Background: Hypoactive delirium may go unrecognized unless routinely screened. At present, there is no valid screening tool for delirium in the Turkish language. This study was conducted to translate the Cornell Assessment of Pediatric Delirium (CAPD) into Turkish and to evaluate its validity and reliability. Methods: In this is validation study, CAPD assessments were conducted by pediatric intensive care unit nurses and compared with assessments by a child psychiatrist. Results: A total of 76 patients were included, 37 participants (48.6%) were younger than 24 months, and 22 participants (28.9%) had developmental disabilities. Prevalence of delirium was 25.0% (n=19). Inter-rater agreement for the identification of delirium by psychiatrists was strong and reliable, with a Cohen’s kappa value of 0.86 (95% confidence interval [CI]: 0.72-0.99). Inter-rater reliability for nurses was also significant, with a Cohen’s kappa of 0.74 (95% CI, 0.57-0.91). Inter-rater reliability ranged from 0.64 to 0.84 for each CAPD item except item 6, indicating reliable scoring. Sensitivity and specificity improved when the CAPD cut-off score was increased from 9 (100% and 95%, respectively) to 11 (100% and 98.02%, respectively). Subgroup analyses showed high sensitivity and specificity in patients with developmental delay (96%) and in patients under 2 years of age (96%) when the CAPD cut-off score was 9. However, specificity decreased slightly to 93% in patients under 6 months of age. Conclusion: The Turkish CAPD, the first delirium screening scale translated into Turkish, has demonstrated validity and reliability in screening for delirium in children of all ages, including those with developmental disabilities.

Background and Objectives: Childhood asthma represents a significant global public health issue and is the most common chronic disease among children. Hospitalization costs, especially for intensive care, are quite high. This study aimed to evaluate the characteristics, prognosis, and preventable risk factors of patients admitted to the Pediatric Intensive Care Unit (PICU) due to severe asthma exacerbations. Materials and Methods: We assessed patients admitted to the Ankara Bilkent City Hospital PICU from January 2013 to December 2022 diagnosed with asthma based on The Global Initiative for Asthma (GINA) criteria. The collected data encompassed demographic and clinical characteristics, intensive care treatments, hospitalization duration, atopic conditions, and respiratory viral panel results. The current clinical status was assessed using hospital records and caregiver interviews, with a focus on recent emergency admissions, ongoing treatments, exacerbation frequency, and asthma control based on GINA guidelines. Results: The study comprised 83 patients with a mean age of 72.9 (±45.5) months, predominantly male (63.9%). The average follow-up duration post-discharge was 40.7 ± 26.9 months. Patients received respiratory support in the PICU for a mean of 3.8 (±2.8) days and systemic steroid therapy for 4 (±1.5) days. Respiratory viral panel results identified pathogens in 42 patients, with rhinovirus being the most frequent. Post-discharge, 72.3% of patients continued follow-up at pediatric allergy clinics. Of the 60 patients contacted, 67.5% were on current asthma treatment and 48.2% had experienced an exacerbation in the past year. Asthma management steps remained unchanged for 33 patients, decreased for 13, and increased for 47 (44.6%). Asthma maintenance treatments pre-admission and post-discharge showed that 44.6% (n = 47) of the patients required an increase in their GINA treatment step after PICU admission, which was statistically significant (p < 0.001). History of atopic dermatitis was a significant risk factor for escalating treatment steps in both univariate and multivariate analyses (p = 0.018, p = 0.03). Conclusions: We found that admission to the PICU due to severe asthma exacerbation not only increases the risk of recurrent asthma exacerbations but also serves as a risk factor for stepping up maintenance treatment according to GINA guidelines during long-term follow-up.

