Objective: Intravenous immunoglobulin and plasma exchange are proven treatments for Guillain-Barré syndrome. Despite these treatments, the prognosis for severe Guillain-Barré syndrome is still not satisfactory. This article seeks for a logical timing for plasma exchange-intravenous immunoglobulin synergy, which may improve outcome in severe Guillain-Barré syndrome requiring mechanical ventilation. Study Design: This study is an open-label study. Nine pediatric severe Guillain-Barré syndrome patients requiring mechanical ventilation were treated with novel treatment strategy named as "zipper method." In this method, following diagnosis of Guillain-Barré syndrome, plasma exchange was started immediately. In the first session of plasma exchange, one and a half volume of patients' plasma was removed by using 5% albumin as replacement solution. At the end of the plasma exchange session, 0.4 g/kg intravenous immunoglobulin infusion was started immediately. Second plasma exchange session was applied with one volume change after 24 hours from the end of the intravenous immunoglobulin infusion. Each plasma exchange session was followed by intravenous immunoglobulin infusions. This plasma exchange-intravenous immunoglobulin cycle was repeated for 5 times. Results: Among the 9 patients, the mean mechanical ventilation duration was 7 (5-14) days and the mean hospital stay was 18 (10-30) days. Medical Research Council sum score was increased in all patients, especially after the third session. All patients survived and all patients were able to walk unaided on the 28th day of admission. Conclusion: The zipper method as a novel treatment modality seems to reduce mortality, speed up weaning from mechanical ventilation, and shorten hospital stay, with excellent outcome in severe Guillain-Barré syndrome patients, who require intensive care. This technique stands as a promising immunomodulation strategy for various scenarios.

Objective:We studied the prevalence and potential effects of secondhand parental smoking on the diagnosis, severity of disease, duration of hospitalization and length of stay on mechanical ventilation. The aim of this study was to evaluate the effect of secondhand parental smoking in pediatric intensive care unit patients. Material and Methods:This cross sectional prospective survey study was conducted as a questionnaire regarding the smoking habits of all parents of hospitalized patients in our pediatric intensive care unit Results: A total of 125 female and 178 male were included in the study. The median age was 53 (min:1 -max: 216 months). Indications of hospitalizations were intoxication (16.5%), neurological disorders (14.9%), malignancy (12.9%), congenital heart diseases (11.2%), genetic syndromes (9.9%), trauma (9.6%), shock (%7.3), arrhythmia (6.3%), renal failure (5%), diabetes (2.6%), burns (2.6%) and metabolic diseases (%1.3). A total of 42.2% of patients were on invasive, 5.3% were on non-invasive mechanical ventilation. Mothers, fathers and guests smoking rates were 40.6%; 75.2% and 58.4% respectively. The rate of illiterate fathers and mothers were higher in secondhand parental smoking group compared with non-exposure group (6% vs 4%, p=0.004, 10.7% vs 5.7%, p=0.21, respectively). The secondhand parental smoking rate was 76.9%. The secondhand parental smoking rate of children diagnosed as malignancy was 16.4% compared with non-exposed group (1.4%) which was statistically significant (p<0.05). There was no significant difference in secondhand parental smoking rate was of children diagnosed as intoxication, trauma, burns and others. The mean length of stay in mechanical ventilator ( MV ) and pediatric risk of mortality score ( PRISM ) score were 5.8 days ± 6.3 and 11.6 ± 8 respectively. The PRISM score was statistically significant in secondhand parental smoking exposed children compared with non-exposed ones ( 12.2 ± 7.9 vs 9.6 ± 7.8 ; p= 0.007). The length of stay in pediatric intensive care unit (PICU) and duration of mechanical ventilation were longer in children secondhand smoking exposure (p<0.05). Conclusion:Secondhand smoking is related with increased velocity of PICU admissions, severity of disease, increased diagnosis of malignancies, prolonged duration of mechanical ventilation and PICU stay. Besides, secondhand exposed patients are more likely to have low parental education level. ÖZAmaç: Ebeveyn sigara içiminin prevalansı, tanı üzerine etkisi, hastalığın şiddeti, hastanede ve mekanik ventilatörde kalış süresi üzerine potansiyel etkileri araştırıldı. Bu çalışmanın amacı; ebeveyn sigara kullanımının pediatrik yoğun bakım ünitesi hastalarında etkisini değerlendirmektir. Gereç ve Yöntemler:Kesitsel prospektif tanımlayıcı olan bu çalışmada Eylül 2014 -Ocak 2015 tarihleri arasında pediatrik yoğun bakım ünitemizde yatan hastaların ebeveynlerine sigara içme alışkanlıkları ile ilgili anket yapıldı.Bulgular: Çalışmaya toplam 125 kadın, 178 erkek dahil edildi. Ortanca yaş 53 (min: 1 -maks: 216) aydı...

