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Öğe Continuous Renal Replacement Therapy (CRRT) Protocol in Critically Ill Children(Galenos Publishing House, 2024) Köker, Alper; Yaman, Ayhan; Akkuzu, Emine; Duyu, Muhterem; Akçay, Nihal; Dalkıran, Tahir; Besci, Tolga; Demirkol, DemetCritically ill child extracorporeal therapy; renal failure renal replacementÖğe Could the COVID-19 infection have a better prognosis than expected in pediatric hematology oncology and bone marrow transplant patients?(AVES, 2021) Öner, Özlem Başoğlu; Aksoy, Başak Adaklı; Yaman, Ayhan; Sütçü, Murat; Erol Çipe, Funda; Atça, Ali Önder; Bozkurt, Ceyhun; Fışgın, TunçCoronavirus disease 2019 (COVID-19) is a pandemic that spread rapidly worldwide (1). So far, very few reports concerning the impact of COVID-19 among patients with pediatric hematologic-oncologic diseases are available (2). We aimed to describe the clinical features, prevalence, treatments, and outcomes in the COVID-19 patient population.Öğe Covid-19 transmission and clinical features in pediatric intensive care health care workers(2022) Botan, Edin; Uyar, Emel; Öztürk, Zeynelabidin; Şevketoğlu, Esra; Sarı, Yusuf; Dursun, Oğuz; Sincar, Şahin; Duyu, Muhterem; Oto, Arzu; Çelegen, Mehmet; Özçiftçi, Gökçen; Havan, Merve; Öztürk, Makbule Nilüfer; Ağın, Hasan; Yener, Nazik; Yaman, Ayhan; Gün, Emrah; Yılmaz, Merve; Şimşek, Naile; Özdemir, Halil; Yıldızdaş, Dinçer; Kendirli, TanılObjective: This study aims to investigate modes of transmission and clinical features of coronavirus disease 2019 in healthcare workers in pediatric intensive care units. Materials and Methods: This multicenter descriptive study was conducted between March and November 2020. Patient demographics, clinical characteristics, origin of coronavirus disease 2019, treatment modalities, and loss of workdays were recorded. Results: Seven hundred and sixty-eight healthcare workers from 16 pediatric intensive care units were enrolled and 114 (14.8%) healthcare workers with a mean age of 29.7 +/- 6.7 years became coronavirus disease 2019 patients. Seventy-six (66.7%) patients were female. Approximately half (54.3%) of the patients were physicians, 34.2% were nurses, and 11.4% were ancillary staff. Transmission was deemed to occur through patient contact in 54.3% of the patients. Comorbid illness was present 10.5% of the patients. Transmission occurred during endotracheal intubation in 21%, cardiopulmonary resuscitation in 9.6%, and non-invasive ventilation in 12.2% of patients, while transmission was a result of multiple possible procedures in 43.8%. Intensive care admission was needed for 13.1% of the patients. Five patients needed oxygen by cannula, 7 needed oxygen with a non-rebreathing mask, 5 needed high-flow nasal cannula support, 5 needed non-invasive ventilation, and 3 needed invasive mechanical ventilation. Fortunately, no infected healthcare workers died. Conclusion: Coronavirus disease 2019 in healthcare workers is a significant problem in pediatric intensive care units. Transmission seems to occur particularly frequently during patient care procedures such as intubation, ventilation and aerosol therapy, which highlights the importance of proper use of full sets of personal protective equipment during all procedures during care of coronavirus disease 2019 patients.Öğe Defective kinase activity of IKKα leads to combined immunodeficiency and disruption of immune tolerance in humans(Nature Research, 2024) Çıldır, Gökhan; Aba, Ümran; Pehlivan, Damla; Tvorogov, Denis; Warnock, Nicholas I.; İpşir, Canberk; Arık, Elif; Kok, Chung Hoow; Bozkurt, Ceren; Tekeoğlu, Sidem; İnal, Gaye; Cesur, Mahmut; Küçükosmanoğlu, Ercan; Karahan, İbrahim; Savaş, Berna; Balcı, Deniz; Yaman, Ayhan; Demirbaş, Nazlı Deveci; Tezcan, İlhan; Haskoloğlu, Şule; Doğu, Figen; İkincioğulları, Aydan; Keskin, Özlem; Tümes, Damon J.; Erman, BaranIKKα is a multifunctional serine/threonine kinase that controls various biological processes, either dependent on or independent of its kinase activity. However, the importance of the kinase function of IKKα in human physiology remains unknown since no biallelic variants disrupting its kinase activity have been reported. In this study, we present a homozygous germline missense variant in the kinase domain of IKKα, which is present in three children from two Turkish families. This variant, referred to as IKKαG167R, is in the activation segment of the kinase domain and affects the conserved (DF/LG) motif responsible for coordinating magnesium atoms for ATP