Amaç: Bu çalışmanın amacı, pediatrik yoğun bakım takibi gereken travma hastalarında, travma nedenlerini ve klinik seyrini incelemek ve mülteci çocuklar özelinde demografik özellikler, travma oluşum mekanizması, travma şiddeti ve prognoz açısından olası farklılıkları değerlendirmektir. Gereç ve Yöntemler: 1 Mayıs 2020-30 Nisan 2021 tarihleri arasında çocuk yoğun bakım ünitemize travma ön tanısı ile başvuran 175 hastanın kayıtları geriye dönük olarak incelendi. Hastalar Türk vatandaşları ve Suriye vatandaşları (mülteci hastalar) olarak iki gruba ayrıldı. Elde edilen veriler bu iki grup arasında karşılaştırıldı. Bulgular: Hastaların 119’u (%68) T.C. vatandaşı ve 56’sı (%32) mülteci hastaydı. T.C. vatandaşı hastaların ortanca yaşı 6 (3-12; IQR) ve mülteci hastaların ortanca yaşı 4 (2-10; IQR) olarak saptandı (p=0.092). T.C. vatandaşlarının 70’i (%58.8), mülteci hastaların 43’ü (%76.8) erkekti (p=0.027). Araç içi trafik kazası T.C. vatandaşların 27’sinde (%22.7), mülteci hastaların 4’ünde (%7.2) görüldü ve farklılık istatistiksel olarak anlamlı bulundu (p=0.011). Mülteci hastalardaki araç dışı trafik kazası oranı T.C. vatandaşlarına göre daha fazlaydı (%23.2 ve %10; sırasıyla) (p=0.035). Travma nedeni ile 10 hasta hayatını kaybetmişti. Ölen hastaların yedisi (%5.8) T.C. vatandaşı, üçü (%5.3) göçmendi. Sonuç: Çalışmamızda mülteci çocuklarda araç dışı trafik kazasının daha fazla görüldüğünü ancak her iki grupta klinik olarak bir fark olmadığını saptadık. Göçmen sorunlarının daha dikkatli değerlendirilmesi, çocuk nüfusuna odaklı projeler ve çalışmalar, sosyo-ekonomik koşullarının iyileştirilmesi, eğitim sistemine düzenli katılımın sağlanması yaralanma oranlarını azaltabileceğini düşünmekteyiz.

Background. Pain and sedation management is an integral part of pediatric intensive care practice. Sedoanalgesia management must be balanced in order to optimize comfort and avoid complications. In order to achieve this balance, sedoanalgesia management needs to be clarified in pediatric intensive care units (PICU). With this study, we aimed to investigate sedation, analgesia, withdrawal and delirium practices, pharmacologic agent preferences, and current experiences and practices in scoring systems in PICUs in Türkiye. Method. A questionnaire consisting of 57 questions was sent via e-mail to the ‘Pediatric Intensive Care and Emergency’ group, which includes all intensive care specialists, subspecialty students and lecturers in Türkiye. Results. Our study involved 36 pediatric intensive care physicians working in PICUs in Türkiye. Among the PICU specialists who participated in the study, 83.3% stated that they performed routine assessments of sedation efficacy. While dexmedetomidine was the most commonly used sedative agent in patients undergoing noninvasive mechanical ventilation, benzodiazepines were the most preferred pharmacologic agent for sedation during mechanical ventilation. Of the pediatric intensivists who participated in the study, 94.4% stated that they performed routine pain assessments in their units. Of the PICU specialists who participated in the study, 69.4% stated that muscle relaxants were most commonly used to prevent patient-ventilator incompatibility during mechanical ventilation. Of the participants, 88.8% made withdrawal assessments when discontinuing sedo-analgesic agents. Delirium assessment was routinely performed by 58.3% of the participants. Conclusions. This study showed that the practices in sedoanalgesia management in PICUs in Türkiye are in parallel with recommendations of the sedation guideline. Despite the increased sensitivity in sedoanalgesia management, awareness in the management of delirium and withdrawal syndrome is not at the desired level. Therefore, there is a need to develop guidelines, raise awareness and increase training on these issues in our Türkiye.

Aim: Fluid accumulation occurs in pediatric patients in pediatric intensive care units (PICU). Medications administered in pediatric intensive care units can contribute to significant cumulative load in patients. In present study, we aimed to study fluid accumulation on patients without AKI and to determine contribution of medications over fluid intake. Material and Method: In this study, 527 daily follow-up forms of 101 patients was investigated retrospectively. Results: Total fluid load was found to be higher in patients with comorbidities, who underwent invasive mechanical ventilation, and who needed inotropes. While fluid load was higher in patients with sepsis than in other diagnostic groups, it was significantly lower in patients with multisystem inflammatory syndrome in children (MIS-C). While the median (IQR) of the cumulative fluid load was 11.6% (7.1-16.4) in the first 5 days, the median (IQR) reached 25.7% (14.65-34.1) on the 10th day. The cumulative fluid load increased as the patient's follow-up days increased. The median average daily fluid intake (IQR) from drugs alone was 14.48% (8.07-24.13). The contribution of drugs to the total fluid load increased as the age of patients decreased (r: -0.164, p< 0.001). Conclusion: A cumulative fluid load occurs in PICU patients without AKI. Particularly in young children, the contribution of fluids given with drugs to the fluid load should be kept in mind. Clinicians should perform patient-specific fluid management by supporting fluid status assessments with objective criteria in order to get out of the fluid accumulation- fluid over load dilemma.