Intensive Care Support Research Articles

Effect of Volatile Anesthetics on Myocardial Infarction After Coronary Artery Surgery: A Post Hoc Analysis of a Randomized Trial

To investigate the effect of volatile anesthetics on the rates of postoperative myocardial infarction (MI) and cardiac death after coronary artery bypass graft (CABG). A post hoc analysis of a randomized trial. Cardiac surgical operating rooms. Patients undergoing elective, isolated CABG. Patients were randomized to receive a volatile anesthetic (desflurane, isoflurane, or sevoflurane) or total intravenous anesthesia (TIVA). The primary outcome was hemodynamically relevant MI (MI requiring high-dose inotropic support or prolonged intensive care unit stay) occurring within 48 hours from surgery. The secondary outcome was 1-year death due to cardiac causes. A total of 5,400 patients were enrolled between April 2014 and September 2017 (2,709 patients randomized to the volatile anesthetics group and 2,691 to TIVA). The mean age was 62 ± 8.4 years, and the median baseline ejection fraction was 57% (50-67), without differences between the 2 groups. Patients in the volatile group had a lower incidence of MI with hemodynamic complications both in the per-protocol (14 of 2,530 [0.6%] v 27 of 2,501 [1.1%] in the TIVA group; p=0.038) and as-treated analyses (16 of 2,708 [0.6%] v 29 of 2,617 [1.1%] in the TIVA group; p=0.039), but not in the intention-to-treat analysis (17 of 2,663 [0.6%] v 28 of 2,667 [1.0%] in the TIVA group; p=0.10). Overall, deaths due to cardiac causes were lower in the volatile group (23 of 2,685 [0.9%] v 40 of 2,668 [1.5%] than in the TIVA group; p=0.03). An anesthetic regimen, including volatile agents, may be associated with a lower rate of postoperative MI with hemodynamic complication in patients undergoing CABG. Furthermore, it may reduce long-term cardiac mortality.

Comparative effects of fresh and sterile fecal microbiota transplantation in an experimental animal model of necrotizing enterocolitis

IntroductionNecrotizing Enterocolitis (NEC) is a serious intestinal disease that affects premature neonates, causing high mortality, despite the technological development in neonatal intensive care, with antibiotics, parenteral nutrition, surgery, and advanced life support. The correction of dysbiosis with fecal microbiome transplantation (FMT) has shown beneficial effects in experimental models of the disease. The different forms of administration and conservation of FMT and mixed results depending on several factors lead to questions about the mechanism of action of FMT. This study aimed to compare the effectiveness of fresh, sterile FMT and probiotic treatment under parameters of inflammation, oxidative stress, and tissue damage in a neonatal model of NEC. MethodsOne-day-old Wistar rats were used to induce NEC model. Animals were divided in five groups: Control + saline; NEC + saline; NEC + fresh FMT; NEC + sterile FMT and NEC+ probiotics. Parameters of inflammatory response and oxidative damage were measured in the gut, brain, and serum. It was also determined gut histopathological alterations. ResultsProinflammatory cytokines were increased in the NEC group, and IL-10 levels decreased in the gut, brain, and serum. Fresh and sterile FMT decreased inflammation when compared to the use of probiotics. Oxidative and histological damage to the intestine was apparent in the NEC group, and both FMT treatments had a protective effect. ConclusionFresh and sterile FMT effectively reduced the inflammatory response, oxidative damage, and histological alterations in the gut and brain compared to an experimental NEC model.

COMPARING THE NEEDS OF SUPPORTIVE CARE FOR FAMILIES AND PATIENTS WITH PEDIATRIC CANCER: A PERSPECTIVE OF PATIENTS, CAREGIVERS AND ONCOLOGY HEALTH PROFESSIONALS