binding. As a result, IKKαG167R abolishes the kinase activity of IKKα, leading to impaired activation of the non-canonical NF-κB pathway. Patients carrying IKKαG167R exhibit a range of immune system abnormalities, including the absence of secondary lymphoid organs, hypogammaglobulinemia and limited diversity of T and B cell receptors with evidence of autoreactivity. Overall, our findings indicate that, unlike a nonsense IKKα variant that results in early embryonic lethality in humans, the deficiency of IKKα‘s kinase activity is compatible with human life. However, it significantly disrupts the homeostasis of the immune system, underscoring the essential and non-redundant kinase function of IKKα in humans. © The Author(s) 2024.Öğe Evaluation of forensic cases in the pediatric intensive care unit(KARE PUBL, 2021) Polat, Sinem; Terece, Cem; Yaman, Ayhan; Gürpınar, KağanObjectives: Traffic accidents, falls, assaults, occupational accidents, intoxications, burns, electric shock, lightning strike, all cases of asphyxia, penetrating and firearm injuries, suspected or definite cases of sexual abuse, and suicide attempts should be evaluated in the forensic category. In this study, we aimed to present our intensive care experiences in forensic cases. Methods: We retrospectively evaluated forensic cases admitted to our Pediatric Intensive Care Unit between 1 February 2017 and 1 September 2018. Results: This study included 153 children, 65 (42.5%) boys and 88 (57.5%) girls. The forensic causes of hospitalizations in the intensive care unit included drug intoxication with a rate of 54.9%, followed by suicide attempts with 24.2%, falling from a high place with 5.2%, child abuse with 5.2%, pedestrian (out-of-vehicle) traffic accidents with 2.6%, drowning in water with 2.6%, road (in-vehicle) traffic accidents with 2%, electric shocks with 2%, and CO (carbon monoxide) poisoning with 1.3%. The drug intoxication was caused by drugs prescribed to the mother and the child with a rate of 40.6% and 27.1%, respectively. Analgesic anti-inflammatory drugs (33.1%) and antidepressant drugs (22.3%) were identified as major causes of intoxication. In addition, paracetamol was the most common cause of intoxication, with a rate of 21.9% among all intoxication cases and 72.5% in the analgesic group. Amitriptyline was the most common agent in the antidepressant group (59.2%). The admission rate to the intensive care unit between 08:00 and 14:00 was 35.1% for suicide attempts and 16.4% for non-suicide attempts, with a statistically significant difference (p=0.025; p<0.05, respectively). Conclusion: Drug intoxications had the highest rate of forensic cases followed in our pediatric intensive care unit. The majority of these intoxications (69.4%) arose from accidental drug ingestion. Therefore, we believe that there may be a significant decrease in the number of hospitalizations of forensic cases associated with drug intoxications in pediatric intensive care units by preventing children's access to drugs.Öğe High flow nasal oxygen therapy in pediatric intensive care unit(Galenos, 2021) Yaman, AyhanObjective: Acute respiratory failure is the most common reason for hospitalization to pediatric intensive care units. Invasive and non-invasive respiratory support methods are used for the treatment of patients with acute respiratory failure findings. The aim of this study is to evaluate the effectiveness of high flow nasal cannula (HFNC) oxygen therapy in pediatric intensive care. Method: This retrospective observational study was conducted between February 2017 and January 2018 in pediatric intensive care unit of Bahçeşehir Liv Hospital, İstinye University Faculty of Medicine. Patients aged between 1 month and 18 years, who received HFNC oxygen therapy for respiratory support in the pediatric intensive care unit, were included in the study. Results: HFNC therapy was received by 67 patients during one year of the study. 58.2% of the patients were male. The mean age of the patients was 37.2 months (R, 1-192), and their average body weight was 11.8 kg (R, 2.8-50). 65.7% of patients had an underlying disease. The most underlying disease was neurological disease with the rate of 35.8%. 94% of our patients received HFNC therapy due to acute respiratory failure, 3% due to acute heart failure and 3% due to shock. 40.3% of our patients received HFNC therapy due to pneumonia, 16.4% due to bronchopneumonia, 14.9% due to bronchiolitis, and 11.9% due to postextubation. 