scholarly journals Factors prolonging length of stay in the cardiac intensive care unit following the arterial switch operation

2007 ◽  
Vol 18 (01) ◽  
Author(s):  
Derek S. Wheeler ◽  
Catherine L. Dent ◽  
Peter B. Manning ◽  
David P. Nelson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Arterial Switch Operation ◽  
Cardiac Intensive Care Unit ◽  
Arterial Switch ◽  
Switch Operation ◽  
Cardiac Intensive Care

Abstract 18729: Comparative Analysis of the Use of Extracorporeal Membrane Oxygenation During Cardiopulmonary Resuscitation Within a Pediatric Cardiac Intensive Care Unit

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Stephanie J Conrad ◽  
Matthew K Bacon ◽  
Brittney C Hatch ◽  
John David Hughes ◽  
Michelle K Terrell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Mechanical Support ◽  
Cardiac Intensive Care Unit ◽  
Icu Discharge ◽  
Cardiac Intensive Care

Background: Mechanical support to aid in restoration of circulation during cardiopulmonary resuscitation (CPR) is increasingly common in the pediatric cardiac intensive care unit (CICU). We sought to both identify and quantify factors predicting the implementation of extracorporeal membrane oxygenation to support CPR (eCPR). Methods and Results: Events associated with CPR from July 2010 through December 2013 within our pediatric CICU were retrospectively reviewed. Of 135 arrests among 88 patients, 84% were among postsurgical patients and 98% (n=133) resulted in a return of circulation, either spontaneous (n=100, 74%) or with the assistance of mechanical support (n=33, 24%). Median age at arrest was 106 days (interquartile range [IQR] 26-207 days) and weight was 3.9 kg (IQR 3.0-6.0 kg). Median length of stay (LOS) at the time of arrest was 5 days (IQR 1-49 days). Common primary causes included low cardiac output (38%), respiratory failure (33%), and arrhythmia (15%). Univariate predictors of an eCPR arrest included smaller size (3.3 v. 4.3 kg, p=0.004), younger age (25 v. 130 days, p<0.001), shorter length of stay at time of arrest (1 v. 8.5 days, p=0.001), single ventricle physiology (30% v. 14% among biventricular physiology arrests, p=0.04), and arrests not related to respiratory failure (34% v. 5% eCPR among respiratory failure arrests, p<0.001). Unit factors not associated with an increased frequency of arrests resulting in eCPR included unit capacity, night shift, and the experience levels of both the bedside nurse and attending. Among patients with at least one arrest, median ICU LOS was 18 days (IQR 9-72 days) and overall survival to ICU discharge was 72%. Survival to ICU discharge was not significantly different with respect to use of eCPR as compared to conventional CPR (60% v. 77% respectively, p=0.11). Conclusions: We report predictors of the need for mechanical support during cardiopulmonary resuscitation within a pediatric CICU, and demonstrate comparable post-resuscitation survival to ICU discharge among those rescued with eCPR. Further longitudinal investigation is necessary to identify potential eCPR-associated differences in morbidity and neurocognitive outcomes following a CICU arrest.

scholarly journals Manajemen Perioperatif Operasi Arterial Switch pada Transposition of The Great Arteries with Intact Ventricular Septum

2020 ◽  
Vol 12 (2) ◽  
pp. 11-22
Author(s):  
Dian Kesumarini ◽  
Herdono Poernomo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Myocardial Protection ◽  
Septal Defect ◽  
Arterial Switch Operation ◽  
Ductus Arteriosus ◽  
Intact Ventricular Septum ◽  
Arterial Switch ◽  
Switch Operation ◽  
Patent Ductus

Latar belakang: Penyakit jantung bawaan (PJB) berkontribusi terhadap hampir sepertiga dari kelainan kongenital secara keseluruhan. Transposition of the great arteries (d-TGA) adalah satu kelainan jantung bawaan (PJB) yang kompleks. Tindakan arterial switch operation (ASO) menjadi pilihan koreksi pada kasus TGA. Tindakan ini mempunyai risiko morbiditas dan mortalitas yang cukup tinggi.Kasus: Bayi berusia 42 hari dengan berat badan 3100 gram dirujuk ke Rumah Sakit Jantung dan Pembuluh Darah (RSJPD) Harapan Kita karena kelainan jantung. Pasien dilakukan diagnosik ekokardiografi dan didapatkan TGA dengan septum ventrikular yang intak (TGA-IVS), atrium septal defect (ASD) sekundum L-R shunt, dan patent ductus arteriosus (PDA). Prosedur pembedahan meliputi ASO menggunakan manuver Le Compte, pemotongan PDA, ASD ditutup sebagian dan disisakan 3mm. Durasi cardiopulmonary bypass (CPB) 136 menit dengan cross clamp 85 menit, diberikan tranfusi PRC, FFP, dan TC, lalu dipindahkan ke intensive care unit (ICU) dengan support adrenalin 0.05 mcg/kg/menit dan milrinone 0.375 mcg/kg/menit. Ekstubasi dilakukan 72 jam pascaoperasi.Pembahasan: Operasi arterial switch merupakan tindakan berisiko tinggi, dengan angka kematian dan morbiditas yang tinggi. Konsiderasi perianestesia pada pasien TGA ini di antaranya tatalaksana preanestesi, manajemen selama operasi, topangan hemodinamik, aritmia yang diakibatkan masalah pembuluh darah koroner, dan penilaian ekokardiografi epikardial pascaoperasi. Manajemen pascaoperasi penting untuk mengantisipasi efek dari CPB yang berpengaruh pada miokardium, sindroma curah jantung rendah, risiko infeksi, dan komplikasi lain yang sering terjadi pada infant setelah pembedahan ini.Kesimpulan: Manajemen preoperatif dengan mengenali faktor risiko, tatalaksana anestesia intraoperatif, myocardial protection, serta perawatan komprehensif pascaoperasi di ICU sangat menentukan outcomepasien yang menjalani prosedur ini. 

