Objectives: This descriptive study aimed to compare the clinical and laboratory features of the children with the multisystem inflammatory syndrome in children (MIS-C), requiring pediatric intensive care unit (PICU), admission with the MIS-C patients who did not require PICU admission. Patients and methods: This study was conducted between March 2020 and February 2021 at the University of Health Sciences Dr. Behçet Uz Children’s Hospital, a referral center for pediatric infectious diseases in the Aegean Region of Turkey. All hospitalized patients aged 18 years old or less with MIS-C according to the definition of the universal guidelines were included in the study. Data of the patients with the diagnosis of MIS-C were recorded and collected from the electronic medical records of the hospital. The data included demographic characteristics, presenting signs and symptoms, laboratory findings and clinical data. Results: A total of 58 patients with MIS-C were included in this study. Thirty-eight (65.5%) patients were male. The median age was 6 years (2 months–16 years). The patients admitted to PICU were 15 (25.9%). The rate of pulmonary involvement was 81.3% (n = 13) in the PICU group. The median procalcitonin, C-reactive protein, erythrocyte sedimentation rate, D-Dimer and ferritin values were significantly higher in the PICU group compared to non-PICU group (p < 0.001, p = 0.02, p < 0.001, p = 0.006 and p = 0.031). Conclusions: Besides the depressing cardiac functions reported before, the pulmonary involvement and signs of shock are important factors for PICU admission in children with MIS-C.

Background: The inability to ensure adequate nutrition for patients, and failure to provide adequate calorie and protein intake, result in malnutrition, leading to increased morbidity and mortality. The present study assesses the two approaches to enteral nutrition—intermittent and continuous enteral feeding—in critically ill pediatric patients in Türkiye to determine the superiority of one method over the other. Methods: Included in this multicenter prospective study were patients receiving enteral nutrition via a tube who were followed up over a 3-month period. Anthropometric data, calorie and protein intake, and signs of feeding intolerance were evaluated in a comparison of the different feeding methods. Results: A total of 510 patients were examined. In the continuous enteral feeding (CEF) group, 20.2% of patients developed metabolic abnormalities, and 49.5% experienced enteral nutrition intolerance, both of which were higher than in the intermittent enteral feeding (IEF) group, and the differences were statistically significant. No significant differences were observed between the two feeding methods in terms of reaching the target calorie intake on days 2 and 7 (p > 0.05). On day 7, there were significant differences between the two feeding methods in terms of calorie and protein intake (p = 0.023 and 0.014, respectively). Conclusions: In the present study, assessing the IEF and CEF approaches to enteral nutrition, critically ill pediatric patients receiving intermittent feeding exhibited lower rates of enteral nutrition intolerance and metabolic abnormalities. Furthermore, the calorie and protein intake on day 7 were noted to be higher in the IEF group than in the CEF group. Further randomized controlled trials are needed to confirm the findings of the present study.

Background/aim: Hyperlactatemia is a common finding in critically ill patients and has significant prognostic implications. However, a single lactate measurement has not been correlated to mortality consistently. In this study, we aimed to correlate the clinical efficacy of lactate clearance for the prediction of mortality in pediatric intensive care unit patients. Materials and methods: This retrospective observational study was performed in the pediatric intensive care unit in patients with lactate level >3 mmol/lt. Initial, 6th h, and 24th h lactate levels were recorded and lactate clearance was calculated using these values (lactate level at admission - level 6 h later × 100/lactate level at admission). Results: A total of 172 patients were included in the study. Forty-four out of 172 patients died. Median (IQR) lactate (mmol/L) at admission was low in those who survived in comparison to nonsurvivors 4.4 (3.1) vs. 5.75 (7.7) (p = 0.002). Clearance at 6th h was significantly lower in those who died (11.7%) than those who survived (36.7) (p = 0.001). 6th h lactate clearance level <20.7% predicted mortality with a sensitivity of 63.6% and specificity of 69.5% along with a positive predictive value of 41.8 and a negative predictive value of 84.8 (p = 0.004). Both lactate levels and lactate clearance values were significantly predictive factors for mortality (p < 0.05). Only a positive moderate correlation was found between the percentage of PRISM-IV % and 6th h lactate level. Conclusion: The present study revealed that lactate clearance is a simple and rapid risk-stratification tool holding to be a potential biomarker of managing the treatment efficacy of children in the pediatric intensive care unit.

Aim: To reveal the effect of synchronous or asynchronous patients on these values by examining the esophageal pressure (Pes ), transpulmonary pressure (PL), and time-pressure-product (PTP) in active patients who are planned to be weaned from the mechanical ventilator and can trigger their own respiration. Material and Methods: Patients who are monitored on a mechanical ventilator and who can trigger their own respiration, and who are planned to be separated from the mechanical ventilator in the near future, were taken and an esophageal catheter was inserted, then the catheter filling volume was first optimized and then validated, and PL was started to be recorded by removing Pes from the airway pressure. With the recording devices on the ventilator, the mechanical ventilation parameters of the patients were recorded as both monitoring values and waveforms. Then, the mechanical ventilation settings were rearranged by the clinician at the bedside with reference to the esophageal waveform. Then, the waveforms of these patients have examined on the Matlab E2019a (Mathworks, USA) software, and each breath was marked as synchronous-asynchronous and the asynchrony index (AI) was calculated. Accordingly, the asynchronous and synchronous periods of the patient were defined, and the values of ∆Pes, ∆PL, PTP-Pes, PTP-PL, PTP-Pes-minutes, PTP-PL-minutes between the synchronous and asynchronous periods of the same patient were calculated on Matlab software, and synchronous and The changes in these values between asynchronous periods were analyzed with the SPSS statistical program. After examining the distribution of the variables by visual and analytical methods (Shapiro-Wilk), the statistical difference between the groups was examined. Results: When the synchronous and asynchronous periods of all patients were compared, the following differences were found between the synchronous and asynchronous groups in favor of the synchronous group. ∆Peso [5.98 (3.55-9.08)] cmH2O, ∆PL [5 (2.7-7.25]cmH2O, ∆PTP-Peso [3.70 (2.81-4.6)) ]cmH2O*s, ∆PTP-PL [3.36 (1.39-4.18)]cmH2O*s, ∆PTP-Peso/min [1.72 (1.02-2.67)]cmH2O*min , ∆PTP-PL/min [1.25 (0.30-3.01)]cmH2O*min. Conclusion: It has also been shown by statistical analyzes that the synchronization of active patients who are planned to be weaned from mechanical ventilator and who can trigger their own respiration causes a decrease in the values of ∆Peso, ∆Ptranspulmonary, PTP-Peso,PTP-Ptranspulmonary, PTP-Peso-minute, PTP-Ptranspulmonary-minute. When this information about synchronization is correlated with the literature, Pes monitoring in patients and synchronization of patients prevent mechanical ventilation-related lung damage that may occur in these patients, and thus the duration of hospital stay due to asynchrony, failure to wean from the ventilator, and the consequences that may occur. It is a method that can be useful in reducing mortality and morbidity.