Esra Kockuzu - Academia.edu (original) (raw)

Papers by Esra Kockuzu

Pediatric Infectious Disease Journal, Feb 7, 2023

Journal of contemporary medicine, Sep 30, 2022

Fluid accumulation occurs in pediatric patients in pediatric intensive care units (PICU). Medicat... more Fluid accumulation occurs in pediatric patients in pediatric intensive care units (PICU). Medications administered in pediatric intensive care units can contribute to significant cumulative load in patients. In present study, we aimed to study fluid accumulation on patients without AKI and to determine contribution of medications over fluid intake. Material and Method: In this study, 527 daily follow-up forms of 101 patients was investigated retrospectively. Results: Total fluid load was found to be higher in patients with comorbidities, who underwent invasive mechanical ventilation, and who needed inotropes. While fluid load was higher in patients with sepsis than in other diagnostic groups, it was significantly lower in patients with multisystem inflammatory syndrome in children (MIS-C). While the median (IQR) of the cumulative fluid load was 11.6% (7.1-16.4) in the first 5 days, the median (IQR) reached 25.7% (14.65-34.1) on the 10th day. The cumulative fluid load increased as the patient's follow-up days increased. The median average daily fluid intake (IQR) from drugs alone was 14.48% (8.07-24.13). The contribution of drugs to the total fluid load increased as the age of patients decreased (r:-0.164, p< 0.001). Conclusion: A cumulative fluid load occurs in PICU patients without AKI. Particularly in young children, the contribution of fluids given with drugs to the fluid load should be kept in mind. Clinicians should perform patient-specific fluid management by supporting fluid status assessments with objective criteria in order to get out of the fluid accumulation-fluid over load dilemma.

Journal of Pediatric infectious diseases, May 1, 2022

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Journal of Contemporary Medicine

Aim: It is aimed to describe clinical properties and outcomes of pediatric hemolytic uremic syndr... more Aim: It is aimed to describe clinical properties and outcomes of pediatric hemolytic uremic syndrome hospitalized in pediatric intensive care. Material and Method: Our study was intended as observatory and retrospective. Symptoms before PICU admission, interventions before PICU admission, time period before PICU admission in days were defined as pre-PICU findings. Glasgow Coma Score (GCS) at admission, Pediatric Risk of Mortality Score (PRİSM-III), laboratory parameters, medical treatments, extracorporeal treatments data was collected as PICU interventions. Outcomes were examined as days in PICU, days in hospital and survival. Results: Twenty-three patients were included into study. Before PICU admission more than half of the patients were treated with antibiotics. Twenty-two were suffered from diarrhea. 3 patients had non-bloody diarrhea. 3 patients had central nervous system involvement presented as seizures. Intravenous diuretics (86.9%) and oral antihypertensives (73.9%) were th...

Turkish Journal of Pediatric Disease, 2021

Objective: This study aimed to examine the causes and clinical course of trauma in trauma patient... more Objective: This study aimed to examine the causes and clinical course of trauma in trauma patients requiring pediatric intensive care unit (PICU) follow-up and evaluate possible differences related to demographic characteristics, trauma mechanism, trauma severity, and prognosis in refugee children. Material and Methods: The records of 175 patients admitted to our PICU between May 1, 2020 and April 30, 2021 with a preliminary diagnosis of trauma were retrospectively reviewed. The patients were divided into two groups as Turkish citizens and Syrian citizens (refugee children). The obtained data were compared between these two groups. Results: 119 (68%) were Turkish citizens and 56 (32%) were refugees. The median age of the Turkish citizens was 6 (3-12; IQR) years and the median age of the refugee patients was 4 (2-10; IQR) years (p = 0.092). Further, 70 (58.8%) of the Turkish citizens and 43 (76.8%) of the refugee patients were males (p = 0.027). In-vehicle traffic accidents were observed in 27 (22.7%) of the Turkish citizens and 4 (7.2%) of the refugee patients, with the difference being statistically significant (p = 0.011). The rate of non-vehicle traffic accident in the refugee patients was higher than that in the Turkish citizens (23.2% and 10%, respectively) (p = 0.035). Ten patients died due to trauma, of which 7 (5.8%) patients were Turkish citizens and 3 (5.3%) were refugee patients. Conclusion: In our study, we found that non-vehicle traffic accidents were more common in refugee patients, but there was no clinical difference between Turkish citizens and refugee patients. We think that more careful evaluation of immigrant problems, projects, and studies focused on the child population, improvement of socioeconomic conditions, and regular participation in the education system can reduce injury rates.

