Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study.

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.

COVID-19 Transmission and Clinical Features in Pediatric Intensive Care Health Care Workers.

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.

Rare causes of anisocoria: Ipratropium bromide and Angel's trumpet.

It is considered a neurological emergency when a patient presents with anisocoria. It is important that the anisocoria whether or not accompanied by the neurological findings. Other reasons of anisocoria should be considered when the absence of neurological or ophthalmological signs such as change of mental status, hemiparesis, ophthalmoplegia, ptosis. Herein we report two cases of temporary anisocoria due to inhaler ipratropium bromide and Angel's trumpet.

Oxygen therapy via high flow nasal cannula in pediatric intensive care unit.

The aim of the present study was to assess the efficacy and safety of oxygen therapy via high flow nasal cannula in pediatric patients with acute respiratory failure. Patients who were admitted to pediatric intensive care unit and were administered high flow nasal cannula (HFNC) therapy between January 2015 and January 2016 were enrolled. Arterial blood gas parameters, respiratory rates (RR), heart rates (HR), systolic, db > iastolic, and mean arterial pressures (SBP, DBP, MAP), dyspnea scores, fractional oxygen indices (FiO < sub > 2 < /sub > ), and oxygen saturations (SatO < sub > 2 < /sub > ) were recorded at baseline, 30 minutes, and 12 hours. The study enrolled a total of 50 patients of whom 24 (48%) were female and 26 (52%) were male. Statistically significant reductions occurred in mean HR and RR values at 30 minutes and 12 hours compared to those at 0 minute (p < 0.05). Significant increases were observed in SatO2 values at 30 minutes (p.0.001) and 12 hours (p:0.005) compared to SatO2 value at 0 minute (p < 0.05). Similarly, there occurred significant reductions in mean FiO < sub > 2 < /sub > values at 30 minutes and 12 hours compared to baseline (p < 0.05). Significant reductions occurred in mean dyspnea score at 30 minutes (p:0.001) and 12 hours (p:0.001) compared to that at 0 minute (p < 0.05). pH, PaCO < sub > 2 < /sub > , PaO < sub > 2 < /sub > , SBP, and DBP values at 0 minute, 30 minutes, and 12 hours were not significantly different from one another (p > 0.05). No significant correlations were found between treatment failure and age at admission; mean pediatric index of mortality (PIM II), pediatric risk of mortality (PRISM), pediatric logistic organ dysfunction (PELOD) and pediatric multiple organ dysfunction score (P-MODS); and HR, RR, SatO2, pH, PaCO2, PaO2, SBP, DBP, MAP, FiO2 at baseline (p > 0.05). Therapy was successful in 40 (80%) patients whereas there occurred a need for invasive ventilation in 10 (20%) patients. High flow nasal oxygen therapy can be used for patients with acute severe hypoxemic respiratory failure without concurrent hypercapnia when adequate equipment and monitorization tools exist.

Reliability of cerebral oximeter in non-invasive diagnosis and follow-up of hypercapnia.

In this study, aimed to evaluate the sensitivity and specificity of cerebral oximetry and EtCO2 values in non-invasive diagnosis and monitoring of hypercapnia. This study enrolled pediatric patients admitted to and mechanically ventilated at the Pediatric Intensive Care Unit of Gaziantep University Faculty of Medicine Hospital between January 2014 and January 2015. Patients' age, gender, diagnosis, ventilatory parameters, a measured of the mean end-tidal carbon dioxide value stream method, and the simultaneously monitored arterial blood gas PaCO < sub > 2 < /sub > level and near infrared spectroscopy device (NIRS) measurements were recorded. The mean age of patients was 61 months (min 4-max 193), and there were 8 (53.4%) female and 7 (46.6%) male subjects. A significant correlation was found between PCO2 and NIRS, PCO < sub > 2 < /sub > and EtCO < sub > 2 < /sub > (r = 0.571, p < 0.001). There was a significant positive correlation between EtCO2 and NIRS (r = 0.479, p < 0.001). NIRS levels were significantly higher (p < 0.001) in the group with pCO < sub > 2 < /sub > > 45; EtCO < sub > 2 < /sub > > 40 and pH < 7.35, compared to the group with PCO < sub > 2 < /sub > < 45 EtCO < sub > 2 < /sub > < 40 and ph≥7.35 . The best cut-off point for NIRS to distinguish the groups with PCO < sub > 2 < /sub > > 45 with PCO < sub > 2 < /sub > < 45 was 80.5, with a sensitivity of 65.3%, specificity of 84.3%, and positive and negative predictive values of 81.9% and 69.1%, respectively. The best cut-off point for NIRS to distinguish the groups with EtCO < sub > 2 < /sub > > 40 and EtCO < sub > 2 < /sub > < 40 was 81, with a sensitivity of 62.2%, specificity 77.9%, and positive and negative predictive values of 61.2% and 72.3%, respectively. As for pH < 7.35 and PaCO < sub > 2 < /sub > > 45, while sensitivity of EtCO < sub > 2 < /sub > (at a cut-off point of 40) was 64.9%; the sensitivity of NIRS (at a cut-off point of 80.5) was 28.1%, with EtCO < sub > 2 < /sub > being significantly more sensitive than NIRS (p < 0.001). The results of the present study suggest that NIRS values of above 80 should alert clinicians for hypercapnia associated with increased cerebral blood flow.

The relation between mean platelet volume and mortality in critical pediatric patients.

Mean platelet volume (MPV) is a simple and economical test that is easy to interpret and is routinely measured with automatic cell counters. It indicates platelet volume and platelet function and activation. Variations in platelet volume may occur more as a result of varying differentiation of megakaryocytes in association with production agents in bone marrow rather than of ageing of platelets in circulation. The purpose of this study was to evaluate the relation between mortality and changes in MPV values in patients hospitalized in the pediatric intensive care unit. We evaluated MPV1 levels at the first hour of hospitalization of patients monitored in the pediatric intensive care unit between February 2014 and February 2015, MPV2 levels at the 48th hour, Δ MPV (MPV2-MPV1) values PIM, PRISM, PELOD and PMODS values, diagnosis, age and sex. Fifty-four patients were female (45.4%) and 65 (54.6%) male. The mean age was 51.2 months m(range, 2-189 months). The mean PIM value was 35.4 ± 27.7, the mean PRISM was 18.5 ± 9.3, the mean was PELOD 21.3 ± 10.5, and the mean PMODS was 5.6 ± 3.0. Mortality was correlated with PIM, PRISM, PELOD and PMODS (p<0.001). Sixty-six (55.5%) patients survived. The standardized mortality rate (observed/expected mortality) was 0.99. The mean MPV1 was 9.5 ± 1.05 (range, 6.1-12.4) and mean MPV2 was 9.6 ± 1.15 (range, 6.5-12.5). There was a significant correlation between Δ MPV >0 and mortality (p<0.001). Mortality in patients with Δ MPV ≤0 was 21.4%, but 65.1% in those with levels >0. No correlation was determined between MPV1 and MPV2 and mortality (p= 0.480 and p= 0.213). Δ MPV>0, low levels of albumin and PRISM score were identified as independent risk factors for mortality.