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Pediatric cardiac surgery and intensive care

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https://www.readbyqxmd.com/read/29623729/pharmacokinetic-considerations-for-pediatric-patients-receiving-analgesia-in-the-intensive-care-unit-targeting-postoperative-ecmo-and-hypothermia-patients
#1
G A Zeilmaker, P Pokorna, P Mian, E D Wildschut, C A J Knibbe, E H J Krekels, K Allegaert, D Tibboel
Adequate postoperative analgesia in pediatric patients in the intensive care unit (ICU) matters, since untreated pain is associated with negative outcomes. Compared to routine postoperative patients, children undergoing hypothermia (HT) or extracorporeal membrane oxygenation (ECMO), or recovering after cardiac surgery likely display non-maturational differences in pharmacokinetics (PK) and pharmacodynamics (PD). These differences warrant additional dosing recommendations to optimize pain treatment. Areas covered: Specific populations within the ICU will be discussed with respect to expected variations in PK and PD for various analgesics...
April 6, 2018: Expert Opinion on Drug Metabolism & Toxicology
https://www.readbyqxmd.com/read/29594089/the-need-for-specialized-pediatric-cardiac-critical-care-training-program-in-limited-resource-settings
#2
REVIEW
Indah K Murni, Ndidiamaka L Musa
Congenital heart disease (CHD) is one of the major global health problems with the highest birth prevalence in low- and middle-income countries. In these populous countries, basic health services for the children with CHD, including surgery, are lacking. Even though surgery is performed, outcome after cardiac surgery is influenced by the quality of the postoperative management with a reported high morbidity and mortality. Henceforth, there is an urgent need for comprehensive interventions to provide high quality cardiac intensive care programs to improve the quality of pediatric cardiac surgery services in order to address high morbidity and mortality after cardiac surgery...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29588140/cochlear-implant-function-in-a-patient-with-jervell-and-lange-nielsen-syndrome-after-defibrillation-by-countershock
#3
Shinsuke Kaneshiro, Harukazu Hiraumi, Kirito Shimamoto, Kaori Sasamori, Yumiko Kobayashi, Hiroaki Sato
Jervell and Lange-Nielsen syndrome (JLNS), a rare autosomal recessive congenital QT prolongation syndrome, is characterized by cardiac arrhythmias, syncopal episodes, and profound deafness. A cochlear implant (CI) for patients with JLNS is expected to result in hearing improvement. Sometimes, defibrillation is required if a patient experiences lethal arrhythmia. In this paper, we report a pediatric patient with JLNS who received defibrillation after CI surgery in his right ear at the age of 2 years. With intensive care, the post-operative course was uneventful, and the patient acquired satisfactory speech and hearing abilities...
March 24, 2018: Auris, Nasus, Larynx
https://www.readbyqxmd.com/read/29587521/orthotopic-heart-transplantation-in-children
#4
Nagarajan Muthialu
Heart transplantation is a relatively infrequent but technically demanding procedure in pediatric cardiac surgery. Orthotopic heart transplantation is often offered to older children or adolescents following multiple previous operations, but with advances in intensive care, diagnostics, and management, more infants with complex congenital heart diseases are being listed for transplantation. Primary cardiomyopathies remain the most common indication. Outcomes following cardiothoracic transplantation have improved steadily in recent times...
January 1, 2018: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/29550071/admission-to-dedicated-pediatric-cardiac-intensive-care-units-is-associated-with-decreased-resource-use-in-neonatal-cardiac-surgery
#5
Joyce T Johnson, Jacob F Wilkes, Shaji C Menon, Lloyd Y Tani, Hsin-Yi Weng, Bradley S Marino, Nelangi M Pinto
OBJECTIVE: Neonates undergoing congenital heart surgery require highly specialized, resource-intensive care. Location of care and degree of specialization can vary between and within institutions. Using a multi-institutional cohort, we sought to determine whether location of admission is associated with an increase in health care costs, resource use and mortality. METHODS: We retrospectively analyzed admission for neonates (<30 days) undergoing congenital heart surgery between 2004-2013 using the Pediatric Health Information Systems database (44 children's hospitals)...
