Does interatrial communication affect post-operative course of children undergoing tetralogy of Fallot repair? Single centre retrospective cohort study: propensity score matching

2021 ◽  
pp. 1-6
Author(s):  
Mohamed S. Kabbani ◽  
Abdulraouf Jijeh ◽  
Obayda M. Diraneyya ◽  
Fatimah A. Basakran ◽  
Najla S. Bin Sabbar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Right Ventricle ◽  
Tetralogy Of Fallot ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Interatrial Communication ◽  
Ventilation Time ◽  
Restrictive Physiology ◽  
Tetralogy Of Fallot Repair

Abstract Introduction: During tetralogy of Fallot repair, leaving or even create an interatrial communication may facilitate post-operative course particularly with right ventricle restrictive physiology. The aim of our study is to assess the influence of atrial communication on post-operative course of tetralogy of Fallot repair. Methods: Retrospectively, we studied all children who had tetralogy of Fallot repair (2003–2018). We divided them into two groups: tetralogy of Fallot repair with interatrial communication (TOFASD) group and tetralogy of Fallot repair with intact atrial septum (TOFIAS) group. We performed propensity match score for specific pre- or intra-operative variables and compared groups for post-operative outcome variables. Secondarily, we looked for right ventricle restrictive physiology incidence and influence of early repair performed before 3 months of age on post-operative course. Results: One hundred and sixty children underwent tetralogy of Fallot repair including (93) cases of TOFIAS (58%) and (67) cases of TOFASD (42%). With propensity matching score, 52 patients from each group were compared. Post-operative course was indifferent in term of positive pressure ventilation time, vasoactive inotropic score, creatinine and lactic acid levels, duration and amount of chest drainage and length of intensive care unit and hospital stay. Right ventricle restrictive physiology occurred in 38% of patients with no effects on outcome. 12/104 patients (12%) with early repair needed longer pressure ventilation time (p = 0.003) and intensive care unit stay (p = 0.02). Conclusion: Leaving interatrial communication in tetralogy of Fallot repair did not affect post-operative course. As well, right ventricle restrictive physiology did not affect post-operative course. Infants undergoing early tetralogy of Fallot repair may require longer duration of positive pressure ventilation time and intensive care unit stay.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

Noninvasive Ventilation to Facilitate Extubation in a Pediatric Intensive Care Unit

2000 ◽  
Vol 15 (2) ◽  
pp. 99-103 ◽  
Author(s):  
John F. Pope ◽  
David J. Birnkrant
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Pediatric Patients ◽  
Positive Pressure Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pediatric Intensive Care ◽  
Positive Pressure ◽  
Chronic Respiratory Insufficiency

Noninvasive ventilation has been used extensively to treat chronic respiratory failure associated with neuromuscular and other restrictive thoracic diseases, and is also effective in the treatment of acute respiratory failure, allowing some patients to avoid intubation. Noninvasive positive pressure ventilation is a potentially effective way to transition selected patients off endotracheal mechanical ventilation. The authors present a retrospective chart review of pediatric patients extubated with the use of noninvasive ventilation. Extubation with noninvasive positive pressure ventilation was attempted in 25 patients. The patients had a variety of diagnoses, including neuromuscular diseases, cerebral palsy with chronic respiratory insufficiency, asthma, and acute respiratory distress syndrome (ARDS), reflecting the diversity of patients with respiratory failure seen in our pediatric intensive care unit (ICU). Indications for noninvasive ventilation-assisted extubation were chronic respiratory insufficiency, clinical evidence the patient was falling extubation, or failure of a previous attempt to extubate. Extubation was successfully facilitated in 20 of 25 patients. Of the five patients failing an initial attempt at noninvasive ventilation-assisted extubation, two required tracheostomy, two were subsequently extubated with the aid of noninvasive ventilation, and one was subsequently extubated without the use of noninvasive ventilation. Risk factors for failure to successfully extubate with the assistance of noninvasive positive pressure ventilation included the patient's inability to manage respiratory tract secretions, severe upper airway obstruction, impaired mental status, and ineffective cough with mucus plugging of the large airways. AU patients had mild to moderate skin irritation due to the mask interface. No patient had any serious or long-term adverse effect of noninvasive positive pressure ventilation. All patients left the hospital alive. Noninvasive positive pressure ventilation can facilitate endotracheal extubation in pediatric patients with diverse diagnoses who have failed or who are at risk of failing extubation, including those with neuromuscular weakness.

scholarly journals Control of cross-infection in an intensive care unit

1969 ◽  
Vol 67 (3) ◽  
pp. 525-532 ◽  
Author(s):  
D. M. Harris ◽  
J. M. Orwin ◽  
J. Colquhoun ◽  
H. G. Schroeder
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Positive Pressure Ventilation ◽  
Intensive Therapy ◽  
Intermittent Positive Pressure Ventilation ◽  
Cross Infection ◽  
Positive Pressure ◽  
Intensive Therapy Unit ◽  
And Staphylococcus Aureus

SUMMARYIn a survey undertaken in an intensive care unit, coliform bacilli were found to be responsible for most infections,Pseudomonas aeruginosaand Staphylococcus aureus being isolated much less frequently. Tracheostomy or endotracheal intubation predisposed to infection, but in our experience intermittent positive pressure ventilation did not significantly affect its incidence. Little cross-infection has occurred, and it has never been possible to incriminate the ventilators in its transmission.We gratefully acknowledge the assistance we have received from colleagues in the Intensive Therapy Unit and the Department of Bacteriology during the course of this investigation.

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