71.6% of patients receiving HFNC therapy improved their clinical findings without intubation. After HFNC therapy, there was a statistically considerable decrease in the respiratory rate, heart rate and retraction of the patients. HFNC therapy failure rates were statistically significantly higher in patients with underlying disease and especially in those with cardiac disease. Conclusion: As a result, it is known that HFNC therapy has been used effectively in children in recent years, and it provides improvement in vital findings and blood gas parameters. In our study, 71.6% of our patients benefited from HFNC therapy.Öğe Immediate Extubation in the Operating Room Following Pediatric Liver Transplantation: A Retrospective Cohort Study(Elsevier Science Inc, 2023) Sahin, Taylan; Yaman, Ayhan; Kavakli, Ali Sait; Eren, Eryigit; Dinckan, AyhanBackground. Although immediate extubation in the operating room following pediatric liver transplantation can be safe and beneficial for select patients, many surgeons and anesthesiologists are still cautious. The study aimed to evaluate the safety and efficiency of immediate extubation in the operating room following pediatric liver transplantation.Methods. Sixty-four pediatric liver transplant recipients were included in this retrospective study. Patients were divided into 2 groups: immediate extubation (IE) (those who were extubated in the operating room) and delayed extubation (DE) (those who were extubated in the intensive care unit). Preoperative, intraoperative, and postoperative variables were recorded.Results. Although a total of 19 (29.7%) patients were extubated in the pediatric intensive care unit (group DE), 45 (70.3%) were extubated in the operating room at the end of surgery (group IE). The use of fresh frozen plasma and platelets was statistically higher in group DE (P = .017 and P = .002, respectively). Duration of anesthesia and length of stay in the pediatric intensive care unit was statistically longer in group DE (P = .020 and P = .0001, respectively). Three (15.8%) patients required reintubation in group DE and 2 (4.4%) in group IE. Hospital stay was statistically longer in group DE (P = .012).Conclusions. The current study demonstrated that immediate extubation in the operating room after surgery for pediatric patients who have undergone liver transplantation was safe. The duration of anesthesia and the intraoperative use of blood products such as platelet and fresh frozen plasma can effectively decide immediate extubation.Öğe Kidney replacement therapies and outcomes in children with crush syndrome-associated kidney injury(Amer medical assoc, 2025) Demirkol, Demet; Besci, Tolga; Havan, Merve; Karacanoğlu, Dilek; Yaman, AyhanImportance This study addresses the characteristics, kidney replacement therapy (KRT) modalities, and outcomes in children diagnosed with crush syndrome following an earthquake in Turkey. Objective To analyze the associations of different KRT modalities with long-term dialysis dependency and length of stay (LOS) in the pediatric intensive care unit (PICU). Design, Setting, and Participants This multicenter, prospective, and retrospective cohort study was conducted across 20 PICUs in Turkey. Participants included children diagnosed with crush syndrome after the 2023 Kahramanmara & scedil; earthquake, and eligibility criteria included age, diagnosis, and need for KRT. Data were analyzed from August to October 2024. Exposure Children diagnosed with crush syndrome who underwent KRT. Main Outcomes and Measures The primary outcome was dialysis dependency at discharge. Secondary outcomes included LOS in the PICU. Results The study included 183 pediatric patients (median [IQR] age, 158 (108-192) months; 49 [54.4%] males) with earthquake-related injury, of whom 90 required KRT. The median (IQR) time under the rubble was 25.7 (1-137) hours. At admission, 51 patients (56.6%) had stage 3 acute kidney injury, and the median (IQR) serum creatinine phosphokinase level was 15 555 (9386-59 274) IU/L. There was a significant association between the Kidney Disease-Improving Global Outcomes (KDIGO) stage at admission and serum creatinine phosphokinase level (area under the curve, 0.750; 95% CI, 0.621-0.879; P < .001). Among patients undergoing KRT, 33 (36.7%) received continuous venovenous hemodiafiltration, and 23 (25.6%) underwent intermittent hemodialysis (IHD). IHD treatment was the only independent factor associated with shorter PICU LOS (odds ratio [OR], 6.87; 95% CI, 1.54-30.67; P = .01). The dialysis dependency at discharge was higher