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Therapeutic plasma exchange (TPE) is an effective treatment method in selective indications. Secondary to access and technical features, it is more difficult to apply in pediatric population than adults. The aim of this study is investigate safety, clinical indications, and results of this method in critically ill pediatric patients who need TPE treatment. All of the TPE procedures performed in a pediatric intensive care unit providing tertiary care during 4 years (2015–2019) were evaluated retrospectively. TPE procedures (635) were performed for 135 patients. Median age was 34 months (10‐108). Ninety‐seven patients had mechanical ventilation support. Sepsis with multiple organ failure was the most frequent indication and accounted for 44.4% (n = 60) of the indications followed by hematological and neurological diseases (19.2% and 9.6% respectively). TPE was performed alone in 469 cases (73.9%), in combination with continuous renal replacement therapy in 154 cases (24.2%), and additional to extracorporeal membrane oxygenation in 12 cases (1.9%). Hematological disease and sepsis subgroups had the highest intubation rate, mechanical ventilation period, PRISM score, organ failure count, and mortality. Fresh frozen plasma (FFP) was the most frequently used replacement fluid in 90.4% of the procedures. The most frequent anticoagulant used in TPE was acid citrate dextrose solution (79.3%). Procedural complications were detected in 104 cases (16.3%) and occurred during TPE sessions. Overall survival rate was 78.5%. We found that the non‐survivor group had significantly higher rates of organ failures (P = 0.0001), higher PRISM scores on admission (P = 0.0001), and higher rates of invasive ventilation support needed (P = 0.012). TPE is a treatment method which can be safely provided in healthcare facilities with necessary medical and technical requirements. Although it is riskier to provide such treatment to critically ill children, complications can be minimized in experienced healthcare facilities. Overall results are good and can vary depending on indication.

Objectives The hyperinflammatory state and the viral invasion may result in endothelial dysfunction in SARS-CoV-2 infection. Although a method foreseeing microvascular dysfunction has not been defined yet, studies conducted in patients diagnosed with COVID-19 have demonstrated the presence of endotheliitis. With this study, we aimed to investigate the microvascular circulation in patients diagnosed with COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by nailfold videocapillaroscopy (NVC). Methods Thirty-one patients with SARS-CoV-2 infection, 25 of whom were diagnosed with COVID-19 and 6 with MIS-C and 58 healthy peers were included in the study. NVC was performed in eight fingers with 2 images per finger and 16 images were examined for the morphology of capillaries, presence of pericapillary edema, microhemorrhage, avascular area, and neoangiogenesis. Capillary length, capillary width, apical loop, arterial and venous width, and intercapillary distance were measured from three consecutive capillaries from the ring finger of the non-dominant hand. Results COVID-19 patients showed significantly more capillary ramification ( p < 0.001), capillary meandering ( p = 0.04), microhemorrhage (p < 0.001), neoangiogenesis (p < 0.001), capillary tortuosity ( p = 0.003). Capillary density ( p = 0.002) and capillary length (p = 0.002) were significantly lower in the patient group while intercapillary distance ( p = 0.01) was significantly longer compared with healthy volunteers. Morphologically, patients with MIS-C had a higher frequency of capillary ramification and neoangiogenesis compared with COVID-19 patients (p = 0.04). Conclusion Abnormal capillary alterations seen in COVID-19 and MIS-C patients indicate both similar and different aspects of these two spectra of SARS-CoV-2 infection and NVC appears to be a simple and non-invasive method for evaluation of microvascular involvement.

Objectives: Anticoagulation is used to prevent filter clotting in patients undergoing continuous renal replacement therapy. Regional citrate anticoagulation is associated with lower rates of bleeding complications and prolongs the filter life span; however, a number of metabolic side effects had been associated with this therapy. The aim of this study was to evaluate the effect and safety of citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill children. Methods: A retrospective comparative cohort study. Department of Pediatric Intensive Care, Acibadem Mehmet Ali Aydınlar University School of Medicine. Results: From August 2016 to August 2018, 45 patients (19 in the citrate group and 26 in the heparin group) were included. A total of 101 hemofilters were used in all therapies: 44 in the citrate group (total continuous renal replacement therapy time: 2699 h) and 57 in the heparin group (total continuous renal replacement therapy time: 2383 h). The median circuit lifetime was significantly longer for regional citrate anticoagulation (53.0; interquartile range, 40–70 h) than for heparin anticoagulation (40.25; interquartile range, 22.75–53.5 h; p = 0.025). Mortality rates were similar in both groups (31.58% vs 30.77%). The most common indication for dialysis was hypervolemia in both groups. Transfusion rates were 1.65 units (interquartile range, 0.5–2.38) with heparin and 0.8 units (interquartile range, 0.3–2.0) with citrate (p = 0.32). Clotting-related hemofilter failure occurred in 11.36% of filters in the citrate group compared with 26.31% of filters in the heparin group. Conclusion: Our study showed that citrate is superior in terms of safety and efficacy, with longer filter life span. Regional citrate should be considered as a better anticoagulation method than heparin for continuous renal replacement therapy in critically ill children.

