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Post pediatric cardiac surgery care

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https://www.readbyqxmd.com/read/27713672/outcomes-in-postoperative-pediatric-cardiac-surgical-patients-who-received-an-antiepileptic-drug
#1
Mindl M Messinger, Kimberly L Dinh, Erin J McDade, Brady S Moffett, Angus A Wilfong, Antonio G Cabrera
BACKGROUND: Advances in cardiac operations over the last few decades, including corrective operations in early life, have dramatically increased the survival of children with congenital heart disease. However, postoperative care has been associated with neurologic complications, with seizures being the most common manifestation. The primary objective of this study is to describe the outcomes in pediatric patients who received an antiepileptic drug (AED) post-cardiac surgery. METHOD: A retrospective cohort study was performed in all patients less than 18 years of age who received an AED in the cardiovascular intensive care unit at Texas Children's Hospital from June 2002 until June 2012...
July 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/27706462/effectiveness-of-prophylactic-non-invasive-ventilation-on-respiratory-function-in-the-postoperative-phase-of-pediatric-cardiac-surgery-a-randomized-controlled-trial
#2
Camilla R S Silva, Lívia B Andrade, Danielle A S X Maux, Andreza L Bezerra, Maria C M B Duarte
Objective: To evaluate the effectiveness of prophylactic, non-invasive ventilation (NIV) on respiratory function in seven- to 16-year-old children in the post-operative phase of cardiac surgery. Method: A randomized, controlled trial with 50 children who had undergone cardiac surgery with median sternotomy. After extubation, patients were randomly assigned to one of two groups: control group (n=26), which received instructions regarding posture, early ambulation, and cough stimulation, and CPAP group (continuous positive airway pressure; n=24), which received the same instructions as the control group and CPAP=10 cmH20 twice daily for 30 minutes from the 1st to the 5th post-operative day (POD)...
September 29, 2016: Brazilian Journal of Physical Therapy
https://www.readbyqxmd.com/read/27618336/assessment-of-risk-factors-for-a-sustainable-on-table-extubation-program-in-pediatric-congenital-cardiac-surgery-5-year-experience
#3
Reena Khantwal Joshi, Neeraj Aggarwal, Mridul Agarwal, Veronique Dinand, Raja Joshi
OBJECTIVE: To delineate risk factors for failure of extubation in the operating room among pediatric cardiac surgery patients. DESIGN: Prospective, observational study. SETTING: Single center, tertiary care, teaching hospital. PARTICIPANTS: The study comprised 448 congenital cardiac surgery patients who were enrolled for intended extubation in the pediatric cardiac operating room over 5 years. INTERVENTIONS: The airways of enrolled patients were extubated in the operating room if predetermined suitability criteria were met...
December 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27561544/latent-aki-is%C3%A2-still-aki-the-quantification-of-the-burden-of-renal-dysfunction
#4
Zaccaria Ricci, Stefano Romagnoli, Luca Di Chiara
The association between pediatric cardiac surgery, acute kidney injury (AKI), and clinical outcomes has been studied several times in the recent literature. In this issue of Critical Care an interesting and original study analyzed the path from causal AKI entities to clinical AKI consequences through the application of structural equation modeling. The authors described the complex connections linking duration of cardiopulmonary bypass, cross clamp-time, and descriptors of low cardiac output syndrome to AKI modeled as a complex variable composed of post-operative serum creatinine increase of 50 % over baseline, urine output <0...
2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27306543/frequency-of-mammary-artery-coiling-in-single-ventricle-patients-and-future-coronary-artery-grafting
#5
Khaled Abdelhady, Anas Taqatqa, Carlos Miranda, Sawsan Awad
Pre-Fontan coil closure of aorto-pulmonary collaterals decreases single-ventricle volume load and improves outcome. Coiling of right and left internal mammary arteries may present a challenge to cardiothoracic surgery teams caring for these patients when future coronary artery bypass grafting is needed for SV patients. The goal of this study was to determine the frequency of internal mammary artery coil closure in SV patients in a single tertiary care center. A retrospective review of all pediatric single-ventricle patients who underwent cardiac catheterization between March 2009 and October 2015 at Rush Center for Congenital Heart Disease was performed...