The pediatric cancer cases diagnosed each year is increasing at a rapid rate. With high health risks and infant mortality associated to pediatric cancer, it is crucial to recognize educational and psychosocial support among patients and caregivers to alleviate care burden. To provide them with intensive supportive care in the initial phase and equipping them to deliver specialized treatment is valuable to the child health. Thus, a qualitative and exploratory study was conducted at a Private-Tertiary Care Hospital in Karachi. Through purposive sampling, participants (N=10) were selected to conduct in-depth interviews. The data was analyzed via Qualitative content analysis method through manual and using NVIVO 11 software. The themes were constructed from the categories emerged from the data codes. The result signifies four themes that indicate stressful experience among family and children with newly diagnosed pediatric cancers substantially require mental health professionals for emotional strength, there is utmost necessity of a multidisciplinary team to increase their health literacy, inadequate educational support due to limited access to resources, and insufficient psychosocial support system with healthcare setting. The findings also highlight that child’s level of understanding of diseases, language barrier, and financial crisis also impede support provision. The initial phase of childhood cancer demands appropriate individualized educational psychosocial interventions, psychological assistance to improve coping responses, and increased exposure of social support groups in assisting patients and families. Formulating new policies, need-focused services, psychoeducation, and future research are discussed. KEYWORDS Pediatric cancer, caregiver, education, psychosocial, supportive care, healthcare, children, Pakistan

Vernix caseosa peritonitis following vaginal delivery

The incidence of the acute abdomen during early postpartum is not uncommon. In this report, we highlight an extremely rare cause of acute abdomen which posed significant diagnostic and management dilemmas. In this case, the patient presented at day 5 postvaginal delivery with progressive respiratory embarrassment, mild abdominal pain, and fever. Her clinical signs, blood and laboratory parameters, and imaging (ultrasound and computed tomography scan) were however nonspecific except for worsening ascites. Laparotomy was determined as the best procedure for her in view of her polymorphonuclear cell count from an abdominal paracentesis being very high and the absence of clinical improvement even with the best intensive care support. Vernix caseosa peritonitis (VCP) was finally diagnosed based on histological examination of the “cheesy” slough extracted intraoperatively. Our case illustrates the nonspecific features of VCP which may be potentially fatal if undiagnosed early and no definitive care is provided.

Post-discharge follow-up of patients with COVID-19: A Brazilian experience.

Objective:The objective of this study is to evaluate post-acute symptoms in patients with confirmed severe and critical coronavirus disease 2019 infections.Methods:We evaluated patients with confirmed severe and critical coronavirus disease 2019 infections. Post-acute symptoms were defined as symptoms persisting 4 weeks after the onset of the symptoms and classified as pulmonary, muscular, hematologic, neuropsychiatric, renal, and dermatological.Results:We recovered data from 565 patients (43.7% female) with a mean age of 61.1 years. In 18.2%, at least one hospital readmission was necessary and 11.1% died. In 62.6%, there was at least one persistent symptom, and 28.8% had more than one. Among associated factors, obesity, intensive care support, and mechanical ventilation were related to persistent symptoms.Conclusion:The most prevalent symptoms were pulmonary and neuropsychiatric sequelae, as reported in previous studies. This finding underscores the severity of the coronavirus disease 2019 infection and the need for follow-up after recovery from the initial illness. Obese patients, those requiring mechanical ventilation, female patients, and increased hospital length are at greater chance of having persistent symptoms.

The Hookah, an Emerging Form of Smoking, Systemic Effects and Harmful Effects of Its Use

Hookah originates from India and in the last years spread around the world. The culture and the mystique behind this device promoted the use among the young population. Despite the thought that is the new safe way to smoke tobacco, recent studies showed that it can be more harmful than the cigarette, becoming a public health problem. Hookah increases airway reactivity and inflammation, causing an inflammation in the respiratory and cardiovascular system. The inhaled smoke contains chemicals agents that are toxic to the lung. As known in the literature the inhaled substance can lead to an acute eosinophilic pneumonia with a pulmonary interstitial infiltrate on radiological image. The degree of pulmonary involvement is varied and may cause a serious condition, requiring hospital admission and intensive care support. The treatment consists of ceasing the hookah use and the use of systemic corticosteroids. One important damage to the health is the infection disease like the tuberculosis transmission, cause by sharing the devise. In the cardiovascular system, the alterations were increasing the cardiac frequency and blood pressure in addition to causing inflammation in the endothelium of the vessel. Long-term studies are needed to correlate the use of this device with the risk of developing cancer.

Comparison of clinical and laboratory features in coronavirus disease 2019 and pediatric multisystem inflammatory syndrome patients.

