Variability in the Physiologic Response to Fluid Bolus in Pediatric Patients Following Cardiac Surgery

2020 ◽  
Vol 48 (11) ◽  
pp. e1062-e1070
Author(s):  
Suchitra Ranjit ◽  
Rajeswari Natraj ◽  
Niranjan Kissoon ◽  
Ravi Thiagarajan ◽  
Balakrishnan Ramakrishnan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pediatric Patients ◽  
Fluid Bolus ◽  
Physiologic Response

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

Hemostatic Parameters and Platelet Activation Marker Expression in Cyanotic and Acyanotic Pediatric Patients Undergoing Cardiac Surgery in the Presence of Tranexamic Acid

2000 ◽  
Vol 83 (01) ◽  
pp. 54-59 ◽  
Author(s):  
Elena Levin ◽  
John Wu ◽  
John Alexander ◽  
Clayton Reichart ◽  
Suvro Sett ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Platelet Activation ◽  
Pediatric Patients ◽  
Factor Xiiia ◽  
Congenital Defects ◽  
Plasma Factor ◽  
Pai 1 ◽  
D Dimer

SummaryWe have investigated hemostatic parameters including platelet activation in 56 pediatric patients with or without cyanosis undergoing cardiopulmonary bypass (CPB) and cardiac surgery to repair congenital defects. Patients were participants in a study assessing the effects of tranexamic acid on surgery-related blood loss. Parameters monitored included blood loss, prothrombin F1.2, thrombin-antithrombin complexes, t-PA, PAI-1, plasminogen, fibrin D-dimer, and plasma factor XIII. Additionally, flow cytometry monitored platelet degranulation (P-selectin or CD63), as well as surface-bound fibrinogen, von Willebrand factor and factor XIIIa. Cyanotic patients had evidence of supranormal coagulation activation as both fibrin D-dimer and PAI-1 levels were elevated prior to surgery. While the extent of expression of Pselectin or CD63 was not informative, platelet-associated factor XIIIa was elevated in cyanotic patients at baseline. In both patient groups, CPB altered platelet activation state and coagulation status irrespective of the use of tranexamic acid.

scholarly journals N-terminal B-type natriuretic peptide levels in pediatric patients with congestive heart failure undergoing cardiac surgery

2008 ◽  
Vol 135 (1) ◽  
pp. 98-105 ◽  
Author(s):  
Rowan Walsh ◽  
Clark Boyer ◽  
Jared LaCorte ◽  
Vincent Parnell ◽  
Cristina Sison ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Surgery ◽  
Natriuretic Peptide ◽  
Pediatric Patients

The Efficacy of Tranexamic Acid Versus Placebo in Decreasing Blood Loss in Pediatric Patients Undergoing Repeat Cardiac Surgery

1997 ◽  
Vol 84 (5) ◽  
pp. 990-996 ◽  
Author(s):  
Robert W. Reid ◽  
A. Andrew Zimmerman ◽  
Peter C. Laussen ◽  
John E. Mayer ◽  
Jed B. Gorlin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Pediatric Patients ◽  
Acid Versus

scholarly journals Prolonged Central Venous Desaturation Measured by Continuous Oximetry Is Associated with Adverse Outcomes in Pediatric Cardiac Surgery

2011 ◽  
Vol 115 (5) ◽  
pp. 1033-1043 ◽  
Author(s):  
Ryan Crowley ◽  
Elizabeth Sanchez ◽  
Jonathan K. Ho ◽  
Kate J. Lee ◽  
Johanna Schwarzenberger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Adverse Outcomes ◽  
Central Venous ◽  
Major Adverse Events