October 2016: Pediatric Cardiology
https://www.readbyqxmd.com/read/27233471/a-case-of-severe-perioperative-hypoxia-in-uncorrected-tetralogy-of-fallot-anesthetic-management
#6
M Athar, S Ali, S M Ahmed, R Mazahir
Tetralogy of fallot (TOF) is one of the most common congenital heart disease (CHD) in children. With the development of pediatric surgery and intensive care units, increasing number of grown-up CHD patients are presenting for non-cardiac surgeries. Non-operated TOF patients suffer from chronic hypoxia and decreased pulmonary blood flow resulting in considerable alteration in the physiology. The optimal management of these patients, therefore, require a thorough understanding of the pathophysiology of the uncorrected TOF...
May 24, 2016: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/27052073/serum-albumin-perturbations-in-cyanotics-after-cardiac-surgery-patterns-and-predictions
#7
Poonam Malhotra Kapoor, Jitin Narula, Ujjwal Kumar Chowdhury, Usha Kiran, Sameer Taneja
INTRODUCTION: Hypoalbuminemia is a well-recognized predictor of general surgical risk and frequently occurs in patients with cyanotic congenital heart disease (CCHD). Moreover, cardiopulmonary bypass (CPB)-induced an inflammatory response, and the overall surgical stress can effect albumin concentration greatly. The objective of his study was to track CPB-induced changes in albumin concentration in patients with CCHD and to determine the effect of hypoalbuminemia on postoperative outcomes...
April 2016: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/26961569/pediatric-cardiology-boot-camp-description-and-evaluation-of-a-novel-intensive-training-program-for-pediatric-cardiology-trainees
#8
Scott R Ceresnak, David M Axelrod, Kara S Motonaga, Emily R Johnson, Catherine D Krawczeski
The transition from residency to subspecialty fellowship in a procedurally driven field such as pediatric cardiology is challenging for trainees. We describe and assess the educational value of a pediatric cardiology "boot camp" educational tool designed to help prepare trainees for cardiology fellowship. A two-day intensive training program was provided for pediatric cardiology fellows in July 2015 at a large fellowship training program. Hands-on experiences and simulations were provided in: anatomy, auscultation, echocardiography, catheterization, cardiovascular intensive care (CVICU), electrophysiology (EP), heart failure, and cardiac surgery...
June 2016: Pediatric Cardiology
https://www.readbyqxmd.com/read/26918834/end-stage-ischemic-heart-failure-and-williams-beuren-syndrome-a-unique-scenario-for-pediatric-heart-transplantation
#9
María-Teresa González-López, Ramón Pérez-Caballero-Martínez, Miguel-Ángel Granados-Ruiz, Enrique García-Torres, Reyes Álvarez-García-Rovés, Nuria Gil-Villanueva, Manuela Camino-López, Juan-Miguel Gil-Jaurena
WBS is a rare disorder caused by mutations in the chromosomal sub-band 7q11.23 involving the elastin gene. The clinical features (craniofacial, developmental, and cardiovascular abnormalities) are variable. The association with cardiac anomalies is a well-recognized feature, and SVAS is the most common cardiac defect found. End-stage ischemic heart disease is unusual in this setting but when it occurs, OHT remains the final therapeutic option. This decision can be difficult to determine, and it must be tailored to the individual patient based on the clinical status and concomitant cardiovascular and multisystem lesions...
May 2016: Pediatric Transplantation
https://www.readbyqxmd.com/read/26829892/urinary-tract-infection-in-children-after-cardiac-surgery-incidence-causes-risk-factors-and-outcomes-in-a-single-center-study
#10
Mohamed S Kabbani, Sameh R Ismail, Anis Fatima, Rehana Shafi, Julinar A Idris, Akhter Mehmood, Reetam K Singh, Mahmoud Elbarabry, Omar Hijazi, Mohamed A Hussein
Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in 2012, and we divided the patients into two groups: the UTI (UTI group) and the non-UTI (control group). We compared both groups for multiple peri-operative risk factors...
