Gülhan Atakul

Objectives: We aimed to evaluate the performance of the age-adapted Pediatric Sequential Organ Failure Assessment (pSOFA) score, as a predictor of mortality in patients admitted to pediatric intensive care units (PICUs), and to compare it with the Pediatric Risk of Mortality 4 (PRISM 4) and Pediatric Index of Mortality 3 (PIM 3) scores. Methods: This single-center, retrospective study analyzed data from 1440 eligible PICU admissions to a tertiary PICU. The pSOFA, PRISM 4, and PIM 3 scores were calculated retrospectively for each patient. Results: The overall mortality was 13.1%, and the median length of stay was 11 days. The median (IQR) pSOFA score was significantly higher in non-survivors than in survivors [6 (4–10) vs. 3 (2–4), p < 0.001]. Mortality increased significantly with increasing pSOFA scores (p < 0.001). The area under the receiver operating characteristic curve (AUC) values for pSOFA, PRISM 4, and PIM 3 were 0.807, 0.847, and 0.781, respectively. The pSOFA score exhibited a significant positive correlation with both PRISM 4 and PIM 3 (p < 0.001). PRISM 4 and PIM 3 demonstrated evidence of miscalibration in this cohort, with observed mortality exceeding mean predicted mortality for both models. Conclusions: pSOFA demonstrated good discrimination for PICU mortality and a strong association with mortality in this single-center retrospective cohort. PRISM 4 showed significantly greater discrimination than pSOFA, whereas pSOFA and PIM 3 did not differ significantly. These findings support further prospective multicenter evaluation before broader clinical implementation.

The prognostic significance of mechanical power (MP) and the optimal normalization strategy in pediatric acute respiratory distress syndrome (PARDS) remains uncertain. We evaluated the association between airway and transpulmonary mechanical power normalized using different strategies and 28-day mortality in children with PARDS. In this multicenter retrospective observational study, 128 invasively ventilated subjects with PARDS were included from four tertiary pediatric intensive care units between June 2020 and December 2025. Airway MP and transpulmonary mechanical power (MPL) were calculated during pressure-controlled ventilation and normalized to predicted body weight (PBW), body surface area (BSA), and static respiratory system compliance (Cstat). The primary outcome was 28-day mortality. Associations were examined using multivariable logistic regression adjusted for age, sex, ARDS severity (PALICC-2), and Pediatric Index of Mortality-3 (PIM-3). Discriminative performance was assessed using receiver operating characteristic analysis with DeLong comparisons, and optimal thresholds were identified using the Youden index. The 28-day mortality rate was 20.3%. Absolute airway MP was not associated with mortality. In adjusted analyses, only compliance-normalized airway MP (MP/Cstat) was associated with mortality (adjusted OR 6.8, 95% CI 1.0–44.8; p = 0.044). Compliance-normalized transpulmonary MP (MPL/Cstat) was also associated with mortality (adjusted OR 30.6, 95% CI 1.5–615.7; p = 0.03). PBW- and BSA-normalized indices were not significant. Compliance-normalized indices showed numerically higher AUC values (MP/Cstat 0.68; MPL/Cstat 0.70), although the differences were not significant by DeLong testing. Mortality increased stepwise across MP/Cstat tertiles (p for trend = 0.01). Among MP components, only the compliance-normalized elastic component was significantly associated with mortality. Conclusions: Mechanical power, normalized to static respiratory system compliance rather than anthropometric parameters, was associated with mortality and showed a graded dose–response relationship in PARDS. Compliance-based normalization may provide additional physiological insight into mechanical power assessment in PARDS. What is Known: • Mechanical power integrates multiple ventilatory variables and has been associated with outcomes in adult ARDS. • Different normalization approaches, including anthropometric and physiologic methods, have been proposed to account for variability in body size and lung mechanics. The clinical relevance of these normalization strategies in PARDS remains uncertain. What is New: • In a multicenter cohort of subjects with PARDS, mechanical power normalized to static respiratory system compliance was independently associated with 28-day mortality for both airway and transpulmonary measurements. In contrast, normalization to predicted body weight or body surface area was not independently associated with mortality after adjustment. • Mortality increased progressively across tertiles of compliance-normalized airway mechanical power. Among mechanical power components, only the compliance-normalized elastic component was independently associated with mortality.

The oxygenation index (OI) is widely used to assess disease severity in pediatric ARDS; however, it relies on mean airway pressure (Pmean), which does not reflect lung-distending forces relevant to ventilator-induced lung injury. Driving pressure (DP) is a determinant of lung strain. We developed and evaluated the oxygenation distension index (ODI) by substituting DP for Pmean in the OI formula. This observational study included children aged 1 month to 18 years with PARDS requiring ≥ 24 h of invasive mechanical ventilation in six centers. Lung ultrasound scores (LUS) and respiratory mechanics, including transpulmonary pressure (PL), transpulmonary driving pressure (DPL), mechanical power (MP), and transpulmonary mechanical power (MPL), were assessed 4–24 h after diagnosis according to PALICC-2 recommendations. Associations of OI and ODI with lung injury markers and clinical outcomes were analyzed. Among 56 patients, 41 (73%) had mild-to-moderate and 15 (27%) had severe PARDS. ODI demonstrated stronger correlations than OI with lung injury markers, including LUS (r = 0.818 vs. 0.501), PL (r = 0.779 vs. 0.697), DPL (r = 0.745 vs. 0.671), MP normalized to predicted body weight (r = 0.518 vs. 0.438), and MPL normalized to predicted body weight (r = 0.634 vs. 0.628). For 30-day mortality prediction, ODI showed higher discriminative performance than OI (AUC 0.740 [95% CI, 0.598–0.866] vs. 0.685 [95% CI, 0.535–0.835]; DeLong p = 0.040). Conclusions: By incorporating driving pressure, ODI more closely reflects lung injury severity than the conventional oxygenation index and improves discrimination for mortality in PARDS. What is Known: • The oxygenation index is the standard metric used for severity classification in pediatric acute respiratory distress syndrome. • Driving pressure has been increasingly recognized as a key physiological determinant of lung injury and clinical outcomes in ARDS. What is New: • A driving pressure–based oxygenation metric, the oxygenation distension index (ODI), shows stronger associations with established markers of lung injury than the conventional oxygenation index in PARDS. • ODI provides improved discrimination for 30-day mortality compared with the oxygenation index in mechanically ventilated children with PARDS.