Background The role of continuous central venous oxygen saturation (ScvO₂) oximetry during pediatric cardiac surgery for predicting adverse outcomes is not known. Using a recently available continuous ScvO₂ oximetry catheter, we examined the association between venous oxygen desaturations and patient outcomes. We hypothesized that central venous oxygen desaturations are associated with adverse clinical outcomes. Methods Fifty-four pediatric patients undergoing cardiac surgery were prospectively enrolled in an unblinded observational study. ScvO₂ was measured continuously in the operating room and for up to 24 h post-Intensive Care Unit admission. The relationships between ScvO₂ desaturations, clinical outcomes, and major adverse events were determined. Results More than 18 min of venous saturations less than 40% were associated with major adverse events with 100% sensitivity and 97.6% specificity. Significant correlations resulted between the ScvO₂ area under the curve less than 40% and creatinine clearance at 12 h in the Intensive Care Unit (r = -0.58), Intensive Care Unit length of stay (r = 0.56), max inotrope use (r = 0.52), inotrope use at 24 h (r = 0.40), inotrope index score (r = 0.39), hospital length of stay (r = 0.36), and length of intubation (r = 0.32). Conclusions We demonstrate that ScvO₂ desaturations by continuous oximetry are associated with major adverse events in pediatric patients undergoing cardiac surgery. The most significant associations with major adverse events are seen in patients with greater than 18 min of central venous saturations less than 40%. Our results support the further investigation of ScvO₂ as a potential target parameter in high-risk pediatric patients to minimize the risk of major adverse events.

scholarly journals Association Between Early Postoperative Acetaminophen Exposure and Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery

2018 ◽  
Vol 172 (7) ◽  
pp. 655 ◽  
Author(s):  
Sara L. Van Driest ◽  
Edmund H. Jooste ◽  
Yaping Shi ◽  
Leena Choi ◽  
Leon Darghosian ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Pediatric Patients ◽  
Kidney Injury

Mobile extracorporeal membrane oxygenation for children: single-center 10 years’ experience

Perfusion ◽  
2019 ◽  
Vol 34 (5) ◽  
pp. 384-391 ◽  
Author(s):  
Virginie Fouilloux ◽  
Célia Gran ◽  
Olivier Ghez ◽  
Caroline Chenu ◽  
Fedoua El Louali ◽  
...  
Keyword(s):  
Adverse Event ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Gold Standard ◽  
Pediatric Patients ◽  
Air Transport ◽  
Single Center ◽  
Reference Center ◽  
Membrane Oxygenation ◽  
Experienced Team

Objectives: Extracorporeal membrane oxygenation has become a gold standard in treatment of severe refractory circulatory and/or pulmonary failure. Those procedures require gathering of competences and material. Therefore, they are conducted in a limited number of reference centers. Emergent need for such treatments induces either hazardous transfers or a mobile pediatric extracorporeal membrane oxygenation team able to remote implantation and transportation. The aim of this work is not to focus on pediatric extracorporeal membrane oxygenation outcomes or indications, which have been extensively discussed in the literature. This study would like to detail the implementation, safety, and feasibility, even in a middle-size pediatric cardiac surgery reference center. Patients: This is a retrospective analysis of a series of patients initiated on extracorporeal membrane oxygenation in a peripheral center and transferred to a reference center. The data were collected from 10 consecutive years: from 2006 to 2016. Results: A total of 57 pediatric patients with a median weight of 6.00 (3.2-14.5) kg and median age of 2.89 (0.11-37.63) months were cannulated in peripheral center and transported on extracorporeal membrane oxygenation. We did not experience any adverse event during transport. The outcomes were comparable to our literature-reported on-site extracorporeal membrane oxygenation series with 42 patients (74%) weaned from extracorporeal membrane oxygenation and a 30-day survival of 60%. Neither patient’s age nor weight, indication for extracorporeal membrane oxygenation or length of transport, was statistically significant in terms of outcomes. Conclusion: Offsite extracorporeal membrane oxygenation implantation and ground or air transport for pediatric patients on extracorporeal membrane oxygenation appeared to be safe when performed by a dedicated and experienced team, even within a mid-size center.

Fluid Overload Is Associated With Higher Mortality and Morbidity in Pediatric Patients Undergoing Cardiac Surgery*

2016 ◽  
Vol 17 (4) ◽  
pp. 307-314 ◽  
Author(s):  
Daniel J. Lex ◽  
Roland Tóth ◽  
Nikoletta R. Czobor ◽  
Stephen I. Alexander ◽  
Tamás Breuer ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Pediatric Patients ◽  
Fluid Overload ◽  
Mortality And Morbidity
Sign in / Sign up

Export Citation Format

Share Document