Especially in recent years, the use of point-of-care ultrasound by non-radiologist clinicians has become widespread. Point-of-care ultrasound provides rapid responses to the problems of critically ill patients at the bedside. This technique has many important advantages, including being non-invasive, cheap, repeatable, painless, and radiation-free. Numerous studies have revealed the most important clinical benefits of point-of-care ultrasound use by pediatric intensive care providers. The inferior vena cava is a vessel that is highly sensitive to fluid changes. The inferior vena cava diameter can be measured by a point-of-care ultrasound, and represents a critical parameter in assessing the patient’s fluid status. The inferior vena cava collapsibility index (in spontaneously breathing patients) and the inferior vena cava distensibility index (in mechanically ventilated patients) are calculated by determined formulas by using maximum and minimum diameters of the inferior vena cava. The indices are important guides for pediatric intensive care providers for managing their patients’ fluid treatment. Although some authors claim it is not a reliable method, the technique is coming to fore in intensive care units day by day, and has an increasing trend among pediatric intensive care specialists. Here, we aim to give detailed information on the ultrasonographic inferior vena cava diameter measurement methods, and calculations of the inferior vena cava collapsibility index and inferior vena cava distensibility index, and emphasize the importance of a noninvasive, bedside, and objective method of detecting the volume status of critically ill patients for pediatric intensive care specialists according to the published literature.

Albumin, a vital component in regulating human blood oncotic pressure, plays an important role in the prediction of prognosis in pediatric patients.Previous research identified significant differences in serum albumin levels of healthy and critically ill children. The present study aims to investigate the correlation between albumin levels measured during pediatric intensive care unit(PICU) admission and clinical outcomes. In 2022, a comprehensive analysis of the records was conducted retrospectively in four tertiary hospital PICUs in different cities in the south-east region of Turkey. We then conducted a ROC analysis to predict mortality based on hypoalbuminemia.A cut-off value was determined, and the patients were divided into two groups: hypoalbuminemic and normoalbuminemic.Based on this cut-off level, we evaluated the association between admission serum albumin levels and mortality, length of stay, laboratories, need for mechanical ventilation, and extracorporeal treatments. A total of 1329 patients admitted to the PICUs between January 1, 2022 and January 1, 2023 were included. The mortality rate amounted to 16.2%.The mean albumin level was 4.03 ± 0.69 g/dl in the surviving and 3.35 ± 0.90 g/dl in the non-surviving group(p < 0.001).The average length of stay in the PICU amounted to 8.98 ± 17.07, while the mean length of hospital stay was 11.23 ± 18.81days.Patients with hypoalbuminemia had significantly longer stays in the PICU and hospital as compared to those with normal albumin levels(p = 0.025 and p < 0.001,respectively).We found robust evidence that albumin levels are a strong predictor of mortality, with a predictive rate of 84.5%(OR:0.322, 95% CI:0.263–0.395, p < 0.001).The cut-off value was 3.785(AUC:0.731, Sensitivity:68.3%, Specificity:67%). A negative correlation was identified between albumin levels and lactate, C- reactive protein (CRP), and Blood urea nitrogen (BUN) levels across all patients. Conversely, a positive correlation was observed between neutrophil, lymphocyte, platelet, hemoglobin, sodium, and glucose levels. However, in patients with a cut-off point of 3.785 for albumin levels, a negative correlation was observed between albumin and lactate, CRP, and creatine levels. Conversely, a positive correlation was found between bicarbonate, platelet, hemoglobin, and glucose levels. Based on these findings, we conclude that hypoalbuminemia is associated with a higher rate of inotrope therapy and mechanical ventilation support. Furthermore, the rates of plasmapheresis, continuous renal replacement therapy, and extracorporeal membrane oxygenation initiation were markedly reduced in patients with elevated albumin levels (p < 0.001). The serum albumin, which is an excellent and cost-effective biomarker that can be readily and economically evaluated in any center worldwide, as evidenced by the findings of our study, is a highly efficacious indicator of admission albumin levels for the prediction of mortality and outcomes in PICUs. Furthermore, it predicts the selection of appropriate treatment and mechanical supports. It is straightforward to utilise, as it does not necessitate the use of scoring systems or tests that require lengthy and intricate analyses, and it is readily available.

Background: Planning optimal fluid and inotrope-vasopressor-inodilator therapy is essential in critically ill children. Pulse index Contour Cardiac Output (PiCCO) monitoring is an invasive, hemodynamic monitor that provides parameter measurements such as cardiac output (CO), cardiac index (CI). Use of ultrasonography and critical care echocardiography by the pediatric intensivists has increased in recent years. In the hands of an experienced pediatric intensivist, critical echocardiography can accurately measure both CO and CI. Our objective in this study is to compare the CO and CI values measured by pediatric intensivist using critical care echocardiography to the values measured by PiCCO monitor in critically ill pediatric patients. Methods: A prospective observational study from a tertiary university hospital PICU. A total of 15 patients who required advanced hemodynamic monitoring and applied PiCCO monitoring were included the study. The diagnosis of patients were septic shock, cardiogenic shock, acute respiratory distress syndrome, pulmonary edema. Forty nine echocardiographic measurements were performed and from 15 patients. All echocardiographic measurements were performed by a pediatric intensive care fellow experienced in cardiac ultrasound. The distance of left ventricle outflow tract (LVOT) in the parasternal long axis and LVOT-Velocity Time Integral (LVOT-VTI) measurement was performed in the apical five chamber image. Cardiac output_echocardiography (CO_echo) and CI_echocardiography (CI_echo) were calculated using these two measurements. PiCCO (PiCCO, Pulsion Medical Systems, Munich, Germany) monitoring was performed. Cardiac output (CO_picco) and CI (CI_picco) were simultaneously measured by PiCCO monitor and echocardiography. We performed a correlation analysis with this 49 echocardiographic measurements and PiCCO measurements. Results: We detected a strong positive correlation between CO_echo and CO_picco measurements (p < 0.001, r = 0.985) and a strong positive correlation between CI_echo and CI_picco measurements (p < 0.001, r = 0.943). Conclusions: Our study results suggest that critical care echocardiography measurement of CO and CI performed by an experienced pediatric intensivist are comparable to PiCCO measurements. The critical care echocardiography measurement can be used to guide fluid and vasoactive-inotropic management of critically ill pediatric patients.