Amaç Solunum yetmezliği, çocuk yoğun bakım ünitesi hastalarında en sık ölüm nedenlerinden biridir. Yetişkin ve az sayıda pediatrik çalışmada akut solunum distresi sendromu (ARDS) hastalarında sürüş baskısı ile mortaliteyi ilişkilendirmiştir, ancak ARDS'si olmayan hastalarda sürüş basıncı ile mortalite arasındaki ilişkiyi gösteren çalışmalar tutarsız ve sınırlıdır. Bu çalışmada solunum yetmezliği nedeniyle mekanik ventilasyon desteği alan pediatrik ARDS (pARDS) ve non-pARDS tanılı pediatrik hastalarda sürüş basıncının mortalite ile ilişkisinin belirlenmesi amaçlandı. Gereç ve Yöntem Öngörülen ventilasyon süresi 24 saatten fazla mekanik ventilasyon uygulanan hastalar kaydedildi. pARDS ve non-PARDS gruplarındaki hastaların sürüş basıncı ve diğer ventilatör parametreleri 30 günlük mortaliteleri ile karşılaştırıldı. Bulgular Çalışmamıza toplam 116 çocuk dahil edildi. Otuz dört hasta pARDS grubunda sınıflandırılırken, 82 hasta PARDS dışı gruptaydı. Tüm hastaların mekanik ventilasyonun ilk günü parametreleri [∆P (p

The most common and serious complication of central venous catheter usage is central line–associated bloodstream infections (CLABSIs) in children and adults. Between 2011 and 2014, CLABSIs were the most frequently reported healthcare-associated illness among hospitals in the USA. Bloodstream infections associated with central lines are […]

Introduction: Succinyl-CoA:3-oxoacid CoA transferase (SCOT, EC 2.8.3.5) deficiency is a rare autosomal recessive inborn error of metabolism (IEM). We report here an infant admitted to intensive care unit with the diagnosis of sepsis. Case Presentation: A five-month-old female patient was admitted to the intensive care unit with lethargy and respiratory distress. She had severe high anion gap metabolic acidosis. The IEM was screened by plasma amino acid analysis, showing no abnormalities, and by acylcarnitine analysis, showing low-normal levels of free carnitine. Urine organic acid analysis revealed massive ketonuria and elevated levels of dicarboxylic acids. Fatty acid oxidation disorder-targeted gene panel revealed a homozygous splice site variant (c.78+1_78+6 del) in the OXCT1 gene. Discussion and Conclusion: SCOT deficiency should be considered when massive ketosis is detected in increased anion gap metabolic acidosis with sepsis-like manifestation. Supportive therapy should be initiated quickly to prevent irreversible neurological damage.

Objectives: The aim of our study was to investigate the changes in thyroid hormone levels during and after acute metabolic disorder in patients with diabetic ketoacidosis (DKA). Methods: Eighty five patients diagnosed with DKA were included in the study. Patients with control thyroid function test (TFT) values at admission (the first blood sample) and 1 month later were included in the study. Thyroid function tests obtained during diabetic ketoacidosis and at the first month follow-up were compared. Euthyroidism and euthyroid sick syndrome were defined and grouped according to current guidelines. The mild and moderate groups, according to DKA classification, were combined and compared with the severe group. Results: A significant increase was observed between the first admission and the control TFT values 1 month later. However, there was no significant difference found in TFT between mild/moderate and severe groups taken at the time of DKA. Difference between two groups, euthyroid sick syndrome and euthyroid, was examined and the result that was different from the literature was the difference between TSH levels. We found that low FT4 levels were associated with higher HgbA1c, although the correlation was weak. Conclusions: Thyroid hormone levels may not reflect a thyroid disease during severe DKA attack. Therefore, it is unnecessary to check thyroid function tests.

Amaç: Çocuk yoğun bakım ünitesinde (ÇYBÜ) laktat düzeylerinin eşik değerini belirlemeyi ve bunun mortalite biyobelirteci olarak kullanımının skorlama sistemleriyle korelasyonunu analiz etmeyi amaçladık.Gereç ve Yöntemler: Gözlemsel retrospektif bir kohort çalışmasıdır. Çalışmamız 2015 yılında hastanemizin 24 yataklı üçüncü basamak ÇYBÜ’sine başvuran hastalar arasında yapılmıştır. 1 ay-18 yaş arasındaki tüm çocuklar değerlendirildi. Yatış sürecinde takipte arteriyel kan gazı alınan 433 hastanın 382’si çalışmaya alındı. Laktik asidozlu konjenital metabolik hastalığı olan hastalar çalışma dışı bırakıldı.Hastaların başvuru anında alınan arteriyel kan laktat düzeyleri, PIM-2, PRISM-III, PELOD skorları ve hastaların sağkalım durumları değerlendirildi. Laktat seviyeleri ile mortalite skorları arasındaki korelasyon, laktat seviyelerinin eşik değerleri ve mortalite riskini etkileyen faktörler ana değişkenlerdi.Bulgular: Ölen hastaların laktat düzeyleri ile mortalite skorları arasında anlamlı bir ilişki vardı (p