Nihan Şık

and 4 more

Background: The aim of this study was to assess the efficacy of intravenous (IV) magnesium sulfate (MgSO4) on clinical severity scores, need for respiratory support and outcomes for previously healthy children with bronchiolitis. Methods: We retrospectively assessed children with moderate-severe bronchiolitis. Patients who received 40 mg/kg/dose of IV MgSO4 (group 1) or not (group 2) were compared for vital signs, clinical findings and outcomes. Results: There were 74 patients in group 1 and 33 in group 2. The median age, the mean respiratory rates, oxygen saturation/fraction of inspired oxygen (S/F) ratios and, The Modified Respiratory Distress Assessment Instrument (mRDAI) scores at the time of starting MgSO4 treatment were similar for two groups. Respiratory rate and mRDAI score significantly decreased at the 2th hour of MgSO4 treatment and the decrease was observed for 4th, 8th and 12th hours, compared with group 2. Patients in group 1 had a higher S/F ratio at 4th hour compared with group 2 and in group 1, the elevation was observed at the 4th hour. Patients in group 2 had a higher rate of requirement and an earlier start high flow nasal cannula oxygen therapy but the total duration time was similar for two groups. Patients in group 2 had a longer hospital stay than group 1. Conclusion: Intravenous MgSO4 provided significant improvement on clinical severity, early phase of oxygenation, need for respiratory support, length of stay in the hospital and outcomes. It seems to be an effective treatment option for management of bronchiolitis.

Nihan Şık

and 4 more

Background: The present study aimed to assess the efficacy of non-invasive ventilation (NIV) on the clinical course, oxygenation, need for invasive mechanical ventilation (IMV), and outcomes for children with pulmonary edema after drowning. Methods: We conducted a retrospective chart review. Children who were referred to the pediatric emergency department due to drowning-related pulmonary edema and underwent NIV between May 2014 and October 2020 were included. Demographics, vital signs, clinical findings, and results of laboratory and radiologic investigations were recorded. Patients were divided into 6 groups using the Szpilman classification system. The need for IMV, the need for pediatric intensive care unit (PICU) admission, and the length of NIV treatment and stay in the PICU were recorded for each patient. Results: Twenty-five patients were enrolled. According to the Szpilman classification, 13 (52.0%) patients were evaluated as grade 3 and 12 (48.0%) as grade 4. All patients were treated with bi-level positive airway pressure in the spontaneous/timed mode. A significant increase in oxygen saturation (SpO₂) and SpO₂/fraction of inspired oxygen ratios was observed from the beginning of NIV treatment and this increase was also observed for the 2nd and 4th hours. There was a decrease in respiratory rate at the 4th hour of NIV treatment. No patient subsequently deteriorated to IMV. Conclusion: We have reported a favorable clinical course of drowning patients who underwent early use of NIV in the pediatric emergency department. Management of drowning patients with pulmonary edema by NIV with close follow-up can be successfully applied in selected cases.

Nihan Şık

and 4 more

Background: Pneumonia is one of the most common serious infections in children. Scoring systems have been adopted to quantify the severity of the disease, but they were based on clinical findings that can vary according to the subjective assessment of the clinician. We hypothesized that diaphragm ultrasound (DUS) parameters may be a new useful tool to objectively score the severity of the disease and predict outcomes in children with pneumonia. Methods: Children diagnosed with pneumonia, aged between 1 month and 18 years, were prospectively evaluated in the pediatric emergency department. The Pediatric Respiratory Severity Score was used to indicate the severity of the disease and DUS was performed. Diaphragm thickness at the end of inspiration and expiration, thickening fraction (TF), diaphragm excursion, inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were calculated. Results: There were 96 patients enrolled in the study. Inspiratory slope and ES measurements had positive correlations with respiratory rate and length of stay in the hospital and negative correlations with oxygen saturation levels. Furthermore, TF values were negatively correlated with respiratory rate and length of stay in the emergency department. Patients with higher clinical scores had increased IS and ES and decreased TF values. Conclusion: Diaphragm ultrasound can be a promising and useful tool to assess diaphragmatic dysfunction in patients diagnosed with pneumonia. Diaphragm parameters, especially TF, IS, and ES, may provide objective and reliable information to predict the severity of the illness, the need for respiratory support, and outcomes.

Nihan Şık

and 4 more

Background: The aim of this study was to evaluate diaphragmatic parameters in bronchiolitis patients and identify correlations between clinical and sonographic severity scores and outcomes in order to develop a more objective and useful tool in the emergency department. Methods: Children aged between 1 and 24 months and diagnosed with acute bronchiolitis were included in the study. The Modified Respiratory Distress Assessment Instrument (mRDAI) score was used to quantify the clinical severity of the disease. Lung ultrasound was performed and a bronchiolitis ultrasound score (BUS) was calculated. Diaphragm ultrasound was then performed and diaphragm thickness at the end of inspiration and expiration, thickening fraction, diaphragm excursion (EXC), inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were measured. Results: There were 104 patients evaluated in this study. The mRDAI score and BUS had a significant positive correlation. There was a positive correlation between IS and respiratory rate at admission. As the clinical score increased, IS, ES, and EXC measurements rose and they were positively correlated. Values of IS, ES, and EXC were higher in the moderate-severe group than the mild group for both mRDAI and BUS scores. Inspiratory slope values were correlated with the length of stay in the hospital. Conclusion: Values of IS and ES were correlated with clinical and sonographic severity scores. Moreover, IS was a good predictor of outcome. Diaphragm ultrasound appears to be an objective and useful tool to help the physician make decisions regarding the evaluation and management of bronchiolitis.