September 2016: Journal of Infection and Public Health
https://www.readbyqxmd.com/read/26560361/postoperative-management-of-heart-failure-in-pediatric-patients
#11
REVIEW
Mahsun Yuerek, Joseph W Rossano, Christopher E Mascio, Robert E Shaddy
Low cardiac output syndrome (LCOS) is a well-described entity occurring in 25-65% of pediatric patients undergoing open-heart surgery. With judicious intensive care management of LCOS, most patients have an uncomplicated postoperative course, and within 24 h after cardiopulmonary bypass, the cardiac function returns back to baseline. Some patients have severe forms of LCOS not responsive to medical management alone, requiring temporary mechanical circulatory support to prevent end-organ injury and to decrease myocardial stress and oxygen demand...
2016: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/26463989/pathophysiology-of-post-operative-low-cardiac-output-syndrome
#12
REVIEW
Conrad L Epting, Mary E McBride, Eric L Wald, John M Costello
Low cardiac output syndrome frequently complicates the post-operative care of infants and children following cardiac surgery. The onset of low cardiac output follows a predictable course in the hours following cardiopulmonary bypass, as myocardial performance declines in the face of an elevated demand for cardiac output. When demand outstrips supply, shock ensues, and early recognition and intervention can decrease mortality. Multifactorial in etiology, this article will discuss the pathophysiology of low cardiac output syndrome, including myocardial depression following bypass, altered cardiac loading conditions, and inflammation driving a hypermetabolic state...
2016: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/25901715/prognostic-role-of-bnp-in-children-undergoing-surgery-for-congenital-heart-disease-analysis-of-prediction-models-incorporating-standard-risk-factors
#13
Massimiliano Cantinotti, Raffaele Giordano, Marco Scalese, Sabrina Molinaro, Francesca Della Pina, Simona Storti, Luigi Arcieri, Bruno Murzi, Marco Marotta, Vitali Pak, Vincenzo Poli, Giorgio Iervasi, Shelby Kutty, Aldo Clerico
BACKGROUND: The routine use of brain natriuretic peptide (BNP) in pediatric cardiac surgery remains controversial. Our aim was to test whether BNP adds information to predict risk in pediatric cardiac surgery. METHODS: In all, 587 children undergoing cardiac surgery (median age 6.3 months; 1.2-35.9 months) were prospectively enrolled at a single institution. BNP was measured pre-operatively, on every post-operative day in the intensive care unit, and before discharge...
October 2015: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/25652766/impact-of-the-implementation-of-an-interdisciplinary-infection-control-program-to-prevent-surgical-wound-infection-in-pediatric-heart-surgery
#14
Jaume Izquierdo-Blasco, Magda Campins-Martí, Pere Soler-Palacín, Joan Balcells, Raul Abella, Ferran Gran, Félix Castillo, Rosario Nuño, Joan Sanchez-de-Toledo
UNLABELLED: Surgical site infection (SSI) remains a major source of morbidity, mortality, and increased health care costs in children undergoing heart surgery. The aim of this study was to assess the effectiveness of an intervention program designed to reduce the high incidence of SSI observed at our center in pediatric patients. An interdisciplinary infection control program including pre-, intra-, and postoperative measures was introduced for children undergoing heart surgery with cardiopulmonary bypass...
July 2015: European Journal of Pediatrics
https://www.readbyqxmd.com/read/25645468/urinary-ngal-to-define-aki-in-asphyxiated-infants
#15
COMMENT
Stuart L Goldstein
Acute kidney injury (AKI) is independently associated with poor outcomes in the critically ill patient. The standard kidney function biomarker, serum creatinine, shows a demonstrable rise in concentration many hours to days after insult to the kidney. Thus, creatinine-based AKI diagnosis is likely delayed, rendering treatments to mitigate or prevent AKI ineffective. Neonatal AKI is further confounded by the fact that infant serum creatinine concentrations reflect maternal levels. The past 15 years has seen a massive research effort to identify early damage markers of AKI, with the hope that earlier "sub-clinical" AKI diagnosis can lead to earlier initiation of AKI treatment, or to adjustment of care to mitigate the adverse effects of AKI until renal function recovery occurs...
