Management of an Earthquake in a Pediatric Intensive Care Unit

Year 2023, , 223 - 232, 24.10.2023

Murat Tanyıldız , Ömer Özden , Lasin Ozbek Karya Senkoylu Aysu Cakar İlker Eren , Aslıcan Cakkalkurt Mehmet Emin Menentoglu Ilmay Bilge

https://doi.org/10.26650/jchild.2023.1341364

Abstract

Objective: The 2023 Kahramanmaraş earthquake (7.8 magnitude) devastated Turkey, impacting approximately 14 million people and causing over 50,000 fatalities. This study suggests a pediatric protocol for managing earthquake victims in pediatric intensive care units (PICUs).
Materials and Methods: A retrospective, observational study was conducted. Within a week, 72 patients were followed and initially treated post-stabilization, per the treatment protocol and PICU organization. Of these, 58 were referred to tertiary PICUs in other cities. Thirteen patients treated at our regional PICU were reviewed.
Results: Thirteen patients were studied. Eight had severe crush injuries, including four extremities in one patient and both legs in another. The average time under debris was 14.8±13.8 h. Fasciotomy was performed on 46.1% (n=6) of patients. Debridement was needed in 61.5% (n=8), averaging 3.6±3.8 procedures per patient. Vacuum-assisted closure (VAC) was applied to 53.8% (n=7). Continuous renal replacement therapy (CRRT) was given to two of the three patients with acute kidney injury, while one received intermittent hemodialysis. Four patients underwent an average of 5.2±9.5 therapeutic plasma exchange (TPE) sessions. Hyperbaric oxygen therapy (HBOT) was administered for an average of 15.0±17.5 sessions to eight patients. No patient deaths occurred at our center.
Conclusion: Implementing a treatment protocol was crucial for disaster management. Specialized treatments, including daily TPE, frequent HBOT, anticoagulant and vasodilator therapies, and VAC, contributed to favorable outcomes for patients with severe crush syndrome.

Keywords

disaster, earthquake, pediatric intensive care management, protocol

Çocuk Yoğun Bakım’da Deprem Yönetimi

Abstract

Amaç: 2023 Kahramanmaraş depremi (7.8 büyüklüğünde) Turkiye’de yaklaşık 14 milyon insanın etkilendiği ve 50,000’den fazla kişinin yaşamını kaybettiği büyük bir felakete yol açmıştır. Bu çalışmada çocuk yoğun bakım ünitelerinde (ÇYBÜ) takip edilen pediatrik depremzede hastaları için bir tedavi protokolü oluşturulması amaçlanmıştır.
Metod: Bu çalışma gözlemsel, retrospektif bir çalışmadır. Deprem sonrası bölgesel yoğun bakıma destek amacıyla gidilmiş bir hafta içerisnde 72 hasta izlenmiş, bu hastaların 58’i başka üçüncü basamak merkezlere sevk edilmiş, 13 hasta hemodinamik ve metabolik stabilizasyonu sağlandıktan sonra kendi merkezimize sevk edilmiştir.
Sonuçlar: Çalışmaya 13 hasta alındı. Sekiz hastada ciddi ezilme hasarı mevcuttu bu hastaların birinin dört ekstremitesi, bir diğer hastanın her iki alt ekstremitesi etkilenmişti. Enkaz altında ortalama kalış süresi 14.8±13.8 saatti. Fasiyotomi hastaların % 46.1 (n=6)’ine uygulandı. Debridman hastaların % 61.5 (n=8)’ine uygulandı, hasta başına ortalama debridman sayısı 3.6±3.8 bulundu. Vakum yardımlı kapama (VAC) hastaların % 53.8 (n=7)’ine uygulandı. Akut böbrek hasarı üç hastada gelişti ve bu hastaların ikisine sürekli renal replasman tedavisi (CRRT) uygulandı, bir hastaya aralıklı hemodiyaliz tedavisi uygulandı. Dört hastaya ortalama 5.2±9.5 seans terapötik plazma değişimi (TPE) yapıldı. Hiperbarik oksijen tedavisi (HBOT) ortalama 15.0±17.5 seans olmak üzere sekiz hastaya uygulandı. Merkezimizde hiçbir hasta kaybedilmedi ve tüm hastalar taburcu edildi.
Sonuç olarak: Afet yönetiminde bir protokol oluşturmak oldukça önemlidir. Günlük TPE, sık aralıklarla uygulanan HBOT, antikoagülasyon ve VAC dahil olmak üzere uygulanan özel tedaviler ile ciddi ezilme sendromu olan hastalarda olumlu sonuçlar elde edilmiştir.

Keywords

afet, çocuk yoğun bakım yönetimi, deprem, protokol

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