Indian Journal of Critical Care Medicine, 2019

Objectives: To analyze the course of seasonal viral infections of respiratory tract in patients h... more Objectives: To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. Materials and methods: It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. Results: Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p <0.05). Clinical presentations influencing mortality were neurologic symptoms, tachycardia, hypoxia, hypotension, elevated lactate, and acidosis. The critical pH value related with mortality was ≤7.10, and critical PCO 2 ≥60 mm Hg. Conclusion: Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them.

Sultan Qaboos University Medical Journal [SQUMJ], 2018

Noninvasive ventilation (NIV) refers to the use of techniques to deliver artificial respiration t... more Noninvasive ventilation (NIV) refers to the use of techniques to deliver artificial respiration to the lungs without the need for endotracheal intubation. As NIV has proven beneficial in comparison to invasive mechanical ventilation, it has become the optimal modality for initial respiratory support among children in respiratory distress. High-flow nasal cannulae (HFNC) therapy is a relatively new NIV modality and is used for similar indications. This review discusses the usefulness and applications of conventional NIV in comparison to HFNC.Keywords: Noninvasive Ventilation; Nasal Cannulae; Endotracheal Intubation; Mechanical Ventilation; Children.

Indian Journal of Critical Care Medicine, 2017

Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as e... more Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as early as the 1970s. [1,2] Beginning of continuous renal replacement therapies (CRRTs) also dates back to 1970s, and expectations from the therapy as well as the technique has evolved since then. [3,4] In our day, continuous venovenous hemofiltration or hemodiafiltration is used frequently in Pediatric Intensive Care Units (PICUs) for renal replacement therapy, but experience of CRRT application on ECMO circuit is still limited. Acute kidney injury is frequently observed in ECMO patients. The hypoxic insult and systemic inflammatory response associated with the ECMO process or the underlying condition are the two important factors causing acute kidney injury. Reduced perfusion of the kidneys before ECMO, reperfusion injury after ECMO, and disrupted hormonal mechanisms are predisposing factors. [5] Acute kidney injury and requirement of renal replacement are associated with increased mortality in these patients. [6] Even when the kidneys are minimally injured and functioning as in a normal child, the massive fluid overload at the beginning of ECMO process cannot be easily overcome solely by the kidneys. It is well described that fluid overload affects survival in critically ill children and CRRT enhances fluid management in ECMO patients. [7,8] Slow but continuous nature of the renal replacement is superior to intermittent hemodialysis in this hemodynamically unstable patient group. [9] Background and Aims: Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. Materials and Methods: The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. Results: CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. Conclusions: Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.

Indian Journal of Critical Care Medicine, 2017

Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as e... more Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as early as the 1970s. [1,2] Beginning of continuous renal replacement therapies (CRRTs) also dates back to 1970s, and expectations from the therapy as well as the technique has evolved since then. [3,4] In our day, continuous venovenous hemofiltration or hemodiafiltration is used frequently in Pediatric Intensive Care Units (PICUs) for renal replacement therapy, but experience of CRRT application on ECMO circuit is still limited. Acute kidney injury is frequently observed in ECMO patients. The hypoxic insult and systemic inflammatory response associated with the ECMO process or the underlying condition are the two important factors causing acute kidney injury. Reduced perfusion of the kidneys before ECMO, reperfusion injury after ECMO, and disrupted hormonal mechanisms are predisposing factors. [5] Acute kidney injury and requirement of renal replacement are associated with increased mortality in these patients. [6] Even when the kidneys are minimally injured and functioning as in a normal child, the massive fluid overload at the beginning of ECMO process cannot be easily overcome solely by the kidneys. It is well described that fluid overload affects survival in critically ill children and CRRT enhances fluid management in ECMO patients. [7,8] Slow but continuous nature of the renal replacement is superior to intermittent hemodialysis in this hemodynamically unstable patient group. [9] Background and Aims: Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. Materials and Methods: The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. Results: CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. Conclusions: Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.

