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Derinoz-Guleryuz O, Uysal-Yazici M, Udurgucu M, Karacan C, Akça H, Ongun EA, Ekinci F, Duman M, Akça-Çaglar A, Vatansever G, Bilen S, Uysalol M, Akcan-Yıldız L, Saz EU, Bal A, Piskin E, Sahin S, Kurt F, Anil M, Besli E, Alakaya M, Gültekingil A, Yılmaz R, Temel-Koksoy O, Kesici S, Akcay N, Cebisli E, Emeksiz S, Kılınc MA, Köker A, Çoban Y, Erkek N, Gurlu R, Eksi-Alp E, Apa H. The skills of defibrillation practice and certified life-support training in the healthcare providers in Turkey. Int J Clin Pract 2021; 75:e14978. [PMID: 34669998 DOI: 10.1111/ijcp.14978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022] Open
Abstract
AIM OF THE STUDY Successful cardiopulmonary resuscitation and early defibrillation are critical in survival after in- or out-of-hospital cardiopulmonary arrest. The scope of this multi-centre study is to (a) assess skills of paediatric healthcare providers (HCPs) concerning two domains: (1) recognising rhythm abnormalities and (2) the use of defibrillator devices, and (b) to evaluate the impact of certified basic-life-support (BLS) and advanced-life-support (ALS) training to offer solutions for quality of improvement in several paediatric emergency cares and intensive care settings of Turkey. METHODS This cross-sectional and multi-centre survey study included several paediatric emergency care and intensive care settings from different regions of Turkey. RESULTS A total of 716 HCPs participated in the study (physicians: 69.4%, healthcare staff: 30.6%). The median age was 29 (27-33) years. Certified BLS-ALS training was received in 61% (n = 303/497) of the physicians and 45.2% (n = 99/219) of the non-physician healthcare staff (P < .001). The length of professional experience had favourable outcome towards an increased self-confidence in the physicians (P < .01, P < .001). Both physicians and non-physician healthcare staff improved their theoretical knowledge in the practice of synchronised cardioversion defibrillation (P < .001, P < .001). Non-certified healthcare providers were less likely to manage the initial doses of synchronised cardioversion and defibrillation: the correct responses remained at 32.5% and 9.2% for synchronised cardioversion and 44.8% and 16.7% for defibrillation in the physicians and healthcare staff, respectively. The indications for defibrillation were correctly answered in the physicians who had acquired a certificate of BLS-ALS training (P = .047, P = .003). CONCLUSIONS The professional experience is significant in the correct use of a defibrillator and related procedures. Given the importance of early defibrillation in survival, the importance and proper use of defibrillators should be emphasised in Certified BLS-ALS programmes. Certified BLS-ALS programmes increase the level of knowledge and self-confidence towards synchronised cardioversion-defibrillation procedures.
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Affiliation(s)
| | - Mutlu Uysal-Yazici
- Department of Pediatric Intensive Care, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Muhammed Udurgucu
- Department of Pediatric Intensive Care, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Candemir Karacan
- Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Halise Akça
- Department of Pediatric Emergency, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ebru Atike Ongun
- Department of Pediatric Intensive Care, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Faruk Ekinci
- Department of Pediatric Intensive Care, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Murat Duman
- Department of Pediatric Emergency, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ayla Akça-Çaglar
- Department of Pediatric Emergency, Dr. Sami Ulus Maternity and Children Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Goksel Vatansever
- Department of Pediatric Emergency, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sevcan Bilen
- Department of Pediatric Emergency, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Metin Uysalol
- Department of Pediatric Emergency, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Leman Akcan-Yıldız
- Department of Pediatric Emergency, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Eylem Ulas Saz
- Department of Pediatric Emergency, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Alkan Bal
- Department of Pediatric Emergency, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Etem Piskin
- Department of Pediatric Intensive Care, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Sabiha Sahin
- Department of Pediatric Emergency, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir, Turkey
| | - Funda Kurt
- Department of Pediatric Emergency, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Murat Anil
- Department of Pediatric Emergency, Faculty of Medicine, İzmir Demokrasi University, Izmir, Turkey
| | - Esen Besli
- Department of Pediatric Emergency, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Alakaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ayse Gültekingil
- Department of Pediatric Emergency, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Resul Yılmaz
- Department of Pediatric Intensive Care, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Ozlem Temel-Koksoy
