Objectives To describe experience with airway pressure release ventilation (APRV) in children with severe acute respiratory distress syndrome (ARDS) refractory to conventional low tidal volume ventilation. Methods This retrospective observational study was performed in an 11-bed, level 3 pediatric intensive care unit. Evaluation was made of 30 pediatric patients receiving airway pressure release ventilation as rescue therapy for severe ARDS. Results Patients were switched to APRV on an average 3.2 ± 2.6 d following intubation. When changed from conventional mechanical ventilation (CMV) to APRV, there was an expected increase in the SpO 2 /FiO 2 ratio (165.1 ± 13.6 vs. 131.7 ± 10.2; p = 0.035). Mean peak inspiratory pressure was significantly lower during APRV (25.4 ± 1.26 vs. 29.8 ± 0.60, p < 0.001) compared to CMV prior to APRV but mean airway pressure (P aw) was significantly higher during APRV (19.1 ± 0.9 vs. 15.3 ± 1.3, p < 0.001). Hospital mortality in this study group was 16.6%. Conclusions The results of this study support the hypothesis that APRV may offer potential clinical advantages for ventilatory management and may be considered as an alternative rescue mechanical ventilation mode in pediatric ARDS patients refractory to conventional ventilation.
Aim of the study Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in‐ or out‐of‐hospital cardiopulmonary arrest. The scope of this multi‐centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic‐life‐support (BLS) and advanced‐life‐support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. Methods This cross‐sectional and multi‐centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. Results A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27‐33) years. Certified BLS‐ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non‐physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self‐confidence in the physicians (P < .01, P < .001). Both physicians and non‐physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non‐certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS‐ALS training (P = .047, P = .003). Conclusions The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS‐ALS programmes. Certified BLS‐ALS programmes increase the level of knowledge and self‐confidence towards synchronised cardioversion‐defibrillation procedures.
Sepsis, defined as an infection with irregular host response that causes life-threatening organ dysfunction, continues to have a high potential for morbidity and mortality in children. 1 Paediatric sepsis is the most common cause of paediatric death worldwide and results in an estimated 7.5 million deaths per year. 2,3 Severe paediatric sepsis is a life-threatening condition that is widely monitored and treated in paediatric intensive care units (PICUs) worldwide. [2][3][4] Severe sepsis is defined as infection plus infection-induced organ dysfunction; in children, it is characterised by the presence of sepsis and cardiovascular or respiratory dysfunction or dysfunction in two or more organs (neurological, hepatic, hematologic or renal). The prevalence of severe sepsis in PICUs has been reported to be between 2% and 3% in developed countries 5,6 and between 18% and 46% in developing countries. 7,8 In a study conducted in southwest China, the mortality
Background and Objective The aim of this multicenter retrospective study was to determine the clinical characteristics, treatment approaches and the course of pediatric acute respiratory distress syndrome (PARDS) which developed associated with the influenza virus in the 2019–20 season. Methods Patients included 1 month to 18 years who were diagnosed with PARDS associated with the influenza virus in the 2019–20 season. Results Sixty-seven patients were included in the study. The mean age of the patients was 64.16 ± 6.53 months, with 60% of the group <5 years. Influenza A was determined in 54 (80.5%) patients and Influenza B in 13 (19.5%). The majority of patients (73.1%) had a comorbidity. Fifty-eight (86.6%) patients were applied with invasive mechanical ventilation, Pediatric Acute Lung Injury Consensus Conference classification was mild in 5 (8.6%), moderate in 22 (37.9%) and severe in 31 (52.5%) patients. Ventilation was applied in the prone position to 40.3% of the patients, and in nonconventional modes to 24.1%. A total of 22 (33%) patients died, of which 4 had been previously healthy. Of the surviving 45 patients, 38 were discharged without support and 7 patients with a new morbidity. Conclusion Both Influenza A and Influenza B cause severe PARDS with similar characteristics and at high rates. Influenza-related PARDS cause 33% mortality and 15.5% morbidity among the study group. Healthy children, especially those aged younger than 5 years, are also at risk.
Yellow nail syndrome, usually autosomal dominant transition and occurs with yellow nails, lymph edema and pleural effusion triad. In this article, a girl, 13 months, who was diagnosed as yellow nail syndrome and followed with pericardial effusion and lymph edema from her birth, has been presented. Yellow nail syndrome has been diagnosed lately due to the occurrence of clinical symptoms which are often more obvious after the puberty. However, neonatal or infant period of pericardial effusion in patients with lymphedema and yellow nail syndrome should be kept in mind.
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