Pediatric Infectious Disease Journal, Feb 7, 2023

Journal of contemporary medicine, Sep 30, 2022

Fluid accumulation occurs in pediatric patients in pediatric intensive care units (PICU). Medicat... more Fluid accumulation occurs in pediatric patients in pediatric intensive care units (PICU). Medications administered in pediatric intensive care units can contribute to significant cumulative load in patients. In present study, we aimed to study fluid accumulation on patients without AKI and to determine contribution of medications over fluid intake. Material and Method: In this study, 527 daily follow-up forms of 101 patients was investigated retrospectively. Results: Total fluid load was found to be higher in patients with comorbidities, who underwent invasive mechanical ventilation, and who needed inotropes. While fluid load was higher in patients with sepsis than in other diagnostic groups, it was significantly lower in patients with multisystem inflammatory syndrome in children (MIS-C). While the median (IQR) of the cumulative fluid load was 11.6% (7.1-16.4) in the first 5 days, the median (IQR) reached 25.7% (14.65-34.1) on the 10th day. The cumulative fluid load increased as the patient's follow-up days increased. The median average daily fluid intake (IQR) from drugs alone was 14.48% (8.07-24.13). The contribution of drugs to the total fluid load increased as the age of patients decreased (r:-0.164, p< 0.001). Conclusion: A cumulative fluid load occurs in PICU patients without AKI. Particularly in young children, the contribution of fluids given with drugs to the fluid load should be kept in mind. Clinicians should perform patient-specific fluid management by supporting fluid status assessments with objective criteria in order to get out of the fluid accumulation-fluid over load dilemma.

Journal of Pediatric infectious diseases, May 1, 2022

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Journal of Contemporary Medicine

Aim: It is aimed to describe clinical properties and outcomes of pediatric hemolytic uremic syndr... more Aim: It is aimed to describe clinical properties and outcomes of pediatric hemolytic uremic syndrome hospitalized in pediatric intensive care. Material and Method: Our study was intended as observatory and retrospective. Symptoms before PICU admission, interventions before PICU admission, time period before PICU admission in days were defined as pre-PICU findings. Glasgow Coma Score (GCS) at admission, Pediatric Risk of Mortality Score (PRİSM-III), laboratory parameters, medical treatments, extracorporeal treatments data was collected as PICU interventions. Outcomes were examined as days in PICU, days in hospital and survival. Results: Twenty-three patients were included into study. Before PICU admission more than half of the patients were treated with antibiotics. Twenty-two were suffered from diarrhea. 3 patients had non-bloody diarrhea. 3 patients had central nervous system involvement presented as seizures. Intravenous diuretics (86.9%) and oral antihypertensives (73.9%) were th...

Turkish Journal of Pediatric Disease, 2021

Objective: This study aimed to examine the causes and clinical course of trauma in trauma patient... more Objective: This study aimed to examine the causes and clinical course of trauma in trauma patients requiring pediatric intensive care unit (PICU) follow-up and evaluate possible differences related to demographic characteristics, trauma mechanism, trauma severity, and prognosis in refugee children. Material and Methods: The records of 175 patients admitted to our PICU between May 1, 2020 and April 30, 2021 with a preliminary diagnosis of trauma were retrospectively reviewed. The patients were divided into two groups as Turkish citizens and Syrian citizens (refugee children). The obtained data were compared between these two groups. Results: 119 (68%) were Turkish citizens and 56 (32%) were refugees. The median age of the Turkish citizens was 6 (3-12; IQR) years and the median age of the refugee patients was 4 (2-10; IQR) years (p = 0.092). Further, 70 (58.8%) of the Turkish citizens and 43 (76.8%) of the refugee patients were males (p = 0.027). In-vehicle traffic accidents were observed in 27 (22.7%) of the Turkish citizens and 4 (7.2%) of the refugee patients, with the difference being statistically significant (p = 0.011). The rate of non-vehicle traffic accident in the refugee patients was higher than that in the Turkish citizens (23.2% and 10%, respectively) (p = 0.035). Ten patients died due to trauma, of which 7 (5.8%) patients were Turkish citizens and 3 (5.3%) were refugee patients. Conclusion: In our study, we found that non-vehicle traffic accidents were more common in refugee patients, but there was no clinical difference between Turkish citizens and refugee patients. We think that more careful evaluation of immigrant problems, projects, and studies focused on the child population, improvement of socioeconomic conditions, and regular participation in the education system can reduce injury rates.