February 21, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29543640/anesthesia-for-percutaneous-pulmonary-valve-implantation-a-case-series
#6
Rafael Arboleda Salazar, Jane Heggie, Piotr Wolski, Eric Horlick, Mark Osten, Massimiliano Meineri
BACKGROUND: Twenty percent of patients born with congenital heart disease present with right ventricular outflow tract abnormalities. These patients require multiple surgical procedures in their lifetime. Transcatheter pulmonary valve replacement (TPVR) has become a viable alternative to conventional pulmonary valve and right ventricular outflow tract surgery in pediatric and adult populations. In this retrospective review, we analyze the perioperative management of adult patients who underwent TPVR in our center...
March 14, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29472494/disparities-in-outcomes-and-resource-use-after-hospitalization-for-cardiac-surgery-by-neighborhood-income
#7
Brett R Anderson, Evan S Fieldston, Jane W Newburger, Emile A Bacha, Sherry A Glied
BACKGROUND: Significant disparities exist between patients of different races and with different family incomes; less is understood regarding community-level factors on outcomes. METHODS: In this study, we used linked data from the Pediatric Health Information System database and the US Census Bureau to examine associations between median annual household income by zip code and mortality, length of stay, inpatient standardized costs, and costs per day, over and above the effects of race and payer, first for children undergoing cardiac surgery (2005-2015) and then for all pediatric discharges (2012-2015)...
February 22, 2018: Pediatrics
https://www.readbyqxmd.com/read/29464581/urinary-neutrophil-gelatinase-associated-lipocalin-ngal-and-serum-cystatin-c-measurements-for-early-diagnosis-of-acute-kidney-injury-in-children-admitted-to-picu
#8
Jameela Abdulaziz Kari, Mohamed Ahmed Shalaby, Kholoud Sofyani, Ahmad Saleh Sanad, Albaraa Fuad Ossra, Rayan Smeer Halabi, Maha Hassan Aljuhani, Wael Mohammad Toffaha, Feras Aymen Moria, Samar Sabry, Hanan AbdelAziz Ahmed, Khalid Abdulaziz Alhasan, Sara Sharief, Osama Safdar
BACKGROUND: Acute kidney injury (AKI) is common in critically ill children with significant mortality and morbidity. Serum creatinine is an insensitive and late biomarker compared to newly proposed AKI biomarkers. METHODS: Prospective study in pediatric intensive care unit (PICU) over three months to compare between serum cystatin-C (s-Cys-C) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) as AKI biomarkers at multiple time points with pediatric risk, injury, failure, loss, end-stage renal disease (pRIFLE) classification in diagnosing AKI...
February 20, 2018: World Journal of Pediatrics: WJP
https://www.readbyqxmd.com/read/29440824/extracorporeal-membrane-oxygenation-in-pediatric-cardiac-surgery-a-retrospective-review-of-trends-and-outcomes-in-scotland
#9
Maziar Khorsandi, Mark Davidson, Omar Bouamra, Andrew McLean, Kenneth MacArthur, Ida Torrance, Gillian Wylie, Ed Peng, Mark Danton
Introduction: Around 3.2%-8.4% of patients receive venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support after pediatric cardiac surgery. The desired outcome is "bridge-to-recovery" in most cases. There is no universally agreed protocol, and given the associated costs and complications rates, the decisions as of when and when not to institute VA ECMO are largely empirical. Methods: A retrospective review of the ECMO database at the Scottish Pediatric Cardiac Services (SPCS) was undertaken...
January 2018: Annals of Pediatric Cardiology
https://www.readbyqxmd.com/read/29395177/delirium-is-a-common-and-early-finding-in-patients-in-the-pediatric-cardiac-intensive-care-unit
#10
Rita V Alvarez, Claire Palmer, Angela S Czaja, Chris Peyton, Gabrielle Silver, Chani Traube, Peter M Mourani, Jon Kaufman
OBJECTIVE: To determine incidence, associated risk factors, and characteristics of delirium in a pediatric cardiac intensive care unit (CICU). Delirium is a frequent and serious complication in adults after cardiac surgery, but there is limited understanding of its impact in children with critical cardiac disease. STUDY DESIGN: Single-center prospective observational study of CICU patients ≤21 years old. All were screened for delirium using the Cornell Assessment for Pediatric Delirium each 12-hour shift...
