Cardiac Disease in Pediatric Intensive Care

2017 ◽  
Author(s):  
Vamsi V. Yarlagadda ◽  
Ravi R. Thiagarajan
Keyword(s):  
Cardiac Output ◽  
Intensive Care ◽  
Cardiac Disease ◽  
Single Ventricle ◽  
Heart Defects ◽  
Viral Myocarditis ◽  
Pediatric Intensive Care ◽  
Low Cardiac Output Syndrome ◽  
Essential Information ◽  
Key Aspects

This chapter on cardiac disease in pediatric intensive care provides essential information on cardiovascular physiology, how to assess cardiovascular and hemodynamic status, and principles of treatment of congenital and acquired cardiac disease in children. The review of physiology includes definitions of preload, afterload, oxygen content, cardiac output, vascular resistance, blood pressure, and cardiopulmonary interactions. Formulas to calculate key parameters are provided. The authors also summarize the presentation and care of most common cyanotic and acyanotic congenital heart defects, including treatment of low cardiac output syndrome, clinical sequelae of cardiopulmonary bypass, and the key aspects of treating pre- and postoperative patients with single-ventricle lesions (e.g., hypoplastic left heart syndrome). All three stages of single-ventricle palliation are discussed, with management summaries of children undergoing the Norwood, bidirectional Glenn, and Fontan operations. Finally, the chapter includes a discussion of the clinical presentation and management of viral myocarditis and cardiomyopathy.

Abstract 285: Resuscitation Practices of Cardiac Arrest in Children with Cardiac Disease in Cardiac Intensive Care Units Compared to Pediatric Intensive Care Units

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Tanya Perry ◽  
Tia T Raymond ◽  
Joanna Fishbein ◽  
Michael G Gaies ◽  
Todd Sweberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Cardiac Disease ◽  
Univariate Analysis ◽  
Pediatric Intensive Care ◽  
Heart Association ◽  
Pediatric Intensive Care Units ◽  
Achievement Measures ◽  
Cardiac Intensive Care

Introduction: Hospitalized children with critical cardiac disease experience cardiac arrest more than any other disease type. Varying models are devoted to caring for this population, including pediatric intensive care units (PICU) and dedicated cardiac intensive care units (CICU). The process of CPR delivery has not been evaluated in CICUs in comparison to PICUs. Hypothesis: There will be no difference in cardiac arrest resuscitation practices between unit types. Methods: We analyzed patients <18 years from the American Heart Association Get with the Guidelines-Resuscitation database (GWTG-R) with an illness category of medical or surgical cardiac disease who received CPR in a CICU or PICU from 2014 to 2018. Events were assessed for compliance with GWTG-R achievement measures of time to first chest compressions ≤ 1 minute, time to IV/IO epinephrine ≤ 5 minutes, time to first shock ≤ 2 minutes for VF/pulseless VT first documented rhythm, and confirmation of endotracheal tube (ETT) placement in trachea. Results: CPR practices were evaluated on 866 patients, 687 CICU and 179 PICU (55% male and 65% neonatal). Surgical cardiac disease was present in 56%. Cardiac malformations were present in 81% (45% cyanotic 29% acyanotic). Pulseless arrest was the initial event in 41% with a shockable rhythm in 14%. Return of spontaneous circulation occurred in 86% and survival to hospital discharge in 58%. Univariate analysis comparing resuscitation practice is shown in Table 1. ECPR use was the only variable noted to be significantly different between units (CICU 22% vs PICU 6%, P<0.01). On multivariate analysis, there were no differences in GWTG-R achievement measures between ICU types for ETT placement confirmation, time to IV/IO epinephrine dose, time to first chest compression to first shock (P>0.05). Conclusion: Despite differences in infrastructure, process, and provider expertise, there were no differences in cardiac arrest resuscitation practice between CICUs and PICUs.

Acquired Cardiac Disease in the Pediatric Intensive Care Unit

2018 ◽  
Vol 47 (7) ◽  
pp. e280-e285
Author(s):  
Kieran Leong ◽  
Jason M. Kane ◽  
Brian F. Joy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Cardiac Disease ◽  
Pediatric Intensive Care

scholarly journals Interest of Monitoring Diaphragmatic Electrical Activity in the Pediatric Intensive Care Unit

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Laurence Ducharme-Crevier ◽  
Geneviève Du Pont-Thibodeau ◽  
Guillaume Emeriaud
Keyword(s):  
Intensive Care ◽  
Electrical Activity ◽  
Care Setting ◽  
Pediatric Intensive Care ◽  
Neurally Adjusted Ventilatory Assist ◽  
Tonic Activity ◽  
Intensive Care Setting ◽  
Essential Information ◽  
Ventilatory Capacity ◽  
Potential Benefits