The coronavirus disease 2019 (COVID-19) and pediatric multisystem inflammatory syndrome (PIMS) are a major public health issue affecting many people worldwide. Although there are new studies in children, little is known about these two new conditions. The aim of this study was to evaluate and compare the clinical and laboratory features of children with COVID-19 and PIMS. We conducted a prospective, single-center study of pediatric COVID-19 and PIMS at a tertiary care hospital in Turkey between November 2020 and March 2021. A total of 115 patients with COVID-19 and PIMS were examined during the study period. The median age was 60 (range, 1-215) months and 64% of the patients were male. The most common clinical symptoms were fever (70%) and cough (43%). Conjunctivitis and skin rash were not seen in PIMS patients. Of all patients, 64% had a history of close contact in household. Lymphopenia was present in 34/115 (30%) patients. Acute phase reactants were significantly higher in PIMS patients. Abnormal chest computed tomography scan findings were detected in 68% of the patients, while 36% had abnormal echocardiographic findings. In multivariate analysis, longer duration of fever, diarrhea, lower thrombocyte and higher neutrophil count were significantly associated with diagnosis of PIMS. The treatment included antibiotics, favipiravir, intravenous immunoglobulin, corticosteroids, interleukin-1 blockade. and supportive therapy. Seven patients (6%) required intensive care support. All patients were discharged without any complications, except one who died. Longer duration of fever, diarrhea, lower thrombocyte, and higher neutrophil count can warn clinicians for diagnosis of PIMS.

Estimation of anti-SARS-CoV-2 IgG titre among blood donors in Ranchi.

Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as novel coronavirus (2019-nCoV). The disease presentation ranges from asymptomatic to severe acute respiratory failure requiring intensive care support. Anti-SARS-CoV-2 IgG antibodies are developed either by natural infection from SARS-CoV-2 or by vaccination against COVID-19. The persistence of IgG antibodies allows identification of the people who have been infected in the past, recovered from illness, and possibly become immune. 7 IgG detection and other serological assays will play an important role in research and surveillance. The objective of the study is to assess anti-SARS-CoV-2 IgG titre among blood donors and to assess the decreasing incidence of COVID-19 in the department of blood bank, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand. An observational, cross-sectional study was conducted at the department of blood bank, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand over a period of 2 months and 14 days from 06 February 2021 to 20 April 2021 who donated at least one unit of blood. This study recorded a greater number of male donors with B+ blood group. The anti-SARS-CoV-2 titre were mostly young adults between 18 and 31 years of age. Seroprevalence was high in males having blood group B+ between 18 and 32 years of age.

A national study of antibiotic use in Greek pediatric hematology oncology and bone marrow transplant units.

We surveyed antimicrobials used in Greek pediatric hematology-oncology (PHO) and bone marrow transplant (BMT) units before and after an intervention involving education regarding the 2017 clinical practice guidelines (CPG) for the management of febrile neutropenia in children with cancer and hematopoietic stem-cell transplant recipients. Antibiotic prescribing practices were prospectively recorded between June 2016 and November 2017. In December 2017, baseline data feedback was provided, and CPG education was provided. Prescribing practices were followed for one more year. For antibiotic stewardship, days of therapy, and length of therapy were calculated. Five of the 6 PHO units in Greece and the single pediatric BMT unit participated. Admitted children in each unit who received the first 15 new antibiotic courses each month. Administration of ≥4 antibiotics simultaneously and administration of antibiotics with overlapping activity for ≥2 days were significantly more common in PHO units in general hospitals compared to children's hospitals. Use of at least 1 antifungal was recorded in ∼47% of the patients before and after the intervention. De-escalation and/or discontinuation of antibiotics on day 6 of initial treatment increased significantly from 43% to 53.5% (P = .032). Although the number of patients requiring intensive care support for sepsis did not change, a significant drop was noted in all-cause mortality (P = .008). We recorded the antibiotic prescribing practices in Greek PHO and BMT units, we achieved improved prescribing with a simple intervention, and we identified areas in need of improvement.

Evaluation of the frequency and intensity of COVID-19 in patients with ankylosing spondylitis under anti-TNF therapy.

