Covıd-19’un Çocuk Yoğun Bakımda İzlemi
Künye
ASLAN, N., & Erhan, B. E. R. K. COVID19’un Çocuk Yoğun Bakımda İzlemi. SDÜ Tıp Fakültesi Dergisi, (1), 177-187.Özet
Çocuklarda COVID19 heterojen bir klinik tablo ile ortaya
çıkabilir. Çin'in Wuhan kentinde bildirilen ilk ciddi
çocukluk çağı enfeksiyonu vakası, gastrointestinal
semptomlarla başlayıp belirgin solunum belirtileri göstermemiş,
ancak hızla akut solunum sıkıntısı sendromuna
ilerlemiştir. Solunum sistemi tutulumu hafif üst
solunum yolu bulgularından ağır akut solunum sıkıntısı
sendromuna (ARDS) kadar değişkenlik gösterebilir.
Ayrıca Nisan 2020’nin sonlarına doğru önce İngiltere
ve İtalya sonrasında pek çok ülkeden çocuklarda
COVID19 ilişkili bir multisistem inflamatuar sendrom
(MIS-C) geliştiği bildirilmiştir. COVID19’a bağlı olarak
çocuklarda gelişen MIS-C, COVID19 ile ilişkili nadir
ancak ciddi bir durumdur. MIS-C'nin kazanılmış bağışıklığın
anormal gelişimi ile enfeksiyöz bir bağışıklık
reaksiyonu mu yoksa yeni bir hastalık mı olduğu bilinmemektedir.
MIS-C'nin klinik özellikleri Kawasaki hastalığı
ve toksik şok sendromuna benzer olabilir. Bunlar
arasında sürekli ateş, hipotansiyon, gastrointestinal
semptomlar, döküntü, miyokardit ve artmış inflamasyonla
ilişkili laboratuvar bulguları bulunur; solunum
semptomları her olguda olmayabilir. COVID19 ilişkili
septik şok, akut akciğer hasarı, mekanik ventilasyon
gereksinimi, ekstrakorporeal solunum ve / veya dolaşım
desteği ihtiyacı, akut renal hasar, ağır MIS-C,
Kawasaki hastalığı gibi kritik çocuk hastaların çocuk
yoğun bakım ünitesinde takip ve tedavisi gerekmektedir.
Biz bu bölümde farklı klinik tablolar ile ortaya çıkabilen
kritik COVID19 çocuk hastaların çocuk yoğun
bakımdaki takip ve tedavisini güncel literatür bilgileri
ışığında gözden geçirmeyi planladık. COVID19 in children may present with a heterogeneous
clinical picture. The first serious childhood infection
reported in Wuhan, China, started with gastrointestinal
symptoms and did not show obvious respiratory
symptoms, but quickly progressed to acute respiratory
distress syndrome. Respiratory system involvement
varies from mild upper respiratory tract symptoms
to severe acute respiratory distress syndrome
(ARDS). In addition, it has been reported that a multisystem
inflammatory syndrome (MIS-C) associated
with COVID19 developed in children from England
and Italy and then from many countries towards the
end of April 2020. MIS-C, which develops in children
due to COVID19, is a rare but serious condition. It
is not known whether MIS-C is an infectious immune
reaction or a new disease with abnormal development
of acquired immunity. The clinical features of MIS-C
may be similar to Kawasaki disease and toxic shock
syndrome. These include laboratory findings associated
with persistent fever, hypotension, gastrointestinal
symptoms, rash, myocarditis, and increased inflammation;
respiratory symptoms may not be present
in all cases. Critical pediatric patients such as COVID19-
associated septic shock, acute lung injury, need
for mechanical ventilation, extracorporeal respiratory
and / or circulatory support, acute renal damage, severe
MIS-C, Kawasaki disease need to be followed
up and treated in the pediatric intensive care unit. In this section, we planned to review the follow-up and
treatment of critical COVID19 pediatric patients who
may present with different clinical presentations in the
pediatric intensive care unit in the light of current literature
information. COVID19 in children may present
with a heterogeneous clinical picture. The first serious
childhood infection reported in Wuhan, China, started
with gastrointestinal symptoms and did not show obvious
respiratory symptoms, but quickly progressed
to acute respiratory distress syndrome. Respiratory
system involvement varies from mild upper respiratory
tract symptoms to severe acute respiratory distress
syndrome (ARDS). In addition, it has been reported
that a multisystem inflammatory syndrome (MIS-C)
associated with COVID19 developed in children from
England and Italy and then from many countries towards
the end of April 2020. MIS-C, which develops
in children due to COVID19, is a rare but serious condition.
It is not known whether MIS-C is an infectious
immune reaction or a new disease with abnormal development
of acquired immunity. The clinical features
of MIS-C may be similar to Kawasaki disease and
toxic shock syndrome. These include laboratory findings
associated with persistent fever, hypotension,
gastrointestinal symptoms, rash, myocarditis, and increased
inflammation; respiratory symptoms may not
be present in all cases. Critical pediatric patients such
as COVID19-associated septic shock, acute lung injury,
need for mechanical ventilation, extracorporeal
respiratory and / or circulatory support, acute renal
damage, severe MIS-C, Kawasaki disease need to
be followed up and treated in the pediatric intensive
care unit. In this section, we planned to review the
follow-up and treatment of critical COVID19 pediatric
patients who may present with different clinical presentations
in the pediatric intensive care unit in the light
of current literature information.
Kaynak
SDÜ Tıp Fakültesi DergisiCilt
28Sayı
1Bağlantı
https://dergipark.org.tr/tr/download/article-file/1674070https://hdl.handle.net/20.500.12899/701