January 29, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29373345/basic-knowledge-of-tracheoesophageal-fistula-and-esophageal-atresia
#11
Sura Lee
BACKGROUND: Tracheoesophageal fistula (TEF) and esophageal atresia (EA) are rare anomalies in neonates. Up to 50% of neonates with TEF/EA will have Vertebral anomalies (V), Anal atresia (A), Cardiac anomalies (C), Tracheoesophageal fistula (T), Esophageal atresia (E), Renal anomalies (R), and Limb anomalies (L) (VACTERL) association, which has the potential to cause serious morbidity. PURPOSE: Timely management of the neonate can greatly impact the infant's overall outcome...
February 2018: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
https://www.readbyqxmd.com/read/29362623/the-prevalence-and-risk-factors-of-early-arrhythmias-following-pediatric-open-heart-surgery-in-egyptian-children
#12
Tarek Ahmed Abdel Gawad, Waleed Mohamed Elguindy, Omneya Ibrahim Youssef, Tamer Ashraf Abosalem
AIM: This study aimed to assess the prevalence of early postoperative arrhythmias after cardiac operation in the pediatric population, and to analyse possible risk factors. MATERIAL AND METHODS: Cross-sectional study included 30 postoperative patients, with age range four up to 144 months. They were selected from those admitted to the Cardiology Unit in the Pediatric department of Ain Shams University hospitals, after undergoing cardiopulmonary bypass (CPB) surgery for correction of congenital cardiac defects...
December 15, 2017: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/29357785/safety-efficacy-and-timeliness-of-intravenous-potassium-chloride-replacement-protocols-in-a-pediatric-cardiothoracic-intensive-care-unit
#13
Rambod Amirnovin, Phuong Lieu, Flerida Imperial-Perez, Carol Taketomo, Barry P Markovitz, David Y Moromisato
OBJECTIVE: Hypokalemia in children following cardiac surgery occurs frequently, placing them at risk of life-threatening arrhythmias. However, renal insufficiency after cardiopulmonary bypass warrants careful administration of potassium (K+). Two different nurse-driven protocols (high dose and tiered dosing) were implemented to identify an optimal K+ replacement regimen, compared to an historical low-dose protocol. Our objective was to evaluate the safety, efficacy, and timeliness of these protocols...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29341967/new-modalities-for-the-administration-of-inhaled-nitric-oxide-in-intensive-care-units-after-cardiac-surgery-or-for-neonatal-indications-a-prospective-observational-study
#14
Philippe Gaudard, Claudio Barbanti, Bertrand Rozec, Philippe Mauriat, Mimoun M'rini, Gilles Cambonie, Jean Michel Liet, Claude Girard, Pierre Louis Leger, Ziad Assaf, Pierre Damas, Gauthier Loron, Laurent Lecourt, Julien Amour, Philippe Pouard
BACKGROUND: Nitric oxide (NO) has a well-known efficacy in pulmonary hypertension (PH), with wide use for 20 years in many countries. The objective of this study was to describe the current use of NO in real life and the gap with the guidelines. METHODS: This is a multicenter, prospective, observational study on inhaled NO administered through an integrated delivery and monitoring device and indicated for PH according to the market authorizations. The characteristics of NO therapy and ventilation modes were observed...
April 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29340730/age-dependent-association-between-pre-transplant-blood-transfusion-and-outcomes-of-pediatric-heart-transplantation
#15
C McKee, D Tumin, B R Alevriadou, K K Nicol, A R Yates, D Hayes, J D Tobias
Avoidance of red blood cell (RBC) transfusions in patients awaiting heart transplantation (HTx) has been suggested to minimize the risk of allosensitization. Although recent studies have suggested that an immature immune system in younger HTx recipients may reduce risks associated with RBC transfusion, the role of age in moderating the influence of transfusion on HTx outcomes remains unclear. We used available data from a national transplant registry to explore whether the association between pre-transplant transfusions and outcomes of pediatric HTx varies by patient age...
