.9%) and continuous renal replacement therapies in 39 (46.4%) patients. Finally, the survival rate was 50% in all patients, and the lowest survival rate was 41.5% (n = 27) in category 3 group. Conclusion: Therapeutic plasma exchange is enlarging to varying indications and showing to be more effective on a lot of disorders in children. Also, it is available in pediatric age groups and in different states like combined with other extracorporeal therapies.
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Affiliation(s)
- Ahmet Gökcan Öztürk
- Department of Pediatrics, Ankara University, Faculty of Medicine, Ankara, Turkey
- Corresponding author:Ahmet Gökcan Öztürk✉
| | - Zeynep Erva Küçük
- Department of Pediatrics, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Serhan Özcan
- Divison of Pediatric Critical Care Medicine, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Merve Havan
- Divison of Pediatric Critical Care Medicine, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Emrah Gün
- Divison of Pediatric Critical Care Medicine, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Edin Botan
- Divison of Pediatric Critical Care Medicine, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Divison of Pediatric Critical Care Medicine, Ankara University, Faculty of Medicine, Ankara, Turkey
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25
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Vatansever G, Yılmaz HL, Nalbant T, Kanğin M, Almış H, Köker A, Çeleğen M, Tekşam Ö, Bozlu G, Havan M, Arslanköylü AE, Güleryüz OD, Battal F, Özkaya PY, Yener N, Yıldızdaş D, Duran R, Tekin D, Ulukol B, Kendirli T. Clinical characteristics of firearm-related injuries in children in Turkey. Turk J Pediatr 2022; 64:971-984. [PMID: 36583879 DOI: 10.24953/turkjped.2021.4564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND A significant number of children are injured by or die from firearm-related incidents every year, although there is a lack of global data on the number of children admitted to pediatric emergency departments (PEDs) and pediatric intensive care units (PICU) with firearm injuries. This study is the most comprehensive analysis of firearm injuries sustained by children in Turkey to date. METHODS This multicenter, retrospective, cohort study was conducted between 2010 and 2020 with the contributions of the PEDs, PICUs, intensive care units, and surgery departments of university hospitals and research hospitals. RESULTS A total of 508 children were admitted to hospital with firearm-related injuries in the research period, although the medical records of only 489 could be obtained. Of the total admissions to hospitals, 55.0% were identified as unintentional, 8.2% as homicide, 4.5% as self-harm, and 32.3% as undetermined. The Glasgow Coma Scale (GCS) and ventilation support were found to be the most significant predictors of mortality, while head/neck injury, length of stay (LOS) in the hospital and surgical interventions were found to be the most significant predictors of disability. The overall mortality of firearm-related injuries was 6.3%, and the mortality for children admitted to the PICU was 19.8%. The probability of disability was calculated as 96.0% for children hospitalized with firearm injuries for longer than 75 days. CONCLUSIONS Head/neck injury, LOS in the hospital, and surgical interventions were found to be the most significant parameters for the prediction of disability. Hospitalization exceeding 6 days was found to be related to disability.
