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

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.

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Perioperative management and considerations in pediatric patients with connective tissue disorders undergoing cardiac surgery

Pediatric Anesthesia ◽

10.1111/pan.14196 ◽

2021 ◽

Author(s):

Jessica A. Berger ◽

Dana D. Huh ◽

Teresa Lee ◽

Rajeev S. Wadia ◽

Melania M. Bembea ◽

...

Keyword(s):

Cardiac Surgery ◽

Connective Tissue ◽

Pediatric Patients ◽

Perioperative Management ◽

Connective Tissue Disorders

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The feasibility of measurement of different right ventricular systolic function parameters by intraoperative trans-esophageal echocardiography and their interchangeability with transthoracic echocardiography in pediatric patients undergoing cardiac surgery- interim results from an ongoing study

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2020.09.007 ◽

2020 ◽

Vol 34 ◽

pp. S5

Author(s):

I. Biswas ◽

G.D. Puri ◽

S. Negi ◽

G.K. Munirathinam

Keyword(s):

Cardiac Surgery ◽

Right Ventricular ◽

Transthoracic Echocardiography ◽

Pediatric Patients ◽

Systolic Function ◽

Ongoing Study ◽

Ventricular Systolic Function ◽

Right Ventricular Systolic Function

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Higher total ultrafiltration volume during cardiopulmonary bypass-assisted infant cardiac surgery is associated with acute kidney injury and fluid overload

Pediatric Nephrology ◽

10.1007/s00467-021-04976-2 ◽

2021 ◽

Author(s):

Dominic Zanaboni ◽

Jungwon Min ◽

Roopa Seshadri ◽

J. William Gaynor ◽

Molly Dreher ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Fluid Overload ◽

Kidney Injury

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Smartphone-Based Prediction Model for Postoperative Cardiac Surgery Outcomes Using Preoperative Gait and Posture Measures

Sensors ◽

10.3390/s21051704 ◽

2021 ◽

Vol 21 (5) ◽

pp. 1704

Author(s):

Rahul Soangra ◽

Thurmon Lockhart

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Cardiac Surgery ◽

Regression Model ◽

Mobile Phone ◽

Gait Speed ◽

Adverse Outcomes ◽

Postoperative Outcomes ◽

Mortality And Morbidity ◽

Prediction Of Mortality

Gait speed assessment increases the predictive value of mortality and morbidity following older adults’ cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were recruited for this study. As per the Society of Thoracic Surgeons (STS) recommendation guidelines, eight of the cardiovascular disease (CVD) patients were classified as frail (prone to adverse outcomes with gait speed ≤ 0.833 m/s) and the remaining eight patients as non-frail (gait speed > 0.833 m/s). Treating physicians and patients were blinded to gait and posture assessment results not to influence the decision to proceed with surgery or postoperative management. Follow-ups regarding patient outcomes were continued until patients were discharged or transferred from the hospital, at which time data regarding outcomes were extracted from the records. In the preoperative setting, patients performed the 5-m walk and stand still for 30 s in the clinic while wearing a mobile phone with a customized app “Lockhart Monitor” available at iOS App Store. Systematic evaluations of different gait and posture measures identified a subset of smartphone measures most sensitive to differences in two groups (frail versus non-frail) with adverse postoperative outcomes (morbidity/mortality). A regression model based on these smartphone measures tested positive on five CVD patients. Thus, clinical settings can readily utilize mobile technology, and the proposed regression model can predict adverse postoperative outcomes such as morbidity or mortality events.

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Complete blood cell count risk score as a predictor of in-hospital mortality and morbidity among patients undergoing cardiac surgery with cardiopulmonary bypass

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.03.227 ◽

2015 ◽

Vol 187 ◽

pp. 60-62 ◽

Cited By ~ 1

Author(s):

Ana Paula Porto Rödel ◽

Manuela Borges Sangoi ◽

Larissa Garcia de Paiva ◽

Jossana Parcianello ◽

José Edson Paz da Silva ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Blood Cell ◽

Hospital Mortality ◽

Cell Count ◽

Risk Score ◽

Complete Blood Cell Count ◽

Blood Cell Count ◽

Mortality And Morbidity

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

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613757 ◽

2000 ◽

Vol 83 (01) ◽

pp. 54-59 ◽

Cited By ~ 49

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.

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