Indian Journal of Critical Care Medicine, 2019

Objectives: To analyze the course of seasonal viral infections of respiratory tract in patients h... more Objectives: To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. Materials and methods: It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. Results: Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p <0.05). Clinical presentations influencing mortality were neurologic symptoms, tachycardia, hypoxia, hypotension, elevated lactate, and acidosis. The critical pH value related with mortality was ≤7.10, and critical PCO 2 ≥60 mm Hg. Conclusion: Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them.

Sultan Qaboos University Medical Journal [SQUMJ], 2018

Noninvasive ventilation (NIV) refers to the use of techniques to deliver artificial respiration t... more Noninvasive ventilation (NIV) refers to the use of techniques to deliver artificial respiration to the lungs without the need for endotracheal intubation. As NIV has proven beneficial in comparison to invasive mechanical ventilation, it has become the optimal modality for initial respiratory support among children in respiratory distress. High-flow nasal cannulae (HFNC) therapy is a relatively new NIV modality and is used for similar indications. This review discusses the usefulness and applications of conventional NIV in comparison to HFNC.Keywords: Noninvasive Ventilation; Nasal Cannulae; Endotracheal Intubation; Mechanical Ventilation; Children.

Indian Journal of Critical Care Medicine, 2017

Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as e... more Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as early as the 1970s. [1,2] Beginning of continuous renal replacement therapies (CRRTs) also dates back to 1970s, and expectations from the therapy as well as the technique has evolved since then. [3,4] In our day, continuous venovenous hemofiltration or hemodiafiltration is used frequently in Pediatric Intensive Care Units (PICUs) for renal replacement therapy, but experience of CRRT application on ECMO circuit is still limited. Acute kidney injury is frequently observed in ECMO patients. The hypoxic insult and systemic inflammatory response associated with the ECMO process or the underlying condition are the two important factors causing acute kidney injury. Reduced perfusion of the kidneys before ECMO, reperfusion injury after ECMO, and disrupted hormonal mechanisms are predisposing factors. [5] Acute kidney injury and requirement of renal replacement are associated with increased mortality in these patients. [6] Even when the kidneys are minimally injured and functioning as in a normal child, the massive fluid overload at the beginning of ECMO process cannot be easily overcome solely by the kidneys. It is well described that fluid overload affects survival in critically ill children and CRRT enhances fluid management in ECMO patients. [7,8] Slow but continuous nature of the renal replacement is superior to intermittent hemodialysis in this hemodynamically unstable patient group. [9] Background and Aims: Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. Materials and Methods: The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. Results: CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. Conclusions: Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.

Indian Journal of Critical Care Medicine, 2017

Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as e... more Successful utilization of extracorporeal membrane oxygenation (ECMO) in children was defined as early as the 1970s. [1,2] Beginning of continuous renal replacement therapies (CRRTs) also dates back to 1970s, and expectations from the therapy as well as the technique has evolved since then. [3,4] In our day, continuous venovenous hemofiltration or hemodiafiltration is used frequently in Pediatric Intensive Care Units (PICUs) for renal replacement therapy, but experience of CRRT application on ECMO circuit is still limited. Acute kidney injury is frequently observed in ECMO patients. The hypoxic insult and systemic inflammatory response associated with the ECMO process or the underlying condition are the two important factors causing acute kidney injury. Reduced perfusion of the kidneys before ECMO, reperfusion injury after ECMO, and disrupted hormonal mechanisms are predisposing factors. [5] Acute kidney injury and requirement of renal replacement are associated with increased mortality in these patients. [6] Even when the kidneys are minimally injured and functioning as in a normal child, the massive fluid overload at the beginning of ECMO process cannot be easily overcome solely by the kidneys. It is well described that fluid overload affects survival in critically ill children and CRRT enhances fluid management in ECMO patients. [7,8] Slow but continuous nature of the renal replacement is superior to intermittent hemodialysis in this hemodynamically unstable patient group. [9] Background and Aims: Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. Materials and Methods: The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. Results: CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. Conclusions: Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.