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Affiliation(s)
- Göksel Vatansever
- Divisions of Pediatric Emergency Medicine Department of Pediatrics, Ankara University Faculty of Medicine, Ankara
| | - Hayri Levent Yılmaz
- Divisions of Pediatric Emergency Medicine Department of Pediatrics, Çukurova University Faculty of Medicine, Adana
| | - Tuğçe Nalbant
- Divisions of Pediatric Emergency Medicine, Department of Pediatrics, Tepecik Education and Research Hospital, İzmir
| | - Murat Kanğin
- Division of Pediatric Intensive Care, Department of Pediatrics, Sağlık Bilimleri University, Gazi Yasargil Training and Research Hospital, Diyarbakır
| | - Habip Almış
- Department of Pediatrics, Adıyaman University Faculty of Medicine, Adıyaman
| | - Alper Köker
- Division of Pediatric Intensive Care, Department of Pediatrics, Antalya University Faculty of Medicine, Antalya
| | - Mehmet Çeleğen
- Division of Pediatric Intensive Care, Department of Pediatrics, Afyon University Faculty of Medicine, Afyon
| | - Özlem Tekşam
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara
| | - Gülçin Bozlu
- Department of Pediatrics, Mersin University Faculty of Medicine, Mersin
| | - Merve Havan
- Division of Pediatric Intensive Care, Mersin City Hospital, Mersin
| | | | - Okşan Derinöz Güleryüz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Gazi University Faculty of Medicine, Ankara
| | - Fatih Battal
- Department of Pediatrics, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale
| | - Pınar Yazıcı Özkaya
- Division of Pediatric Intensive Care, Department of Pediatrics, Ege University Faculty of Medicine, İzmir
| | - Nazik Yener
- Division of Pediatric Intensive Care, Department of Pediatrics, Ondokuz Mayıs University Faculty of Medicine, Samsun
| | - Dinçer Yıldızdaş
- Divisions of Pediatric Intensive Care, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana
| | - Rıdvan Duran
- Department of Pediatrics, Trakya University Faculty of Medicine, Edirne, Türkiye
| | - Deniz Tekin
- Divisions of Pediatric Emergency Medicine Department of Pediatrics, Ankara University Faculty of Medicine, Ankara
| | - Betül Ulukol
- Social Pediatrics and Department of Pediatrics, Ankara University Faculty of Medicine, Ankara
| | - Tanıl Kendirli
- Pediatric Intensive Care, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara
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- Turkish Pediatric Firearm Study Group
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26
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Botan E, Uyar E, Öztürk Z, Şevketoğlu E, Sarı Y, Dursun O, Sincar Ş, Duyu M, Oto A, Celegen M, Özçiftçi G, Havan M, Nilüfer Öztürk M, Ağın H, Yener N, Yaman A, Gün E, Yılmaz M, Şimşek N, Özdemir H, Yıldızdaş D, Kendirli T. COVID-19 Transmission and Clinical Features in Pediatric Intensive Care Health Care Workers. Turk Arch Pediatr 2022; 57. [PMID: 35110085 PMCID: PMC8867499 DOI: 10.5152/turkarchpediatr.2021.21205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE This study aims to investigate modes of transmission and clinical features of coronavirus disease 2019 in healthcare workers in pediatric intensive care units. MATERIALS AND METHODS This multicenter descriptive study was conducted between March and November 2020. Patient demographics, clinical characteristics, origin of coronavirus disease 2019, treatment modalities, and loss of workdays were recorded. RESULTS Seven hundred and sixty-eight healthcare workers from 16 pediatric intensive care units were enrolled and 114 (14.8%) healthcare workers with a mean age of 29.7 ± 6.7 years became coronavirus disease 2019 patients. Seventy-six (66.7%) patients were female. Approximately half (54.3%) of the patients were physicians, 34.2% were nurses, and 11.4% were ancillary staff. Transmission was deemed to occur through patient contact in 54.3% of the patients. Comorbid illness was present 10.5% of the patients. Transmission occurred during endotracheal intubation in 21%, cardiopulmonary resuscitation in 9.6%, and non-invasive ventilation in 12.2% of patients, while transmission was a result of multiple possible procedures in 43.8%. Intensive care admission was needed for 13.1% of the patients. Five patients needed oxygen by cannula, 7 needed oxygen with a non-rebreathing mask, 5 needed high-flow nasal cannula support, 5 needed non-invasive ventilation, and 3 needed invasive mechanical ventilation. Fortunately, no infected healthcare workers died. CONCLUSION Coronavirus disease 2019 in healthcare workers is a significant problem in pediatric intensive care units. Transmission seems to occur particularly frequently during patient care procedures such as intubation, ventilation and aerosol therapy, which highlights the importance of proper use of full sets of personal protective equipment during all procedures during care of coronavirus disease 2019 patients.