April 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29302715/remote-ischemic-preconditioning-has-a-cardioprotective-effect-in-children-in-the-early-postoperative-phase-a-meta-analysis-of-randomized-controlled-trials
#16
Wen Tan, Chaoji Zhang, Jianzhou Liu, Xiaofeng Li, Yuzhi Chen, Qi Miao
In this updated meta-analysis, we assessed the cardioprotective effect of remote ischemic preconditioning (RIPC) in pediatric patients undergoing congenital heart surgery. A total of 9 randomized controlled trials (RCTs) involving 793 pediatric patients under 18 years old were identified. RIPC obviously reduced the release of troponin I at 6 h after surgery [standard mean difference (SMD) -0.59, 95% confidence interval (CI) -1.14 to -0.04; p = 0.03], mitigated the inotropic scores within 4-6 h (SMD -0...
March 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29302123/bloodless-repair-for-a-3-6-kilogram-transposition-of-the-great-arteries-with-jehovah-s-witness-faith
#17
Jeffery L Burnside, Todd M Ratliff, Ashley B Hodge, Daniel Gomez, Mark Galantowicz, Aymen Naguib
Achieving pediatric cardiac surgery using cardiopulmonary bypass (CPB) without allogeneic blood transfusion is challenging. There are many clinical and economic factors that point to the importance of avoiding blood transfusions. In some instances, honoring patients or parents beliefs may be the reason for avoiding blood transfusions. For example, patients or parents of the Jehovah's Witness faith refuse blood transfusion based on their religious beliefs. Over the last decade, our institution has seen a steady increase in our pediatric Jehovah's Witness patient population...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29286568/utilization-of-frozen-plasma-cryoprecipitate-and-recombinant-factor-viia-for-children-with-hemostatic-impairments-an-audit-of-transfusion-appropriateness
#18
Lani Lieberman, Yulia Lin, Christine Cserti-Gazdewich, Qi Long Yi, Jacob Pendergrast, Wendy Lau, Jeannie Callum
BACKGROUND: Blood transfusions and fractionated products are not without risk and may lead to acute and long-term adverse events. The objective of this study was to evaluate the appropriateness of usage of frozen plasma (FP), cryoprecipitate (CRYO), and recombinant factor VIIa (rVIIa) in a pediatric setting. METHODS: All orders for FP, CRYO, and rVIIa were prospectively audited over 6 weeks. Data collected included demographics, laboratory values, indication, and adverse reactions...
April 2018: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/29280785/the-epidemiology-of-health-care-associated-infections-in-pediatric-cardiac-intensive-care-units
#19
Jeffrey A Alten, Akm Fazlur Rahman, Hayden J Zaccagni, Andrew Shin, David S Cooper, Joshua J Blinder, Lauren Retzloff, Inmaculada B Aban, Eric M Graham, Jeffrey Zampi, Yuliya Domnina, Michael G Gaies
BACKGROUND: Health-care associated infections (HAI) represent serious complications for patients within pediatric cardiac intensive care units (CICU). HAI are associated with increased morbidity, mortality, and resource utilization. There are few studies describing the epidemiology of HAI across the entire spectrum of patients (surgical and non-surgical) receiving care in dedicated pediatric CICUs. METHODS: Retrospective analyses of 22,839 CICU encounters from 10/2013-9/2016 across 22 North American CICUs contributing data to the Pediatric Cardiac Critical Care Consortium clinical registry...
December 26, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/29279413/association-between-diastolic-blood-pressure-during-pediatric-in-hospital-cardiopulmonary-resuscitation-and-survival
#20
Robert A Berg, Robert M Sutton, Ron W Reeder, John T Berger, Christopher J Newth, Joseph A Carcillo, Patrick S McQuillen, Kathleen L Meert, Andrew R Yates, Rick E Harrison, Frank W Moler, Murray M Pollack, Todd C Carpenter, David L Wessel, Tammara L Jenkins, Daniel A Notterman, Richard Holubkov, Robert F Tamburro, J Michael Dean, Vinay M Nadkarni
Background -Based on laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data demonstrating that survival depends on attaining adequate arterial diastolic blood pressure (DBP) during CPR, American Heart Association recommends using BP to guide pediatric CPR. However, evidence-based BP targets during pediatric CPR remain an important knowledge gap for CPR guidelines. Methods -All children ≥37 weeks gestation and <19 years old in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for ≥1 minute and invasive arterial blood pressure monitoring prior to and during CPR between July 1, 2013 and June 31, 2016 were included...
December 26, 2017: Circulation
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