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Clinical Presentation and Outcome of COVID-19 in Children: A Case Series

The novel Coronavirus Disease 2019 (COVID-19) is an illness caused by Severe Acute Respiratory Syndrome 2 (SARS-CoV-2), which affects children as well as adults. This case series pertains an observation on six patients, aged 10-17 years, who were admitted to the hospital and found to be COVID-19 positive on testing. All patients had history of contact with COVID-19 positive confirmed family members. Most common symptoms were fever (n=4), cough (n=2) and breathlessness (n=2). No patient had any pre existing co-morbidity. Raised levels of C-Reactive Protein (CRP) and D-dimer were present in four patients (66.6%) each and elevated serum ferritin levels were seen in 3 (50%) patients. Peribronchial cuffing was seen in chest X-ray of one patient. Supportive therapy along with antibiotics (Azithromycin and Doxycycline) was given to all children. Mean duration of hospital stay was 7.5 days. No patient required intensive care support. All patients recovered at discharge.

Construction and Validation of an Obstetric Risk Classification Engine to Support Intensive Care Unit (ICU) Admission Using Machine Learning

Construction and Validation of an Obstetric Risk Classification Engine to Support Intensive Care Unit (ICU) Admission Using Machine Learning

English

BACKGROUND Corona virus disease - 19 (COVID -19) infection is an acute infectious disease caused by a newly discovered beta corona virus, severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). While the primary target organ is the lungs, involvement of many other organs is often evident in patients with COVID - 19. There is emerging evidence to suggest association of SARS-CoV-2 infection with development of many liver abnormalities. The purpose of this study was to evaluate the prevalence of abnormal liver parameters in COVID - 19 patients and their variation in moderate and severe cases. METHODS This is a retrospective study. All patients with COVID -19, between the ages 20 - 75 years, encountered between April and May 2021, were included for the study and compared with age-matched controls. Severity of infection was defined based on the presence of symptoms, oxygen saturation, need for respiratory and intensive care support. Liver parameters such as serum total bilirubin (TBIL), serum aminotransferases, alanine aminotransaminase (ALT) and aspartate aminotransaminase (AST) were analysed. Inflammatory markers such as C-reactive protein (CRP) and D-dimer were also included for assay. RESULTS A total of 52 patients were encountered during the study period. Of these, 29 % (15/52) required intensive care. Abnormal liver parameters were observed in 14 (27 %) patients, and were significantly elevated compared to healthy controls. Liver dysfunction was markedly profound in severe infection than those with moderate disease. Higher levels of CRP and D-dimer were noted in severe patients of COVID - 19. CONCLUSIONS Mild liver abnormalities in the form of elevated ALT and AST are seen in COVID - 19 patients suggesting mild or no liver injury. These abnormal parameters do not generally lead to significant liver function impairment/failure and no specific treatment is required. KEY WORDS COVID - 19, Corona Virus, Liver Injury, Intensive Care Support.

Post-intensive care syndrome in pediatrics

The term “Post-intensive care syndrome” describe new impairments after critical illness, that worsen physical, cognitive, or mental health, and persist after acute care hospitalization. a bibliographic search was carried out using the Medline database. The search period was from 2012 to 2020 using keywords. Emerging evidence suggests that there are significant and persistent physical, cognitive, and psychiatric morbidities among adult and pediatric survivors of critical illness. In this population it can also affect the “social health” sphere. The families of hospitalized patients often manifest psychological symptoms. For prevention and management there are various tools, the package of measures "ABCDEFGH", the conformation and organization of the health team, early mobilization and physical rehabilitation, nutritional contribution, environmental management, intensive care unit diaries and support between pairs. Each patient´s situation is unique and the challenges they face may require different interventions. These should be studied to increase the available evidence in the pediatric population. We still do not have a specific instrument to monitor the syndrome in pediatrics or information on long-term sequelae in children.

Factors Associated With Hospitalization Among Breast Cancer Patients With COVID-19: A Diverse Multi-Center Los Angeles Cohort Study