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Affiliation(s)
- Edin Botan
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey,Corresponding author:Edin Botan✉
| | - Emel Uyar
- Department of Pediatric Critical Care Medicine, Ankara City Hospital, Ankara, Turkey
| | - Zeynelabidin Öztürk
- Department of Pediatric Critical Care Medicine, Health Sciences University, Ankara Dr. Sami Ulus Women, Children’s Health and Diseases Education And Research Hospital, Ankara, Turkey
| | - Esra Şevketoğlu
- Department of Pediatric Critical Care Medicine, Health Sciences University Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Yusuf Sarı
- Department of Pediatric Critical Care Medicine, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Oğuz Dursun
- Department of Pediatric Critical Care Medicine, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Şahin Sincar
- Department of Pediatric Critical Care Medicine, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - Muhterem Duyu
- Department of Pediatric Critical Care Medicine, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Turkey
| | - Arzu Oto
- Department of Pediatric Critical Care Medicine, University of Health Sciences Bursa Highly Specialized Training and Research Hospital, Bursa, Turkey
| | - Mehmet Celegen
- Department of Pediatric Critical Care Medicine, Afyonkarahisar University of Health Sciences, Afyon, Turkey
| | - Gökçen Özçiftçi
- Department of Pediatric Critical Care Medicine, Health Sciences University Van Training and Research Hospital, Van, Turkey
| | - Merve Havan
- Department of Pediatric Critical Care Medicine, Mersin City Education and Research Hospital, Mersin, Turkey
| | - Makbule Nilüfer Öztürk
- Department of Pediatric Critical Care Medicine, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Hasan Ağın
- Department of Pediatric Intensive Care, University of Health Sciences Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Nazik Yener
- Department of Pediatric Intensive Care, Samsun Ondokuz Mayıs University Faculty of Medicine, Turkey
| | - Ayhan Yaman
- Department of Pediatric Intensive Care, Istinye University Liv Hospital, İstanbul, Turkey
| | - Emrah Gün
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Merve Yılmaz
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Naile Şimşek
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Dinçer Yıldızdaş
- Department of Pediatric Intensive Care, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
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27
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Kiral E, Kirel B, Havan M, Keskin M, Karaoglan M, Yildirim A, Kangin M, Talay MN, Urun T, Altug U, Kesici S, Tufan E, Kacmaz E, Bozan G, Azapagasi E, Uysal Yazici M, Ozturk Z, Yesilbas O, Karaguzel G, Kaya G, Barlas U, Duyu M, Boyraz M, Sevketoglu E, Akcay N, Hancili S, Guven A, Dursun O, Ulgen Tekerek N, Ozcifci G, Yazici P, Turanli E, Kendirli T, Kahveci F, Yetimakman AF, Citak A, Şik G, Bingol I, Aygun F, Durak C, Yilmaz R, Bugrul F, Sari Y, Tekguç H, Albayrak H, Yener N, Agin H, Soydan E, Yildizdas D, Dilek SO, Yalindag N, Incekoy-Girgin F, Alacakir N, Tutunculer F, Arslanaoglu MO, Aydin C, Bilgin M, Simsek E, Dinleyici EC. Increased Severe Cases and New-Onset Type 1 Diabetes Among Children Presenting With Diabetic Ketoacidosis During First Year of COVID-19 Pandemic in Turkey. Front Pediatr 2022; 10:926013. [PMID: 35844756 PMCID: PMC9277100 DOI: 10.3389/fped.2022.926013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/31/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION There have been some significant changes regarding healthcare utilization during the COVID-19 pandemic. Majority of the reports about the impact of the COVID-19 pandemic on diabetes care are from the first wave of the pandemic. We aim to evaluate the potential effects of the COVID-19 pandemic on the severity of diabetic ketoacidosis (DKA) and new onset Type 1 diabetes presenting with DKA, and also evaluate children with DKA and acute COVID-19 infection. METHODS This is a retrospective multi-center study among 997 children and adolescents with type 1 diabetes who were admitted with DKA to 27 pediatric intensive care units in Turkey between the first year of pandemic and pre-pandemic year. RESULTS The percentage of children with new-onset Type 1 diabetes presenting with DKA was higher during the COVID-19 pandemic (p < 0.0001). The incidence of severe DKA was also higher during the COVID-19 pandemic (p < 0.0001) and also higher among children with new onset Type 1 diabetes (p < 0.0001). HbA1c levels, duration of insulin infusion, and length of PICU stay were significantly higher/longer during the pandemic period. Eleven patients tested positive for SARS-CoV-2, eight were positive for new onset Type 1 diabetes, and nine tested positive for severe DKA at admission. DISCUSSION The frequency of new onset of Type 1 diabetes and severe cases among children with DKA during the first year of the COVID-19 pandemic. Furthermore, the cause of the increased severe presentation might be related to restrictions related to the pandemic; however, need to evaluate the potential effects of SARS-CoV-2 on the increased percentage of new onset Type 1 diabetes.
