Management of an earthquake in a pediatric intensive care unit

Abstract

Objective: The 2023 Kahramanmara & scedil;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.