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 5 (10.6%), neurological deterioration in 4 (8.5%) and developing ARDS in 3 (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 6th 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 16 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 6th hours and PRISM-3 score >8 predict NIV failure.

Objective: This study aimed to compare the efficacy of direct and videolaryngoscopy procedures performed by pediatric residents who had limited experience of direct endotracheal intubation and had not previously used video laryngoscopes in a normal airway child manikin. Material and Methods: The endotracheal intubations performed by pediatric residents with a direct laryngoscope and Storz C-MAC videolaryngoscope on a pediatric manikin with a normal airway were compared. Theoretical and practical training was given before the study. In the first attempt, the success of the intubation procedure, glottis visual duration, and endotracheal tube insertion time were determined. Practitioners grouped the glottis image between 1-4 according to the Cormack-Lehane Staging (Stage 1 ideal image). After the intervention, the participants scored one to ten points on direct and videolaryngoscopy (1 not useful, 10 very useful). Results: The success of direct and videolaryngoscopy of 51 pediatric residents on the same manikin was 48 out of 51 (94%) for each method (p> 0.05). Glottis visual duration was similar in both methods (p>0.05); tube insertion and total intubation time were shorter in the video laryngoscope group (p<0.05); glottis image was better in the video laryngoscope group according to Cormack-Lehane Classification (p<0.05). Participants’ rating was higher on videolaryngoscope (p<0.05). Conclusion: Users with limited endotracheal intubation experience use Video laryncoscope more effectively than direct laryngoscope in children with normal airway model after training. Cite this article as: Anıl AB, Anıl M, Durak F, et al. Comparison of direct and video laryngoscope endotracheal intubations by pediatric residents: A study of a child model with normal airway. Turk Arch Pediatr 2021; 56(3): 224-9.

Background: Secondary hepatic dysfunction is a frequent yet often under-recognized complication in critically ill children. It commonly arises as a consequence of systemic processes—particularly sepsis, hypoperfusion, hypoxia, and multiorgan dysfunction—rather than primary hepatobiliary disease. This study aimed to determine the incidence, clinical characteristics, and prognostic significance of secondary hepatic dysfunction in a pediatric intensive care unit (PICU) cohort, and to evaluate its relationship with PRISM III and PELOD-2 scores. Methods: This retrospective study included patients hospitalized in a tertiary PICU between January 2022 and December 2024. Children with pre-existing liver disease or primary acute liver failure were excluded. Hepatic dysfunction was defined by elevations in age-adjusted biochemical markers. Demographic variables, clinical interventions, laboratory values, and outcomes were recorded. Mortality risk and prolonged PICU stay (>7 days) were analyzed in relation to hepatic dysfunction, PRISM III, and PELOD-2 scores. Results: Among 567 PICU admissions, 50 patients (8.8%) met criteria for secondary hepatic dysfunction. The cohort had a median age of 57.5 months and 66% were male. Hepatocellular injury predominated (96%), while cholestatic patterns were less common (4%). Overall mortality was 22%. Mortality was significantly associated with sepsis (p = 0.04), mechanical ventilation (p < 0.01), and inotropic support (p < 0.01). Both PRISM III and PELOD-2 scores were higher in non-survivors on day 1 and day 7 (p ≤ 0.01). ALT ≥ 2 × ULN and total bilirubin > 2 mg/dL were not independently predictive of mortality. Conclusions: Secondary hepatic dysfunction is relatively common in critically ill children and is associated with adverse clinical outcomes. Its prognostic relevance appears to extend beyond conventional severity scores, particularly with respect to morbidity-related outcomes such as prolonged PICU stay, suggesting that routine hepatic assessment may contribute to early risk stratification in the PICU setting.

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.

Objective: Hospital-associated multidrug-resistant infections are currently on the rise. Widespread resistance to antibiotics and limited therapeutic options make it a challenge to eradicate these infections. Therefore, the use of different antibiotics was increased in pediatric intensive care (PICU). Fluoroquinolones belong to a class of broad-spectrum antimicrobials, and their use in children has not been associated with any known clinical complications. In this single-centre retrospective study, we aimed to evaluate the effects, results, and safety of levofloxacin treatment. Materials and Methods: A retrospective, single-center study was conducted at a local tertiary hospital involving 22 patients who were treated with levofloxacin in the PICU from July to December 2021. Levofloxacin was initiated at a dose of 10mg/kg twice daily intravenously for 14-21 days. The study examined and evaluated various factors related to the patients, including their demographic characteristics, medical history, comorbidities, length of stay, need for mechanical ventilation support, laboratory results, type of infection/microorganism, duration of treatment, treatment response and adverse effects, morbidity and mortality. Results: Stenotrophomonas maltophilia13(59.1%) and Pseudomonas aeruginosa9(40.9%) were detected in included patients who had levofloxacin treatment 20(90.9%) of their infections were eradicated. The mortality rate was found to be 13.6%, and 19 patients (86.4%) were successfully treated. No complications related to levofloxacin were detected during the treatment period. The duration of levofloxacin treatment in patients with eradication of gram negative bacteria was 21 days (range: 14-27 days), compared to 12 days (range: 10-14 days) in patients without eradication. This difference was found to be statistically significant (p=0.007). Conclusions: Due to the challenge of eradicating infections and the rising antibiotic resistance, it may be necessary to use antibiotics that are not typically prescribed to children or to develop new drug categories. Therefore, there is a need for more multicenter, randomized controlled, and long-term observational studies to evaluate the efficacy of different and new groups of antibiotics, including levofloxacin, in treating gram-negative bacterias.