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Affiliation(s)
- Eylem Kiral
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Birgul Kirel
- Department of Pediatric Endocrinology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Merve Havan
- Pediatric Intensive Care Unit, Mersin City Hospital, University of Health Sciences, Mersin, Turkey
| | - Mehmet Keskin
- Department of Pediatric Endocrinology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Murat Karaoglan
- Department of Pediatric Endocrinology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Ahmet Yildirim
- Department of Pediatric Endocrinology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey
| | - Murat Kangin
- Pediatric Intensive Care Unit, Gazi Yasargil Training and Research Hospital, University of Heath Sciences, Diyarbakir, Turkey
| | - Mehmet Nur Talay
- Pediatric Intensive Care Unit, Gazi Yasargil Training and Research Hospital, University of Heath Sciences, Diyarbakir, Turkey
| | - Tuba Urun
- Pediatric Intensive Care Unit, Gazi Yasargil Training and Research Hospital, University of Heath Sciences, Diyarbakir, Turkey
| | - Umit Altug
- Pediatric Intensive Care Unit, Sanliurfa Training and Research Hospital, University of Heath Sciences, Sanliurfa, Turkey
| | - Selman Kesici
- Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erennur Tufan
- Pediatric Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Kacmaz
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Gurkan Bozan
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Ebru Azapagasi
- Pediatric Intensive Care Unit, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Mutlu Uysal Yazici
- Pediatric Intensive Care Unit, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Zeynelabidin Ozturk
- Pediatric Intensive Care Unit, Dr Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Osman Yesilbas
- Pediatric Intensive Care Unit, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gulay Karaguzel
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical Universit, Trabzon, Turkey
| | - Gulay Kaya
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical Universit, Trabzon, Turkey
| | - Ulkem Barlas
- Pediatric Intensive Care Unit, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Muhterem Duyu
- Pediatric Intensive Care Unit, Prof. Dr. Süleyman Yalcin City Hospital, Medeniyet University, Istanbul, Turkey
| | - Merve Boyraz
- Pediatric Intensive Care Unit, Prof. Dr. Süleyman Yalcin City Hospital, Medeniyet University, Istanbul, Turkey
| | - Esra Sevketoglu
- Pediatric Intensive Care Unit, Bakirköy Dr Sadi Konuk Research and Training Hospital, University of Heath Sciences, Istanbul, Turkey
| | - Nihal Akcay
- Pediatric Intensive Care Unit, Bakirköy Dr Sadi Konuk Research and Training Hospital, University of Heath Sciences, Istanbul, Turkey
| | - Suna Hancili
- Department of Pediatric Endocrinology, Zeynep Kamil Women and Children Diseases Traning and Research Hospital, University of Heath Sciences, Istanbul, Turkey
| | - Ayla Guven
- Department of Pediatric Endocrinology, Zeynep Kamil Women and Children Diseases Traning and Research Hospital, University of Heath Sciences, Istanbul, Turkey
| | - Oǧuz Dursun
- Pediatric Intensive Care Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Nazan Ulgen Tekerek
- Pediatric Intensive Care Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Gokçen Ozcifci
- Van Training and Research Hospital, University of Heath Sciences, Van, Turkey
| | - Pinar Yazici
- Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Eda Turanli
- Pediatric Intensive Care Unit, Ege University Faculty of Medicine, Izmir, Turkey
| | - Tanil Kendirli
- Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fevzi Kahveci
- Pediatric Intensive Care Unit, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ayse Filiz Yetimakman
- Pediatric Intensive Care Unit, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Agop Citak
- Pediatric Intensive Care Unit, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Guntulu Şik
- Pediatric Intensive Care Unit, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ibrahim Bingol
- Pediatric Intensive Care Unit, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Fatih Aygun
- Pediatric Intensive Care Unit, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Cansu Durak
- Pediatric Intensive Care Unit, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Resul Yilmaz
- Pediatric Intensive Care Unit, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Fuat Bugrul
- Department of Pediatric Endocrinology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Yusuf Sari
- Pediatric Intensive Care Unit, Firat University Faculty of Medicine, Elazig, Turkey
| | - Hakan Tekguç
- Pediatric Intensive Care Unit, Dr. Burhan Nalbantoglu Hospital, Lefkosa, Cyprus