BackgroundThe SARS-CoV-2 virus has infected and killed millions of people worldwide. Breast cancer is the most prevalent cancer in women and few studies have investigated the outcomes of patients with a history of breast cancer and COVID-19. We report the clinical outcomes of patients with invasive breast cancer who tested positive for SARS-CoV-2, including hospitalization and death, and evaluate demographic and cancer-related factors associated with these outcomes. PatientsPatients with a history of invasive breast cancer and positive SARS-CoV-2 test from January 1 to December 31, 2020 at two large, academic Los Angeles health systems were included. MethodsRetrospective chart review of the electronic medical record was performed. Data for demographic and cancer-related factors were manually abstracted. Relationships between outcomes and clinical variables were evaluated using Fisher's exact test and linear regression analysis. ResultsAmong a total of 132 patients, 40 (30.3%) were hospitalized, while 11 (8.3%) required intensive care support, and 8 patients (6.1%) died. Older age and presence of one or more additional comorbidities were associated with hospitalization and death (P = .010, P = .003, P = .034, P < .001). Hispanic/Latinx ethnicity was associated with hospitalization (P = .047). Cancer treatment was not associated with hospitalization or death. ConclusionIn our diverse, multi-center, breast cancer cohort, Hispanic/Latinx ethnicity, older age and presence of other comorbidities were associated with worse outcomes from COVID-19. Breast cancer treatment, including surgery, radiation, systemic therapy, and endocrine therapy, was not associated with hospitalization in our cohort. Further studies are needed to explore the relationship between breast cancer and COVID-19 outcomes.

The timing of intubation and principles of ICU care in COVID-19

Coronavirus disease-19 (COVID-19) has been a serious health problem since it was first identified in Wuhan, China, in December 2019 and has created a global crisis with its economic, sociological, and psychological aspects. Approximately 15% of cases have a severe clinical presentation, and 5% of patients require admission to the intensive care unit. A significant proportion of patients presents with a rapidly progressing acute respiratory failure and require invasive mechanical ventilation. This article aimed to evaluate how the optimal intubation timing should be determined in cases of acute respiratory failure due to COVID-19 and to offer recommendations for basic intensive care support in the light of our current knowledge.

When a child is hospitalized in a Covid-19 ward: An emotional roller coaster for parents

PurposeTo examine the emotions demonstrated by parents of children hospitalized in a pediatric Covid-19 ward. BackgroundAlthough Covid-19 is mostly a mild disease in children, a small proportion develop severe disease requiring prolonged intensive care support. MethodsOn October 1st, 2020, a unique ward for children with Covid-19 was established in a large hospital in Israel. Interviews were conducted with parents of children who had been hospitalized in a pediatric Covid-19 ward. FindingsA total of 22 parents of children aged 3 weeks to18 years were interviewed. Three themes emerged: Theme 1: Recognizing their child needed hospitalization in the Covid-19 ward, caused parents anxiety and fear of the unknown. Theme 2: Their child's hospitalization in the Covid-19 ward caused fear and worry at their child's condition, parental stress, shame, boredom, and acceptance. Theme 3: Parents initially felt emotional loneliness towards the healthcare staff in the Covid-19 ward, as well as loss of control, later replaced by feelings of confidence. ConclusionParents have diverse emotions in response to needing to accompany their children who are hospitalized and isolated in a closed ward due to Covid-19. Practical implicationsHealth care professionals are immensely important in providing support for parents and for their children suffering from Covid-19. A national plan should be established to address inpatient childcare during an epidemic. Nurses can encourage parents and family to be involved in the child's care and communicate effectively to reduce both the parents' and the child's uncertainty, shame, fear and stress.