July 2015: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/25548339/pediatric-cardiac-surgery-parent-education-discharge-instruction-pedi-program-a-pilot-study
#16
Sandra L Staveski, Bistra Zhelva, Reena Paul, Rosalind Conway, Anna Carlson, Gouthami Soma, Susan Kools, Linda S Franck
BACKGROUND: In developing countries, more children with complex cardiac defects now receive treatment for their condition. For successful long-term outcomes, children also need skilled care at home after discharge. The Parent Education Discharge Instruction (PEDI) program was developed to educate nurses on the importance of discharge teaching and to provide them with a structured process for conducting parent teaching for home care of children after cardiac surgery. The aim of this pilot study was to generate preliminary data on the feasibility and acceptability of the nurse-led structured discharge program on an Indian pediatric cardiac surgery unit...
January 2015: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/25489437/non-thyroidal-illness-syndrome-and-cardiopulmonary-bypass-in-children-with-congenital-heart-disease
#17
Kazem Babazadeh, Avisa Tabib, Peyman Eshraghi, Hooman Bakhshandeh, Hassan Zamani
BACKGROUND: The thyroid hormones influence on all metabolic pathways. After heart surgery using cardiopulmonary bypass (CPB), serum T3 decreases and remains low for at least 24 hours. Several studies on pediatric have reported reduction of thyroid hormones after heart surgery. This study aimed to investigate the status of thyroid function tests in children with CPB surgery. METHODS: This study was carried out based on the available data on 132 children aged less than 15 years suffering from CHD...
2014: Caspian Journal of Internal Medicine
https://www.readbyqxmd.com/read/25336528/prior-cardiac-surgery-is-independently-associated-with-decreased-survival-following-infant-tracheostomy
#18
Elizabeth Rosner, Christopher W Mastropietro
INTRODUCTION: Previous reports have demonstrated that prior cardiac surgery is independently associated with in-hospital mortality after infant tracheostomy. We aimed to determine whether these infants would continue to be at increased risk for death following hospital discharge. METHODS: A retrospective review was performed on subjects < 2 y of age who recovered from tracheostomy in the pediatric ICU at our institution between January 2007 and December 2011, with follow-up to December 2013...
January 2015: Respiratory Care
https://www.readbyqxmd.com/read/25316975/vasoactive-inotrope-score-as-a-tool-for-clinical-care-in-children-post-cardiac-surgery
#19
Maneesh Kumar, Rajesh Sharma, Sidharth Kumar Sethi, Subeeta Bazaz, Prerna Sharma, Anil Bhan, Vijay Kher
BACKGROUND: Neonates and infants undergoing heart surgery on cardiopulmonary bypass (CPB) are at high risk for significant post-operative morbidity and mortality. Hence, there is a need to identify and quantify clinical factors during the early post-operative period that are indicative of short-term as well as long-term outcomes. Multiple inotrope scores have been used in practice to quantify the amount of cardiovascular support received by neonates. AIMS: The goal of this study was to determine the association between inotropic/vasoactive support and clinical outcomes in children after open cardiac surgery...
October 2014: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/25299721/lack-of-accuracy-of-ventilatory-indexes-in-predicting-extubation-success-in-children-submitted-to-mechanical-ventilation
#20
Silvia Gatiboni, Jefferson Pedro Piva, Pedro Celiny Ramos Garcia, Cinthia Jonhston, Patrícia Hommerding, Flávia Franz, Lucien Gualdi
OBJECTIVES: Between 10% and 20% of children submitted to mechanical ventilation in the pediatric intensive care unit present extubation failure. Several ventilatory indexes have been proposed to predict extubation failure. The aim of this study was to analyze the accuracy of these indices in predicting successful extubation in children and to evaluate these variables according to the age of the patient and the specific disease. METHODS: A prospective observational study including all children submitted to mechanical ventilation in a Brazilian referral pediatric intensive care unit was conducted between August 2007 and August 2008...
June 2011: Revista Brasileira de Terapia Intensiva
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