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Bir parankimal travmatik hasarlanma tipi olan diffüz aksonal hasar (DAH), kafa travması geçiren çocuk hastalarda akut ve kronik dönemde ciddi nörokognitif bozukluklara sebep olabilmektedir. Bu çalışmada klinik ve radyolojik bulgulardan hangilerinin ağır hasar ile ilişkili olduğunu saptanması amaçlanmıştır. Gereç ve Yöntemler: Çalışmamızda 2012-2017 yılları arasında ağır kafa travması sonrası çocuk yoğun bakım ünitesinde izlenen otuz dokuz hastanın verileri incelenmiştir. DAH ön tanısı ile manyetik rezonans görüntüleme (MRG) yapılmış hastaların başvurudaki yaş, Glasgow Koma Skalası (GKS), Pediatric Risk of Mortality (PRISM) skoru, taburculukta Glasgow Outcome Skalası (GOS), vital bulgular, laboratuvar bulguları, hastanede kalma sürelerine ulaşılmıştır. DAH ile uyumlu lezyon yükü, ayrıca bu lezyonların beyindeki anatomik yerleşimleri not edilmiştir. DAH (+) saptanan grup ile saptanmayan grup karşılaştırılmış, ayrıca hangi parametrelerin GOS üzerinde anlamlı etkisi olduğu incelenmiştir. Bulgular ve Sonuçlar: Hastaların 29'unda DAH ile uyumlu MRG bulgusu saptanırken, kalan 10 hastada ise beyin MRG'de DAH saptanmadı. Bu iki grubun karşılaştırılmasında PRISM, GOS ve GKS skorları ve hastanede yatış süreleri farklı bulunmuştur. DAH (+) hasta grubunda GKS ve PRISM skorlarının, ayrıca hastane yatış süresinin GOS ile anlamlı korelasyonu saptanmıştır. Hastalarda toplam lezyon yükü ile GKS ya da GOS arasında anlamlı bir ilişki bulunamamıştır. Talamus ve beyin sapında lezyon bulunan hastalarda GKS diğer hastalara göre anlamlı düşüklük bulunurken GOS ile ilgili böyle bir ilişki gösterilememiştir. Çalışmamızın sonuçları diffüz aksonal hasarın hafif kafa travmalarına göre daha ciddi nörokognitif bozukluğa sebep olduğunu, uzun hastane yatışı ve rehabilitasyon gerektirdiğini göstermektedir. Ancak prognoz ve kalıcı hasar için belirleyici faktörler konusunda hem klinik hem de radyolojik bulguları içeren geniş kohort çalışmalara ihtiyaç vardır.

Post-extubation respiratory failure is associated with a poor prognosis due to increased ventilator-associated pneumonia, and longer length of stay in the ICU and hospital. In this study, we aimed to evaluate the efficacy of high-flow nasal cannula (HFNC) and noninvasive mechanical ventilation (NIMV) on extubation success in children. A total of 48 patients, aged between 1 month and 18 years, who were weaned to either NIMV or HFNC were included. Patients who had tracheostomy or were not weaned and underwent unplanned extubation were excluded. Age, gender, anthropometric parameters, Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores, oxygenation index, mechanical ventilation length of stay (LOS), HFNC/NIMV LOS, Modified Downes-Silverman score (MDS), and venous blood gas parameters, pediatric intensive care unit (PICU) LOS were recorded. 24 patients were extubated to NIMV, and 24 patients to HFNC. HFNC LOS and NIMV LOS were similar ( P = .621). The failure rates at the 48th hour of HFNC and NIMV were 33% (n = 8), and 33% respectively (n = 8) ( P = 1.0). PICU LOS and mortality rate was also similar ( P = .06, P = .312 respectively). MDS decreased significantly in both groups ( P < .001, P = .02 respectively). Changes in blood gas parameters and MDS within the first 48-hour of device application were similar between the 2 groups. HFNC is not inferior to NIMV in patients with extubation difficulty or those expected to have such difficulty in terms of treatment success, PICU LOS, and mortality. Therefore, HFNC appears to be a weaning technique alternative to NIMV after extubation.