81. SARS-CoV-2 RNAemia and Disease Severity in Pediatric Coronavirus Disease 2019 (COVID-19)

Abstract Background Children with COVID-19 may develop severe disease. In hospitalized adults, detection of plasma SARS-CoV-2 RNAemia ranges from 19% to 42% and has been associated with worse clinical outcomes. A similar association in children remains unexplored. We determined the frequency of SARS-CoV-2 RNAemia in children hospitalized with COVID-19 and evaluated its potential association with severe disease. Methods Single center prospective study that enrolled hospitalized children and adolescents ≤21 years old with COVID-19 from March 2020-April 2021 at Nationwide Children’s Hospital, Columbus, OH. Nasopharyngeal (NP) and blood samples were obtained and SARS-CoV-2 RNA was quantified using a real time PCR assay targeting the N1 gene. Pertinent demographic, clinical, laboratory, and outcome data were evaluated. Results We enrolled a convenience sample of 103 hospitalized children (median age, 9 years; range, 3 days-21 years) who had confirmed SARS-CoV-2 infection and both NP and blood samples obtained (Table 1). Overall, 27 (26%) patients with COVID-19 had SARS-CoV-2 RNAemia. Compared with patients who had undetectable RNAemia, those with SARS-CoV-2 RNAemia had significantly higher nasopharyngeal RNA loads (8.1 vs. 4.9 log10 copies/mL; p=0.0006), fever (78 vs 54%; p=0.02), receipt of supplemental oxygen (37% vs 14%; p=0.02), and treatment with anti-COVID-19 medications (30% vs 12%; p=0.04). In addition, patients with SARS-CoV-2 RNAemia were more likely to require intensive care (40%% vs. 20%, p= 0.04) and had longer hospitalization (2.56 vs 2.15 days; p=0.03). There were no COVID-19 related deaths. Table 1. Demographic, clinical, laboratory and virology characteristics of study patients Conclusion The frequency of SARS-CoV-2 RNAemia in pediatric patients was 26% and its finding was associated with worse clinical in-hospital outcomes, similar to that reported in adults. Testing for SARS-CoV-2 RNAemia in children may help identify those who could benefit from more intensive supportive care as well as antiviral and anti-inflammatory medications. Disclosures Octavio Ramilo, MD, Adagio (Consultant)Bill &amp; Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support)Lilly (Consultant)Merck (Consultant, Grant/Research Support)NIH (Grant/Research Support)Pfizer (Consultant)SANOFI (Board Member) Asuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member)Sanofi (Advisor or Review Panel member)

Management of Severe Influenza.

Influenza infection causes severe illness in 3 to 5 million people annually, with up to an estimated 650,000 deaths per annum. As such, it represents an ongoing burden to health care systems and human health. Severe acute respiratory infection can occur, resulting in respiratory failure requiring intensive care support. Herein we discuss diagnostic approaches, including development of CLIA-waived point of care tests that allow rapid diagnosis and treatment of influenza. Bacterial and fungal coinfections in severe influenza pneumonia are associated with worse outcomes, and we summarize the approach and treatment options for diagnosis and treatment of bacterial and Aspergillus coinfection. We discuss the available drug options for the treatment of severe influenza, and treatments which are no longer supported by the evidence base. Finally, we describe the supportive management and ventilatory approach to patients with respiratory failure as a result of severe influenza in the intensive care unit.

Epidemiology of Drowning Incidents among Children at Sultan Qaboos University Hospital Oman.

ObjectivesWe sought to study the epidemiology of drowning among children reported at Sultan Qaboos University Hospital in Oman.MethodsWe conducted a retrospective study of the patients who presented to the emergency department with a history of drowning over 10 years from January 2008 to December 2017. Patients with children aged one to 18 years old were included in the study. The data including demographics, timing and location of drowning, season, adult supervision, swimming ability, medical risk factors, duration of submersion, on spot resuscitation, emergency medicine department assessment, and hospital management and outcome were collected from electronic hospital information system using a preformed proforma. The outcome was categorized into either full recovery, severe neurological injury, or brain death based on the pediatric cerebral performance category (PCPC). A good outcome represents a score of 1–3 points, and a PCPC of 4–6 points corresponds to a poor outcome. We calculated correlation for all variables with the outcome by using chi-square and Fisher’s exact tests. A p-value of < 0.050 is taken as significant value.ResultsA total of 74 patients were included in the study; 54 (73.0%) were male, and 47 (63.5%) were aged < 6 years old. More than half (59.4%) of drownings happened in swimming pool, 21 (28.4%) children were unsupervised during the incident, and 39 (52.7%) required cardiopulmonary resuscitation (CPR). Out of all studied subjects, three (4.1%) were brain dead, and two (2.7%) developed severe neurological injury. On univariate analysis, the following variables were statistically significant (p < 0.050), predicting the poor outcome like lack of adult supervision, duration of submersion >10 minutes, asystole, Glasgow Coma Scale < 8, temperature < 35 oC, pH < 7, anion gap > 20, blood glucose > 10 mmol/L, abnormal chest X-ray findings, rewarming, CPR, intubation, inotropic support, and pediatric intensive care unit admission.ConclusionsOur study suggests that children, especially males under the age of six with no swimming ability, need strict supervision next to bodies of water. Furthermore, preventive measures might include raising community awareness about the risk factors of drowning, commencing public CPR lessons, and strict pool safety regulation by related authorities.