- Department of Pediatric Intensive Care, Konya Training and Research Hospital, Konya, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nihal Akcay
- Department of Pediatric Intensive Care, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Erdem Cebisli
- Department of Pediatric Intensive Care, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Serhat Emeksiz
- Department of Pediatric Intensive Care, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Mehmet Arda Kılınc
- Department of Pediatric Intensive Care, Diyarbakir Children Hospital, Diyarbakir, Turkey
| | - Alper Köker
- Department of Pediatric Intensive Care, Hatay State Hospital, Hatay, Turkey
| | - Yasemin Çoban
- Department of Pediatric Intensive Care, Hatay State Hospital, Hatay, Turkey
| | - Nilgün Erkek
- Department of Pediatric Emergency, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ramazan Gurlu
- Department of Pediatric Emergency, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Emel Eksi-Alp
- Department of Pediatric Emergency, İstanbul University, Istanbul, Turkey
| | - Hursit Apa
- Department of Pediatric Emergency, Dr. Behçet Uz Children's Hospital, University of Health Sciences, Izmir, Turkey
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Akbaş Y, Koker A, Erkek N. Are We Aware that Hyperphosphatemia Affects Mortality and Morbidity as much as Hypophosphatemia in Pediatric Intensive Care Patients? Pediatr Endocrinol Rev 2019; 17:35-40. [PMID: 31599134 DOI: 10.17458/per.vol17.2019.ake.hyperphosphatemiaaffectsmortality] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Hypophosphatemia was previously shown to affect the duration of admission, mechanical ventilator requirements, mortality and morbidity during pediatric intensive care. Different from previous studies, our study was planned with the aim of showing whether hyperphosphatemia affects morbidity and mortality in pediatric intensive care patients as much as hypophosphatemia. METHOD Patients' ages, genders, reason for admission, underlying diseases, phosphorus levels examined on admission and on the 1-4th and 5-10th-days, duration on mechanical ventilation, duration of admission, final status and PRISM and PELOD scores calculated in the first 24 hours of admission were recorded. RESULTS Mortality was distinctly higher for those who were hypophosphatemic and hyperphosphatemic compared to those who were normophosphatemic. The highest mortality was identified in those who were hyperphosphatemic on the 5-10th-days. PELOD scores were only significantly different according to admission phosphorus levels (p:0.04). CONCLUSION In our study, we identified that hyperphosphatemia is a serious problem as hypophosphatemia for patients who admitted to the PICU. Patients identified to be hyperphosphatemic on admission had a significantly higher PELOD score. The significant difference of hyperphosphatemia in terms of PELOD score is one of the important points shown in our study. It should not be forgotten that like hypophosphatemia, hyperphosphatemia may cause serious problems in pediatric intensive care patients.
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Affiliation(s)
- Yılmaz Akbaş
- Hatay State Hospital, Department of Pediatrics, Hatay, Turkey
| | - Alper Koker
- Hatay State Hospital, Department of Pediatrics, Pediatric Intensive Care Unit, Hatay, Turkey, E-mail:
| | - Nilgün Erkek
- Akdeniz University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Emergency Care, Antalya, Turkey
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Öztürk NY, Ak K, Erkek N, Besci T, İşbir S, Arsan S. Veno-venous extracorporal membrane oxygenation in a deeply hypoxemic infant with persistent air leakages: The first successful pediatric veno-venous extracorporeal membrane oxygenation case report in Turkey. Turk Arch Pediatr 2014; 49:66-9. [PMID: 26078634 DOI: 10.5152/tpa.2014.1172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 09/22/2013] [Indexed: 11/22/2022]
Abstract
In severe respiratory failure, extracorporal membrane oxygenation support is life-saving, but it has been started to be used in pediatric intensive care units in our country very recently. Here, we present a five-month old girl who developed acute respiratory distress and air leakages following removal of a foreign body obstructing the airway. Mechanical ventilation only increased the air leaks and - despite drainage-resulted in hypoxemia, acidosis and finally cardiopulmonary arrest. Initiation of veno-venous (VV) ECMO improved oxygenation as well as hemodynamics. The patient was weaned off extracorporal membrane oxygenation support on the 7th day with improvement in the lung parenchyma and ceasing of the air leakages; she was discharged on the 27(th) day of her hospitalization without any neurologicalsequela. As far as we know, this patient is the first pediatric patient who was discharged with success after application of venovenous-extracorporal membrane oxygenation with a respiratory indication in a pediatric intensive care unit in our country. We think that similar patients who need extracorporal membrane oxygenation can be cured with close collaboration of specialists of cardiovascular surgery and pediatric intensive care, dedicated nurses and perfusionist support when necessary.
