Management of an Earthquake in a Pediatric Intensive Care Unit

Yıl 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

Öz

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.

Anahtar Kelimeler

disaster, earthquake, pediatric intensive care management, protocol

Çocuk Yoğun Bakım’da Deprem Yönetimi

Öz

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.

Anahtar Kelimeler

afet, çocuk yoğun bakım yönetimi, deprem, protokol

Kaynakça

• Available from URL: https://earthquake.usgs.gov/earthquakes/ eventpage/us6000jllz/impact google scholar
• Available from URL: https://www.sbb.gov.tr/wp-content/ uploads/2023/03/Turkiye-Recovery-and-Reconstruction-Assessment.pdf google scholar
• Available from URL: https://www.mdcalc.com/calc/549/mangled-extremity-severity-score-mess-score google scholar
• American Heart Association. Systematic approach to the seriously ill or injured child, primary assessment. In: Pediatric advanced life support provider manual. eBook edition; 2020. p 7-8. google scholar
• Kam C, Lai Ch, Lam S, So F, Lau C, Cheung Kh. What are the ten new commandments in severe polytrauma management? Word J Emerg Med 2010;1(2):85-92. google scholar
• Sever MS, Sever L, Vanholder R. Disasters, children, and the kidneys. Pediatr Nephrol 2020;35(8):1381-93. google scholar
• Gibney RT, Sever MS, Vanholder RC. Disaster nephrology: crush injury and beyond. Kidney Int 2014;85(5):1049-57. google scholar
• Stanley M, Chippa V, Aeddula NR, Quintanilla Rodriguez BS, Adigun R. Rhabdomyolysis. 2023 In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. google scholar
• McMahon BA, Chawla LS. The furosemide stress test: current use and future potential. Ren Fail 2021;43(1):830-39. google scholar
• Sever MS, Remuzzi G, Vanholder R. Disaster medicine and response: Optimizing life-saving potential. Am J Disaster Med 2018;13(4):253-64. google scholar
• Sever MS, Vanholder R, Lameire N. Management of crush-related injuries after disasters. N Engl J Med 2006;354(10):1052-63. google scholar
• Suzuki S, Moriyama K, Hara Y, Hinoue T, Kato Y, Hasegawa D, et al. Comparison of myoglobin clearance in three types of blood purification modalities. Ther Apher Dial 2021;25(4):401-06. google scholar
• Ning B, Ye S, Lyu Y, Yin F, Chen Z. Effect of high-volume hemofiltration on children with sepsis. Transl Pediatr 2020;9(2):101-07. google scholar
• Sever MS, Erek E, Vanholder R, Kantarci G, Yavuz M, Turkmen A, et al. Serum potassium in the crush syndrome victims of the Marmara disaster. Clin Nephrol 2023;59(5):326-33. google scholar
• Gerdin M, Wladis A, von Schreeb J. Surgical management of closed crush injury-induced compartment syndrome after earthquakes in resource-scarce setting. J Trauma Acute Care Surg 2012;73(3):758-64. google scholar
• Torlincasi AM, Lopez RA, Waseem M. Acute compartment syndrome. In;StatPearl. Treasure Island(FL):StatPearls Publishing; 2023 Jan 16. Available from https://www.ncbi.nlm.nih.gov/books/ NBK448124/# google scholar
• Better OS, Rubinstein I, Reis DN. Muscle crush compartment syndrome: fulminant local edema with threatening systemic effects. Kidney Int 2003;63(3):1155-57. google scholar
• Sever MS, Erek E, Vanholder R, Akoglu E, Yavuz M, Ergin H, et al. Clinical findings in the renal victims of a catastrophic disaster: the Marmara earthquake. Nephrol Dial Transplant 2002;17(11):1942-49. google scholar
• Sever MS, Vanholder R, RDRTF of ISN Work Group on Recommendations for the management of crush victims in mass disasters. Recommendation for the management of crush victims in mass disasters. Nephrol Dial Transplant 2012;27 Suppl 1:i1-67. google scholar
• Piran S, Schulman S. Treatment of bleeding complications in patients on anticoagulant therapy. Blood 2019;31;133(5):425-35. google scholar
• Crowther MA, Warkentin TE. Bleeding risk and the management of bleeding complications in patients undergoing anticoagulant therapy: focus on new anticoagulant agents. Blood 2008;15;111(10):4871-79. google scholar
• Renaud F, Succo E, Alessi MC, Legre R, Juhan-Vague I. Iloprost and salvage of a free flap. Br J Plast Surg 1996;49(4):245-48. google scholar
• Gauthier J, Morris-Janzen D, Poole A. Iloprost for the treatment of frostbite: a scoping review. Int J Circumpolar Health 2023;82(1):2189552. google scholar
• Kleydman K, Cohen JL, Marmur E. Nitroglycerin: a review of its use in the treatment of vascular occlusion after soft tissue augmentation. Dermatol Surg 2012; 38(12):1889-97. google scholar
• Sushko K, Litalien C, Ferruccio L, Gilpin A, Mazer-Amirshahi M, Chan AK, et al. Topical nitroglycerin ointment as salvage therapy for peripheral tissue ischemia in newborn: a systematic review. CMAJ Open 2021; 9(1)E252-E260. google scholar
• Soares RN, Proctor DN, de Oliveira GV, Alvares TS, Murias JM. Acute application of a transdermal nitroglycerin patch protects against prolonged forearm ischemia-induced microvascular dysfunction. Microcirculation 2020;27(3):e12599. google scholar
• Putzu A, Schorer R, Lopez-Delgado JC, Cassina T, Landoni G. Blood purification and mortality in sepsis and septic shock. A systematic review and meta-analysis of randomized trials. Anesthesiology 2019;131:580-93. google scholar
• Klein MB, Edwards JA, Kramer CB, Nester T, Heimbach DM, Gibran NS. The beneficial effects of plasma exchange after severe burn injury. J Burn Care Res 2009; 30(2):243-48. google scholar
• Chang JC. Sepsis and septic shock: endothelial molecular pathogenesis associated with vascular microthrombotic disease. Thrombosis J 2019;17:10. google scholar
• Knaup H, Stahl K, Schmidt BMW, Idowu TO, Busch M, Wiesner O, et al. Early therapeutic plasma exchange in septic shock: a prospective open-label nonrandomized pilot study focusing on safety, hemodynamics, vascular barrier function, and biologic markers. Crit Care 2018;30: 22(1):285. google scholar
• Schottlender N, Gottfried I, Ashery U. Hyperbaric Oxygen Treatment: Effects on mitochondrial function and oxidative stress. Biomolecules 2021;11:1827. google scholar
• Jirangkul P, Baisoponb S, Pandaeng D, Srisawat P. Hyperbaric oxygen adjuvant therapy in severe mangled extremities. Injury 2021;52: 3511-15. google scholar
• Zannis J, Angobaldo J, Marks M, DeFranzo A, David L, Molnar J, et al. Comparison of fasciotomy wound closures using traditional dressing changes and the vacuum-assisted closure device. Ann Plast Surg 2009;62(4):407-9. google scholar
• Justice LB, Cooper DS, Henderson C, Brown J, Simon K, Clark L, et al. Improving communication during cardiac ICU multidisciplinary rounds through visual display of patient daily goals. Pediatr Crit Care Med 2016;17(7): 677-83. google scholar
• Shen J, Kang J, Shi Y, Li Y, Li Y, Su L, et al. Lessons learned from the Wenchuan earthquake. J Evid Based Med 2012;5(2):75-88. google scholar