| | - Hatice Albayrak
- Pediatric Intensive Care Unit, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Nazik Yener
- Pediatric Intensive Care Unit, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Hasan Agin
- Pediatric Intensive Care Unit, Dr Behçet Uz Children's Hospital, Izmir, Turkey
| | - Ekin Soydan
- Pediatric Intensive Care Unit, Dr Behçet Uz Children's Hospital, Izmir, Turkey
| | - Dincer Yildizdas
- Pediatric Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Semine Ozdemir Dilek
- Department of Pediatric Endocrinology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Nilufer Yalindag
- Pediatric Intensive Care Unit, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Feyza Incekoy-Girgin
- Pediatric Intensive Care Unit, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Nuri Alacakir
- Pediatric Intensive Care Unit, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Filiz Tutunculer
- Department of Pediatric Endocrinology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Mehmet Ozgur Arslanaoglu
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Can Aydin
- Department of Pediatric Endocrinology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Muzaffer Bilgin
- Department of Biostatistics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Enver Simsek
- Department of Pediatric Endocrinology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Ener Cagri Dinleyici
- Pediatric Intensive Care Unit, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
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Botan E, Uyar E, Öztürk Z, Şevketoğlu E, Sarı Y, Dursun O, Sincar Ş, Duyu M, Oto A, Celegen M, Özçiftçi G, Havan M, Öztürk MN, Ağın H, Yener N, Yaman A, Gün E, Yılmaz M, Şimşek N, Özdemir H, Yıldızdaş D, Kendirli T. COVID-19 Transmission and Clinical Features in Pediatric Intensive Care Health Care Workers. Turk Arch Pediatr 2021; 57:93-98. [DOI: 10.5152/turkarchpediatr.2022.21205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Havan M, Kendirli T, Özcan S, Doğan MT, Yiğit AO, Uçar T. A successful treatment with intravenous lipid emulsion therapy in a child with verapamil poisoning. Turk J Emerg Med 2021; 21:217-220. [PMID: 34849436 PMCID: PMC8593422 DOI: 10.4103/2452-2473.329626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
In recent years, intravenous lipid emulsion therapy (ILE) was used for lipophilic drug intoxications, and successful results were obtained. In the literature, there is a small number of reported cases about verapamil intoxication and ILE therapy in the pediatric age group. We used ILE therapy in a 14-year-old girl with verapamil intoxication in the 2nd h of the pediatric intensive care unit stay, before using traditional treatments such as glucagon and hyperinsulinemic euglycemia. She had resistant bradycardia and hypotension which was unresponsive to inotropic agents and a successful result was obtained after using ILE treatment. We believe our report may contribute to the early use of ILE therapy for toxicity with calcium channel blockers such as verapamil in pediatric patients.
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Affiliation(s)
- Merve Havan
- Department of Pediatric Intensive Care, School of Medicine, Ankara University, Ankara, Turkey
| | - Tanıl Kendirli
- Department of Pediatric Intensive Care, School of Medicine, Ankara University, Ankara, Turkey
| | - Serhan Özcan
- Department of Pediatric Intensive Care, School of Medicine, Ankara University, Ankara, Turkey
| | - Melih Timuçin Doğan
- Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
| | - Ahmet Onur Yiğit
- Department of Pediatric Intensive Care, School of Medicine, Ankara University, Ankara, Turkey
| | - Tayfun Uçar
- Department of Pediatric Cardiology, School of Medicine, Ankara University, Ankara, Turkey
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Kendirli T, Özcan S, Havan M, Baran Ç, Çakıcı M, Arıcı B, Selvi Can Ö, Eyileten Z, Uçar T, Tutar E, Akar AR. Pediatric extracorporeal cardiopulmonary resuscitation: single-center study. Turk J Med Sci 2021; 51:1733-1737. [PMID: 33350296 PMCID: PMC8569742 DOI: 10.3906/sag-2002-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022] Open
Abstract