scholarly journals Is arterial switch operation possible with neonatology-focused intensive care unit modality

2021 ◽  
Vol 29 (2) ◽  
pp. 136-142
Author(s):  
Onur Doyurgan ◽  
Fatih Özdemir ◽  
Osman Akdeniz ◽  
Ahmet Kuddusi İrdem ◽  
Nilüfer Matur Okur ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Arterial Switch Operation ◽  
Length Of Hospital Stay ◽  
Morbidity Rate ◽  
Median Length ◽  
Mortality And Morbidity ◽  
Arterial Switch ◽  
Switch Operation

Background: In this study, we aimed to examine the feasibility of arterial switch operation and its perioperative management with neonatology-focused intensive care modality in a region of Turkey where the birth rate and the number of asylum seekers who had to leave their country due to regional conflicts are high. Methods: Between December 2017 and June 2020, a total of 57 patients (48 males, 9 females; median age: 12.2 days; range, 2 to 50 days) who were diagnosed with transposition of the great arteries in our clinic and underwent arterial switch operation were retrospectively analyzed. All patients were followed by the neonatologist in the neonatal intensive care unit during the preoperative and postoperative period. Results: Thirty-eight (66.7%) patients had intact ventricular septum, 16 (28.1%) had ventricular septal defect, two (3.5%) had coarctation of the aorta, and one (1.7%) had Taussig-Bing anomaly. Coronary artery anomaly was present in 14 (24.5%) patients. The most common complications in the intensive care unit were renal failure requiring peritoneal dialysis in seven (12.3%) patients, supraventricular tachyarrhythmia in six (10.5%) patients, and eight (14%) patients left their chests open. The median length of stay in intensive care unit was 13.8 (range, 9 to 25) days and the median length of hospital stay was 24.5 (range, 16 to 47) days. The overall mortality rate for all patients was 12.3% (n=7). The median follow-up was 8.2 months. A pulmonary valve peak Doppler gradient of ≥36 mmHg was detected in five patients (8.7%) who were followed, and these patients were monitored by providing medical treatment. None of the patients needed reoperation or reintervention. Conclusion: We believe that arterial switch operation, one of the complex neonatal cardiac surgery, can be performed with an acceptable mortality and morbidity rate with the use of neonatology-focused intensive care modality, which is supported by pediatric cardiology and pediatric cardiac surgery.

scholarly journals Dying in the dark: sunshine, gender and outcomes in myocardial infarction

1998 ◽  
Vol 91 (7) ◽  
pp. 352-354 ◽  
Author(s):  
Kathleen M Beauchemin ◽  
Peter Hays
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Natural Experiment ◽  
Cardiac Patients ◽  
Psychiatric Unit ◽  
Cardiac Intensive Care Unit ◽  
Significant Difference ◽  
Cardiac Intensive Care

We report a natural experiment that took place in a cardiac intensive care unit (CICU). We had been alerted to the possibility that sunny rooms would be conducive to better outcomes by our findings in the psychiatric unit, and by reports that depressed cardiac patients did less well than those in normal mood. The 628 subjects were patients admitted directly to the CICU with a first attack of myocardial infarction (MI). Outcomes of those treated in sunny rooms and those treated in dull rooms were retrospectively compared for fatal outcomes and for length of stay in the CICU. Patients stayed a shorter time in the sunny rooms, but the significant difference was confined to women (2.3 days in sunny rooms, 3.3 days in dull rooms). Mortality in both sexes was consistently higher in dull rooms (39/335 dull, 21/293 sunny). We conclude that illumination may be relevant to outcome in MI, and that this natural experiment merits replication.