The monitoring of electrical activity of the diaphragm (EAdi) is a new minimally invasive bedside technology that was developed for the neurally adjusted ventilatory assist (NAVA) mode of ventilation. In addition to its role in NAVA ventilation, this technology provides the clinician with previously unavailable and essential information on diaphragm activity. In this paper, we review the clinical interests of EAdi in the pediatric intensive care setting. Firstly, the monitoring of EAdi allows the clinician to tailor the ventilatory settings on an individual basis, avoiding frequent overassistance leading potentially to diaphragmatic atrophy. Increased inspiratory EAdi levels can also suggest insufficient support, while a strong tonic activity may reflect the patient efforts to increase its lung volume. EAdi monitoring also allows detection of patient-ventilator asynchrony. It can play a role in evaluation of extubation readiness. Finally, EAdi monitoring provides the clinician with better understanding of the ventilatory capacity of patients with acute neuromuscular disease. Further studies are warranted to evaluate the clinical impact of these potential benefits.

scholarly journals International Survey on the Use of Arginine Vasopressin in the Postoperative Management of Single Ventricle Patients

2021 ◽  
Vol 9 ◽  
Author(s):  
Vidya R. Raghavan ◽  
Eduardo M. da Cruz ◽  
Jon Kaufman ◽  
Suzanne Osorio Lujan
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Arginine Vasopressin ◽  
Single Ventricle ◽  
Pediatric Intensive Care ◽  
Postoperative Management ◽  
International Survey ◽  
Pediatric Intensive Care Units ◽  
Single Ventricle Physiology ◽  
Surgical Palliation

Management of patients with single ventricle physiology after surgical palliation is challenging. Arginine vasopressin has gained popularity in recent years as a non-catecholamine vasoactive medication due to its unique properties. However, data regarding its use in the pediatric population is limited. Therefore, we designed a survey to explore whether and how clinicians use this medication in intensive care units for the postoperative management of single ventricle patients. This international survey aimed to assess usage, practices, and concepts related to arginine vasopressin in pediatric intensive care units worldwide. Directors of pediatric intensive care units who are members of the following international professional societies: European Society of Pediatric Neonatal Intensive Care, Association for European Pediatric and Congenital Cardiology, and Pediatric Cardiac Intensive Care Society were invited to participate in this survey. Of the 62 intensive care unit directors who responded, nearly half use arginine vasopressin in the postoperative management of neonatal single ventricle patients, and 90% also use the drug in subsequent surgical palliation. The primary indications are vasoplegia, hemodynamic instability, and refractory shock, although it is still considered a second-line medication. Conceptual benefits include improved hemodynamics and end-organ perfusion and decreased incidence of low cardiac output syndrome. Those practitioners who do not use arginine vasopressin cite lack of availability, fear of potential adverse effects, unclear indication for use, and lack of evidence suggesting improved outcomes. Both users and non-users described increased myocardial afterload and extreme vasoconstriction as potential disadvantages of the medication. Despite the lack of conclusive data demonstrating enhanced clinical outcomes, our study found arginine vasopressin is used widely in the care of infants and children with single ventricle physiology after the first stage and subsequent palliative surgeries. While many intensive care units use this medication, few had protocols, offering an area for further growth and development.

Toxicological Emergencies

2017 ◽  
Author(s):  
Sandra D. W. Buttram ◽  
Anne-Michelle Ruha
Keyword(s):  
Intensive Care Unit ◽  
Carbon Monoxide ◽  
Intensive Care ◽  
Tricyclic Antidepressants ◽  
Clinical Presentation ◽  
Pediatric Intensive Care ◽  
Intensive Care Unit Care ◽  
Calcium Channel Antagonists ◽  
Essential Information ◽  
Cardiovascular Medications

This chapter includes essential information about common toxic exposures requiring pediatric intensive care unit care. Specific agents, grouped into categories, are reviewed, including analgesics (acetaminophen and aspirin), opiates, carbon monoxide, cardiovascular medications (calcium channel antagonists and β‎ blockers), tricyclic antidepressants, sulfonylureas, and toxic alcohols. An overview of each agent followed by clinical presentation, and appropriate diagnostic evaluation and management are provided, including alkalinization with administration of sodium bicarbonate, need for hemodialysis, and use of specific antidotes (e.g., naloxone, n-acetyl cysteine, glucagon, fomepizole).

Sedation and Analgesia

2017 ◽  
Author(s):  
Iskra I. Ivanova ◽  
Lynn D. Martin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care ◽  
Neuromuscular Blocking ◽  
Muscle Relaxants ◽  
Neuromuscular Blocking Agents ◽  
Essential Information ◽  
Sedation And Analgesia ◽  
American Society ◽  
American Society Of Anesthesiologists

This chapter on sedation and analgesia provides essential information on how to achieve and monitor the comfort of patients safely in the pediatric intensive care unit. Included is succinct information about dosing, pharmacodynamics, and pharmacokinetics of benzodiazepines, opiates, and other sedatives (propofol, etomidate, ketamine, dexmedetomidine, and nonsteroidal anti-inflammatory agents), as well as the antagonists naloxone and flumazenil. Information is also provided about the use and dosage of both depolarizing and nondepolarizing neuromuscular blocking agents (muscle relaxants) and American Society of Anesthesiologists guidelines for fasting (i.e., nothing by mouth) times before elective endotracheal intubation. The chapter also includes key information regarding the recognition and treatment of malignant hyperthermia.

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