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Affiliation(s)
- Nilüfer Yalındağ Öztürk
- Division of Pediatric Intensive Care, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Koray Ak
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Nilgün Erkek
- Division of Pediatric Emergency, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Tolga Besci
- Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Selim İşbir
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Sinan Arsan
- Department of Cardiovascular Surgery, Marmara University Faculty of Medicine, İstanbul, Turkey
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Demirkol D, Yildizdas D, Bayrakci B, Karapinar B, Kendirli T, Koroglu TF, Dursun O, Erkek N, Gedik H, Citak A, Kesici S, Karabocuoglu M, Carcillo JA. Hyperferritinemia in the critically ill child with secondary hemophagocytic lymphohistiocytosis/sepsis/multiple organ dysfunction syndrome/macrophage activation syndrome: what is the treatment? Crit Care 2012; 16:R52. [PMID: 22715953 PMCID: PMC3681377 DOI: 10.1186/cc11256] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 11/20/2011] [Accepted: 03/19/2012] [Indexed: 12/14/2022]
Abstract
Introduction Hyperferritinemia is associated with increased mortality in pediatric sepsis, multiple organ dysfunction syndrome (MODS), and critical illness. The International Histiocyte Society has recommended that children with hyperferritinemia and secondary hemophagocytic lymphohistiocytosis (HLH) or macrophage activation syndrome (MAS) should be treated with the same immunosuppressant/cytotoxic therapies used to treat primary HLH. We hypothesized that patients with hyperferritinemia associated secondary HLH/sepsis/MODS/MAS can be successfully treated with a less immunosuppressant approach than is recommended for primary HLH. Methods We conducted a multi-center cohort study of children in Turkish Pediatric Intensive Care units with hyperferritinemia associated secondary HLH/sepsis/MODS/MAS treated with less immunosuppression (plasma exchange and intravenous immunoglobulin or methyl prednisolone) or with the primary HLH protocol (plasma exchange and dexamethasone or cyclosporine A and/or etoposide). The primary outcome assessed was hospital survival. Results Twenty-three children with hyperferritinemia and secondary HLH/sepsis/MODS/MAS were enrolled (median ferritin = 6341 μg/dL, median number of organ failures = 5). Univariate and multivariate analyses demonstrated that use of plasma exchange and methyl prednisolone or intravenous immunoglobulin (n = 17, survival 100%) was associated with improved survival compared to plasma exchange and dexamethasone and/or cyclosporine and/or etoposide (n = 6, survival 50%) (P = 0.002). Conclusions Children with hyperferritinemia and secondary HLH/sepsis/MODS/MAS can be successfully treated with plasma exchange, intravenous immunoglobulin, and methylprednisone. Randomized trials are required to evaluate if the HLH-94 protocol is helpful or harmful compared to this less immune suppressive and cytotoxic approach in this specific population.
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Affiliation(s)
- Demet Demirkol
- Department of Pediatric Intensive Care, Bezmialem Vakif University, Faculty of Medicine, Vatan Caddesi, Istanbul, 34093, Turkey.
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Abstract
Hyponatremia and hyperpotassemia occurring in the first few weeks of life primarily indicate aldosterone deficiency due to salt-losing congenital adrenal hyperplasia (SL-CAH), while mineralocorticoid deficiency and insensitivity are the main causes of hyponatremia and hyperpotassemia in older infants. Some patients who present with vomiting and poor sucking, who have hyponatremia and hyperpotassemia and are initially diagnosed as CAH, during follow-up, are found to suffer from pseudohypoaldosteronism (PHA). This situation has been reported several times before. The cases described here represent the opposite situation: they presented with hyponatremia and hyperpotassemia, thus PHA was considered as aldosterone levels were very high, but subsequent investigation and genetic analysis led to the diagnosis of SL-CAH.
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Affiliation(s)
- Sebahat Yılmaz Ağladıoğlu
- Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinics of Pediatric Endocrinology, Ankara, Turkey.
| | - Zehra Aycan
- Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinics of Pediatric Endocrinology, Ankara, Turkey
| | - Havva Nur Peltek Kendirci
- Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinics of Pediatric Endocrinology, Ankara, Turkey
| | - Nilgün Erkek
- Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinics of Pediatrics, Ankara, Turkey
| | - Veysel Nijat Baş
- Dr. Sami Ulus Obstetrics and Gynecology, Pediatric Health and Disease Training and Research Hospital, Clinics of Pediatric Endocrinology, Ankara, Turkey
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