Understanding Excellence in Complex, Dynamic Medical Systems

2000 ◽  
Vol 44 (26) ◽  
pp. 136-139 ◽  
Author(s):  
Jane Carthey ◽  
Marc R. de Leval ◽  
James T. Reason
Keyword(s):  
Intensive Care Unit ◽  
Human Factors ◽  
Arterial Switch Operation ◽  
Medical Systems ◽  
Complex Dynamic ◽  
Cardiac Intensive Care Unit ◽  
Switch Operation ◽  
Oncology Ward ◽  
Cardiac Intensive Care ◽  
Human Factors Research

Human factors research in medicine typically focuses on understanding and controlling those factors which lead to adverse events. However, it is also important to understand the factors that lead to excellence in complex, dynamic medical systems so that clinicians can learn from ‘what goes right’ as well as ‘what goes wrong.’ This paper discusses the application of a framework of surgical excellence, developed from a multi-center UK study on human factors and the outcomes of the arterial switch operation (ASO), to other medical domains (cardiac intensive care unit and hematology/oncology ward).

scholarly journals Assessment of geriatrics outcomes in the cardiac intensive care unit

2021 ◽  
Vol 9 (39) ◽  
pp. 1-8
Author(s):  
Carly Fabrizio ◽  
Matthew Langston ◽  
Keshab Subedi ◽  
Neil Wimmer ◽  
Usman Choudhry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Skilled Nursing Facility ◽  
The Elderly ◽  
Cardiac Intensive Care Unit ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Cardiac Intensive Care

Objective: Critically ill older adults greater than or equal to 80 years old are routinely admitted to contemporary cardiac intensive care units (CICU). Little has been reported about their outcomes when compared to the general CICU population. The primary aim of this study was to compare the mortality, length-of-stay, and disposition outcomes of elderly patients (greater or equal to 80 years old) admitted to the CICU with a younger cohort (less than 80 years old). Methods and Results: A single-center, retrospective cohort study was conducted including 6,194 adult patients admitted to a cardiovascular intensive care unit in Newark, Delaware, from July 1, 2012, to June 30, 2019. Coronary intensive care unit (CICU) mortality, CICU length-of-stay and discharge disposition were compared between elderly patients (greater than or equal to 80 years old) and younger patients (less than 80 years old), adjusted for comorbidities. We observed increased mortality for elderly patients (OR 1.686, CI 1.361-2.090, p<0.001) compared with patients less than 80 years old, even after adjusting for comorbidities. Median length of stay was not statistically different between the two groups. However, the elderly patients were significantly more likely to be discharged to a facility, such as a skilled nursing facility, than those less than 80 years old (26.8% versus 12.5%, respectively, p<0.001). Conclusions: Among patients admitted to the CICU, elderly patients have higher mortality rates than those less than 80 years old. Advanced age (greater or equal to 80 years old) was not a reliable predictor of outcome in the CICU. A large proportion of elderly patients are not able to live independently at home after CICU admissions. Key Words: octogenarians, nonagenarians, cardiac intensive care unit, elderly, ICU mortality

Role of Sildenafil in the Treatment of Persistent Pulmonary Hypertension of Newborn (PPHN) - Should it Be Withdrawn from Market of Bangladesh due to Threat of being Misuses

2020 ◽  
Vol 35 (2) ◽  
pp. 100-104
Author(s):  
Maksudur Rahman ◽  
Mohammad Abdullah Al Mamun ◽  
MAK Azad Chowdhury ◽  
Abu Sayeed Munsi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cardiac Intensive Care Unit ◽  
Cross Sectional ◽  
Cardiac Intensive Care ◽  
Hospital Protocol

Background: Recently it has been apprehended that sildenafil, a drug which has been successfully using in the treatment of PPHN and erectile dysfunction in adult, is going to be withdrawn from the market of Bangladesh due to threat of its misuses. Objective: The aim of this study was to see the extent of uses of sildenafil in the treatment of PPHN and importance of availability of this drugs in the market inspite of its probable misuses. Methods: This cross sectional study was conducted in neonatal intensive care unit (NICU), special baby care unit (SCABU) and cardiac intensive care unit (CICU) of Dhaka Shishu (Children) Hospital from June, 2017 to May 2018. Neonates with PPHN were enrolled in the study. All cases were treated with oral sildenefil for PPHN along with others management according to hospital protocol. Data along with other parameters were collected and analyzed. Results: Total 320 patients with suspected PPHN were admitted during the study period. Among them 92 (29%) cases had PPHN. Male were 49(53 %) cases and female were 43(47%) cases. Mean age at hospital admission was 29.7±13.4 hours. Based on echocardiography,13(14%) cases had mild, 38 (41%) cases moderate and 41(45%) cases severe PPHN. Mean duration of sildenafil therapy was 11.9±7.1 days. Improved from PPHN were 83 (90%) cases. Mortality was 10% (9). Conclusion: In this study it was found that the incidence of PPHN is 29% among the suspected newborns. Sildenafil is successfull in improving the oxygenation of PPHN and to decrease the mortality of neonates. DS (Child) H J 2019; 35(2) : 100-104

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