The aim of this study was to evaluate the Candida species, predisposing factors, antifungal treatment approaches, and clinical outcomes of invasive Candida infections (ICIs) in a tertiary pediatric intensive care unit (PICU). A retrospective study was performed from January 2008 to January 2019 including 102 children with ICIs who were admitted to a university hospital in southeastern Turkey. Positive blood cultures were detected in 43 (42.1%) patients, and positive urine cultures were detected in 59 (57.8%). According to our results, Candida albicans (42.2%) was the most common species for all isolates followed by C. parapsilosis (17.6%). In our patient population, non-albicans Candida species were dominant (57.8%) in all isolates. The most common facilitating factor in our study was the use of mechanical ventilator support (87.3%). The mortality rate of our patients with ICIs was 13.7%. Candida albicans was found to have the highest mortality rate among all Candida species (30.7%). When we compared patients with C. albicans and those with non-albicans Candida species in terms of risk factors, we detected a significant difference between the two groups for total parenteral nutrition use (p = 0.027). Fluconazole was the most preferred (58.8%) treatment option in our PICU for ICIs. Our results showed an increased trend in micafungin use in recent years. ICIs are a significant problem due to the high mortality and morbidity rates in critically ill pediatric patients in PICUs. In recent years, an increase in Candida infections caused by non-albicans Candida species has been reported. Multicenter prospective studies are needed to determine the risk factors for ICIs.

Foreign body aspiration is one of the common home accidents that requires urgent diagnosis and treatment, especially in children aged between 1 and 3 years. The type, location, and obstruction level of the aspirated material, age of the patient, and time of diagnosis influence the severity of the clinical picture. In our study, we aimed to evaluate patients who underwent bronchoscopy in our clinic with a diagnosis of foreign body aspiration in light of literature data. The medical records of 87 patients who underwent rigid bronchoscopy with a prediagnosis of foreign body aspiration in Çukurova University, Faculty of Medicine, between January 2016 and August 2018, and were followed up in the pediatric intensive care unit after the procedure were examined retrospectively. The subjects were evaluated in terms of age, sex, primary referal center, time of presentation, symptoms at presentation, physical examination findings, radiologic investigations, type and location of foreign body, and duration of stay in the intensive care unit. A total of 87 patients were included in the study. Thirty-seven patients (42.5%) were female. The mean age was found as 33.73±39.44 (range, 5-202) months. The most common (74.7%) symptom at presentation was sudden onset of coughing. The foreign body aspirated was organic in 62.1% of patients. The most common foreign bodies aspirated were peanuts, with a rate of 19.5%. Four adolescent female patients underwent broncoscopy because they aspirated needles they held in their mouths while tying their headscarves. Interestingly, one patient aspirated a stone and one patient aspirated a parasite. The most frequent location of foreign body was the right main bronchus (n=27, 31%). In the diagnosis of foreign body aspiration, the most important step is maintaining a high index of suspicion. Foreign body aspiration should be considered in patients who present with cough, respiratory distress or cyanosis, unilaterally diminished breath sounds, ronchi or stridor on physical examination, and air trapping on chest X-ray. Bronchoscopy is life-saving in the presence of any suspicious history suggestive foreign body aspiration or refractory pneumonia, even if a physical examination and radiologic findings are normal, especially in high-risk children between 1-3 years old.

Background. Measurement of the optic nerve sheath diameter (ONSD) with point-of-care ultrasound (POCUS) is a non-invasive and radiation-free technique that can be used to assess increased intracranial pressure (ICP). Ophthalmic artery and central retinal artery Doppler indices can be used like transcranial Doppler to evaluate increased ICP. This study aims to examine the diagnostic value of ONSD measurements and central retinal artery Doppler indices in the evaluation of pediatric patients with increased ICP. Methods. This was a prospective, case-controlled single center study. The study group was comprised of a total of 38 pediatric patients with increased ICP and the control group included 19 healthy children. Ophthalmic ultrasound was performed and ONSD and central retinal artery Doppler indices were measured. Results. The mean age of the study group was 80.84 ± 65.12 months. The mean ONSD was 5.9 ± 0.8 (3.6-8.1) mm in the study group and the mean resistive index (RI) was 0.71 ± 0.08 (min:0,55-max:1) and was significantly greater than the control group (p < 0.001 and p < 0.001, respectively). In terms of predicting increased ICP, the ONSD measurement was the strongest parameter, with its area under the curve: 0.767 (95 percent confidence interval: 0.68-0.85). In the study group, the cut-off value for ONSD was 5.8 mm (66 percent sensitivity, 100 percent specificity) and the cut-off value for RI was 0.68 (63 percent sensitivity, 83 percent specificity). Conclusions. Point-of-care ultrasound is a noninvasive and important tool in pediatric intensive care units. Our study is significant as one of the few pediatric studies where central retinal artery Doppler indices are evaluated in addition to OSND, in patients with increased ICP.