Introduction: Brain death is currently defined as the loss of full brain function including the brainstem. The diagno-

Purpose: Successful resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. This study aimed to determine the knowledge, skills, and attitudes of the pediatric healthcare professionals about the defibrillator use and to offer solutions if there was room for improvement. Procedures: This was a multicenter survey study. Findings: The study included 716 healthcare professionals with an average age of 30.1 ± 5.8 years; 50% (n=358) were pediatric residents and 41.3% (n=296) had less than three years of professional experience. Self-declared level of knowledge about defibrillation/cardioversion was low-to-medium for 66.5% (n=476); 60.8% (n=435) had never practiced these procedures and 22.2% (n=159) had never received any training about defibrillator use. There was a significant relationship between professional experience and the proportion of participants who correctly responded to the first-shock dose for defibrillation but not for cardioversion. Conclusion: Professional experience is crucial in the correct defibrillator use. However, the defibrillation/cardioversion procedures are prone to errors since they are not commonly applied in day to day practice. An ideal approach to improve the experience of personnel could be to use practical training with case-based simulations and to educate the personnel about the features of the defibrillators available in their clinics.

The aim of this study was to identify demographic and clinical characteristics of patients who were subjected to plasma exchange (PE) at our unit, and to investigate the effect of these factors on treatment outcome and patient prognosis. Methods: Demographic, clinical and laboratory data of patients who were subjected to PE between January 2012 and August 2015 were obtained from the hospital information system, medical records and the records of apheresis unit. Results: Plasma exchange was performed in 40 patients for 168 times throughout the study. The median age of the patients was 9.4 (range: 1.5-17.3) years, with a male/female ratio of 1.35. Of the patients, 47.5% had an underlying disease. The most common comorbidity was malignancy. The most common indication for PE was sepsis-related multiple organ failure (n=19, 47.5%). The mortality rate was higher in patients with an underlying chronic disease, compared to those without (25% and 7.5%, respectively). No life-threatening complication associated with the apheresis procedure was observed. Conclusion: Our results suggest that PE can be safely performed in children. It seems that indication for PE and the presence of underlying diseases are affecting the mortality rate.

Background/aim: To characterize the clinical course of noninvasive positive pressure ventilation (NIPPV) and high flow humidified nasal cannula ventilation (HFNC) procedures; perform risk analysis for ventilation failure. Material and methods: This prospective, multi-centered, observational study was conducted in 352 PICU admissions (1 month-18 years) between 2016 and 2017. SPSS-22 was used to assess clinical data, define thresholds for ventilation parameters and perform risk analysis. Results: Patient age, onset of disease, previous intubation and hypoxia influenced the choice of therapy mode: NIPPV was preferred in older children (p = 0.002) with longer intubation (p < 0.001), ARDS (p = 0.001), lower respiratory tract infections (p < 0.001), chronic respiratory disease, (p = 0.005), malignancy (p = 0.048) and immune deficiency (p = 0.026).The failure rate was 13.4%. Sepsis, ARDS, prolonged intubation and use of nasal masks were associated with NIV failure (p = 0.001, p < 0.001, p < 0.001, p = 0.025). The call of intubation or re-intubation was given due to respiratory failure in twenty-seven (57.5%), hemodynamic instability in eight (17%), bulbar dysfunction or aspiration in five (10.6%), neurological deterioration in four (8.5%) and developing ARDS in three (6.4%) children. A reduction of less than 10% in the respiration within an hour increased the odds of failure by 9.841 times (OR:9.841, 95% CI: 2.0021-48.3742). FiO 2 >55% at 6 th hours and PRISM-3 >8 were other failure predictors. Of the 9.9% complication rate, the most common complication was pressure ulcerations (4.8%) and mainly observed when using full-face masks (p = 0.047). Fifteen (4.3%) patients died of miscellaneous causes. Tracheostomy cannulation was performed on sixteen children due to prolonged mechanical ventilation (8% in NIPPV, 2.6% in HFNC) Conclusion: Absence of reduction in the respiration rate within an hour, FiO 2 requirement >55% at 6 th hours and PRISM-3 score >8 predict NIV failure.

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