Background/aim Extracorporeal cardiopulmonary resuscitation (ECPR) is defined as the venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in a patient who experienced a sudden pulseless condition attributable to cessation of cardiac mechanical activity and circulation. We aimed to evaluate the clinical outcomes of our ECPR experience in a pediatric patient population. Materials and methods Between September 2014 and November 2017, 15 children were supported with ECPR following in-hospital cardiac arrest (IHCA) in our hospitals. VA-ECMO setting was established for all patients. Pediatric cerebral performance category (PCPC) scales and long-term neurological prognosis of the survivors were assessed. Results The median age of the study population was 60 (4–156) months. The median weight was 18 (4.8–145) kg, height was 115 (63–172) cm, and body surface area was 0.73 (0.27–2.49) m2. The cause of cardiac arrest was a cardiac and circulatory failure in 12 patients (80%) and noncardiac causes in 20%. Dysrhythmia was present in 46%, septic shock in 13%, bleeding in 6%, low cardiac output syndrome in 13%, and airway disease in 6% of the study population. Median low-flow time was 95 (range 20–320) min. Central VA-ECMO cannulation was placed in only 2 (13.3%) cases. However, the return of spontaneous circulation (ROSC) was obtained in 10 (66.6%) patients, and 5 (50%) of them survived. Overall, 5 patients were discharged from the hospital. Finally, survival following ECPR was 33.3%, and all survivors were neurologically intact at hospital-discharge. Conclusion ECPR can be a life-saving therapeutic strategy using a promising technology in the pediatric IHCA population. Early initiation and a well-coordinated, skilled, and dedicated ECMO team are the mainstay for better survival rates.
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Affiliation(s)
- Tanıl Kendirli
- Department of Pediatric Critical care Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Serhan Özcan
- Department of Pediatric Critical care Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Merve Havan
- Department of Pediatric Critical care Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Çağdaş Baran
- Department of Cardiovascular Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Mehmet Çakıcı
- Department of Cardiovascular Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Burcu Arıcı
- Department of Cardiovascular Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Özlem Selvi Can
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Zeynep Eyileten
- Department of Cardiovascular Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Tayfun Uçar
- Department of Pediatric Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ercan Tutar
- Department of Pediatric Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ahmet Rüçhan Akar
- Department of Cardiovascular Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
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Havan M, Razi CH, Bulus AD, Köksal AO, Andıran N. Effects of 25 hydroxy vitamin D levels on the severity and asthma control in school age asthma patients. ARCH ARGENT PEDIATR 2018; 115:336-342. [PMID: 28737861 DOI: 10.5546/aap.2017.eng.336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/23/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective was to determine vitamin D levels in patients between the ages 6 and 18 years, followed for asthma, and the relation between vitamin D levels and asthma control and severity. MATERIALS AND METHODS Patients with asthma and healthy volunteers between the ages 6 and 18 years were enrolled into the study as patient and control groups, respectively. Patient demographic information and clinical findings were recorded; a respiratory function test was performed. Body mass index (BMI), 25(OH) D,calcium, phosphorus, alkaline phosphatase, total IgE and eosinophil levels were determined for all patients. Asthma severity and control conditions were established based on GINA (Global Initiative for Asthma) criteria. RESULTS Seventy two patients with asthma and 66 healthy children were included. Compared to the control group, decreased serum vitamin D levels were detected in patient group. Thirty eight (52.8%) patients in asthma patient group had vitamin D defficiency; in this group, asthma control was poor and asthma severity was significantly higher. No significant correlation was found between vitamin D levels and gender, obesity, respiratory functions, skin test, serum eosinophil and total IgE levels. CONCLUSION The frequency of vitamin D deficiency and insufficiency was higher in children with asthma, compared to the controls. Lower levels of vitamin D are associated with poor asthma control and increased asthma severity.
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Affiliation(s)
- Merve Havan
- Pediatrics, Keçiören Research and Educational Hospital, Ankara, Turkey
| | - Cem H Razi
- Pediatric Allergy and Immunoloy, Keçiören Research and Educational Hospital, Ankara, Turkey
| | - Ayse D Bulus
- Pediatric Endocrinology, Keçiören Research and Educational Hospital, Ankara, Turkey
| | - Ali O Köksal
- Pediatrics, Keçiören Research and Educational Hospital, Ankara, Turkey.
| | - Nesibe Andıran
- Pediatrics, Keçiören Research and Educational Hospital, Ankara, Turkey
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