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Özgün Araştırma / Original Investigation Öz Giriş: Çalışmada, çocuk yoğun bakım ünitesi (YBÜ)'nde alt solunum yolu enfeksiyonu tanısıyla yatan hastalarda viral patojen sıklığının ve hastaların klinik özelliklerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntemler: Kasım 2016-Eylül 2017 tarihleri arasında çocuk YBÜ'ye yatan, viral enfeksiyon şüphesiyle viral solunum paneli gönderilen ve pozitif saptanan 80 hasta çalışmaya dahil edildi. Solunum panelinde adenovirüs (ADV), metapnömovirüs (MPV), parainfluenza virüs (PIV) 1, PIV 2, PIV 3, PIV 4, influenza virüs (IV) A ve IVB, rinovirüs (RV), respiratuvar sinsityal virüs (RSV) A ve RSV B multipleks polimeraz zincir reaksiyonu (PCR) ile çalışıldı. Örnekler entübe olmayan hastalarda nazofarengeal sürüntüden, entübe olan hastalarda trakeal aspirasyon materyalinden alındı. Bulgular: Kasım 2016-Eylül 2017 tarihleri arasında YBÜ'ye toplam 514 hasta yatırıldı. Alt solunum yolu enfeksiyonu tanısıyla yatan 123 hastada nazofarengeal sürüntü veya trakeal aspirasyon materyalinden örnek alınarak Multipleks PCR ile viral enfeksiyon paneli çalışıldı. Ortalama yaş 6.1 ± 3.6 aydı, hastaların %60 (n= 48)'ı erkekti. Seksen hastada 93 pozitiflik saptandı. On üç (%16) hastada çift etken pozitifliği vardı. En sık saptanan viral ajanlar 36 (%45) hastada RSV (A + B), 26 (%27.9) hastada RV, 7 (%7.5) hastada PIV 1, 6 (%6.4) hastada ADV, 5 (%5.3) hastada human MPV, 4 (%4.3) hastada IVA, 4 (%4.3) hastada IVB idi. Çift etken pozitifliğinde en sık RV ve RSV B pozitifliği saptandı. En çok viral etken pozitifliği saptanan aylar aralık (n= 15) ve şubattı (n= 13). Hastaların %57'sine yüksek akımlı

Yoğun bakımda boğmaca tanısı ile izlenen aşısız süt çocuklarının klinik özellikleri ve seyri etkileyen etmenlerThe clinical characteristics and prognosis of pertussis among unvaccinated infants in pediatric intensive care unit Öz Amaç: Çocuk yoğun bakım biriminde boğmaca tanısıyla izlenen hastaların klinik özelliklerini, risk etmenlerini ve seyri etkileyen etmenleri değerlendirmeyi amaçladık. Gereç ve Yöntemler:Çocuk yoğun bakım birimimizde Ocak 2017-Ocak 2019 tarihleri arasında yatan ve boğmaca tanısı alan hastalar geriye dönük olarak değerlendirildi. Örnekler entübe olarak izlenen hastalarda trakeal aspirat materyalinden, diğer hastalarda nazofaringeal sürüntüden alındı. Bordetella pertussis için örnekler multiplex real-time polimeraz zincir reaksiyonu yöntemi ile çalışıldı. Bulgular:On sekiz hasta boğmaca tanısı ile çocuk yoğun bakım birimimize yatırıldı. Hastaların %55,5'i kızdı (n=10), tüm hastalar aşısızdı. Ortanca yaş 40 (38-47,5) gün, ortanca yoğun bakım yatış süresi 9 (5-14) gündü. Başvuru anında hastaların tümünde solunum sıkıntısı, 14 hastada (%77,7) öksürük, 4 hastada (%22.2) ateş, 3 hastada (%16,6) konvülziyon saptandı. Yedi hasta entübe edilerek izlendi. Üç hasta ekstrakorporeal tedavi yöntemleri uygulanmasına rağmen çoklu organ yetersizliği ve kardiyojenik şok nedeniyle kaybedildi. Ölen hastaların ikisinde respiratuar sinsityal virüs, birinde rhinovirüs ko-enfeksiyonu vardı. Toplam lökosit sayıları karşılaştırıldığında ölen hasta grubunda lökosit sayısı Abstract Aim: To evaluate the clinical characteristics, risk factors, and prognosis of pertussis in the pediatric intensive care unit. Material and Methods:Patients who were hospitalized in pediatric intensive care unit between January 2017 and January 2019 and diagnosed as having pertussis were retrospectively evaluated. Samples were taken from tracheal aspirate material in intubated patients and nasopharyngeal swabs in the other patients. Samples for Bordetella pertussis were studied using multiplex real-time polymerase chain reaction.Results: Eighteen patients were admitted to our pediatric intensive care unit with a diagnosis of pertussis. Ten patients were female (55.5%), and all patients were unvaccinated. The median age was 40 (range, 38-47.5) days and the median intensive care unit stay was 9 (range, 5-14) days. All patients had respiratory distress, 14 patients had cough (77.7%), four patients had fever (22.2%), and three patients had convulsions (16.6%). Seven patients were intubated. Three patients died of multiple organ failure and cardiogenic shock despite extracorporeal treatment. Respiratory syncytial virus was found in two patients and rhinovirus was found in one patient. The median leukocyte count was significantly higher in non-survivors than in survivors. Blood exchange was performed in Boğmaca aşı ile önlenebilir bir hastalıktır. Etkeni Bordetella Pertussis'tir, süt çocuklarında sıklıkla pnömoniye yol açar. Aşısız süt çocuklarında ciddi hastalık tablosu oluşturabilir. Çalışmanın katkısıYoğun bakıma kabul edilen hastalarda ciddi b...

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