in children who were transferred late to the PICU (beta = 0.003; 95% CI, 0.001-0.005; P < .001) and those with a high Pediatric Trauma Score (beta = 0.022; 95% CI, 0.003-0.041; P = 02). IHD was not statistically significantly associated with remaining dialysis-dependent at discharge (OR, 2.18; 95% CI, 0.53-8.98; P = .28). The overall mortality rate in the cohort was 6 patients (6.6%). Conclusions and Relevance This cohort study found that children who were transferred late to intensive care and those with a high trauma score after earthquake-related crush injury were more likely to remain dialysis-dependent at discharge. Furthermore, KDIGO stage at admission was associated with elevated serum creatinine phosphokinase levels. These findings highlight the critical importance of early intervention and appropriate treatment in children with AKI following prolonged entrapment.Öğe Kidney transplantation in children weighing 15 kilograms or less(SPRINGER, 2021) Özkaya, Ozan; Evrengül, Havva; Eren, Eryiğit; Tokaç, Mehmet; Yaman, Ayhan; Şahin, Taylan; Sütçü, Murat; Dursun, İsmail; Dinçkan, Ayhan[No Abstract Available]Öğe Severe rhabdomyolysis and acute renal failure treated by continuous venovenous hemodiafiltration in a child with diabetic ketoacidosis(Jaypee Brothers Medical Publishers, 2022) Yaman, AyhanDiabetic ketoacidosis (DKA) is the most serious hyperglycemic emergency in patients with type I diabetes mellitus and is associated with significant morbidity and mortality. DKA may be a life-threatening condition due to severe clinical and biological impairments and treatment-associated complications [cerebral edema, acute respiratory failure, acute renal failure (ARF), hypokalemia, hypophosphatemia]. The development of ARF with rhabdomyolysis is a rare but potentially lethal disorder in children with DKA with an estimated mortality of about 50%. Continuous renal replacement therapy is commonly used in intensive care units to provide renal replacement and fluid management. We successfully treated a 13-year-old boy with continuous venovenous hemodiafiltration, who had been diagnosed with severe DKA, complicated with hypophosphatemia-induced acute respiratory failure, rhabdomyolysis and ARF, persistent acidosis, and coma.Öğe The effect of ultrasound-guided central venous catheterization on complications and success rate in critically ıll children: a multicenter study(T.C. Sağlık Bakanlığı Ankara Şehir Hastanesi, 24 Eylül 2024) Yaman, Ayhan; Emeksiz, Serhat; Yıldızdaş, Dinçer; Kendirli, Tanıl; Ödek, Çağlar; Boşnak, Mehmet; Bayraktar, Süleyman; Ağın, Hasan; Anıl, Ayşe Berna; Kutlu, Nurettin Onur; Arslan, Gazi; Bayrakçı, Benan; Kalkan, Gökhan; Dursun, Oğuz; Sevketoglu, Esra; Azapağası, Ebru; Perk, Oktay; Yılmaz, HayriObjective: The aims of this study were to compare the results of ultrasound (US) guidance and the landmark (LM) technique for central venous catheter (CVC) placement in pediatric intensive care units (PICUs) as performed by clinicians. Material and Methods: The patients were divided into two groups according to the technique used: an LM group (459 patients) and a US-guided group (200 patients). We evaluated the success rate, the number of attempts, and the complication rates based on each patient’s age and weight. Results: The time required for the successful placement of the CVC was significantly different between the two groups: 10.9±10.8 min in the LM group and 8.1±7.6 min in the US-guided group (p=0.012). Additionally, the average number of attempts for successful catheterization was 1.8±0.8 in the US-guided group; and 2.5 ± 1.4 in the LM group (p=0.024). A total of 115 (17.3%) complications were noted: 24 (3.6%) in the US-guided group and 91 (13.7%) in the LM group (p=0.014). The frequency of complications decreased as the age and weight of the patients increased. When the inserted catheters used by ultrasound were evaluated, 59.5% of them were placed by clinicians who had ultrasound training while 40.5% were inserted by clinicians who did not have ultrasound training. There was no significant difference in the complication rate, number of punctures, and success rates between the ultrasound-trained and untrained clinicians (p=0.476). Conclusion: This is the largest multicenter study comparing the US-guided vs. LM technique for CVC placement in children. We believe that the US-guided CVC procedure is more safe and takes less time than the LM technique. Also, point-of-care ultrasound is useful, beneficial, and easily available for pediatric intensivists.
