Abstract 17199: Airway Mucociliary Clearance is Impaired After Infant Congenital Cardiac Surgery

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Phillip S Adams ◽  
Timothy Corcoran ◽  
Michael Czachowski ◽  
Al Saville ◽  
Ivy Lin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Period ◽  
Mucociliary Clearance ◽  
Sulfur Colloid ◽  
Congenital Cardiac Surgery ◽  
Icu Length Of Stay ◽  
Quantitative Measurements ◽  
First Time ◽  
Ciliary Dyskinesia ◽  
Postoperative Pulmonary Dysfunction

Introduction: A link between congenital heart disease and airway ciliary dyskinesia has been identified. Postoperative pulmonary dysfunction is highly prevalent after cardiac surgery and contributes to morbidity, mortality, and healthcare costs. We hypothesized that respiratory mucociliary clearance (MCC) would be impaired in the immediate postoperative period after infant congenital cardiac surgery. Methods: 41 infants from 5-254 days old underwent MCC scans using nebulized technetium-99m sulfur colloid either immediate postoperative or later postoperative periods after congenital cardiac surgery. Physiologic variables and medications at the time of scan were recorded. Results: There was no significant correlation between MCC and age, gender, race or any of the of the physiologic variables, such as temperature, SpO2, or FiO2, at the time of the MCC scan. MCC was lowest on the first 2 postoperative days, increased at days 3-7, and highest beyond postoperative day 7 (Fig1). Fentanyl (p=0.023) and paralytics agents (p=0.018) were significantly associated with lower MCC, while benzodiazepines (p=0.447) and dexmedetomidine (p=0.675) showed no measurable impact (Table 1). Conclusion: We show for the first time, with quantitative measurements, the near absence of infant MCC in the immediate postoperative period after congenital cardiac surgery. This may be exacerbated by opioid exposure, which should be minimized. Our results further suggest sedative alternatives such as benzodiazepines and dexmedetomidine are preferable to help optimize infant airway clearance. This may reduce ICU length of stay and improve outcomes after cardiac surgery.

scholarly journals Will New Approaches in The Treatment of Supraventricular Tachycardia Affect The Cardiologists’ Perspective?

2019 ◽  
Vol 2 (2) ◽  
pp. 01-01
Author(s):  
Cetin Sanlialp Sara
Keyword(s):  
Cardiac Surgery ◽  
Supraventricular Tachycardia ◽  
Postoperative Period ◽  
Common Type ◽  
Supraventricular Arrhythmias ◽  
Junctional Ectopic Tachycardia ◽  
Congenital Cardiac Surgery ◽  
Congenital Form ◽  
New Approaches

Junctional ectopic tachycardia(JET) is one of the rare supraventricular arrhythmias(1). JET is categorized by two types. The less common type of JET is congenital form and the more common type has been seen in postoperative period of congenital cardiac surgery

scholarly journals Mucociliary Clearance Scans Show Infants Undergoing Congenital Cardiac Surgery Have Poor Airway Clearance Function

2021 ◽  
Vol 8 ◽  
Author(s):  
Phillip S. Adams ◽  
Timothy E. Corcoran ◽  
Jiuann-Huey Lin ◽  
Daniel J. Weiner ◽  
Joan Sanchez-de-Toledo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Gamma Camera ◽  
Clinical Decision Making ◽  
Mucociliary Clearance ◽  
Positive Pressure ◽  
Study Objective ◽  
Congenital Cardiac Surgery ◽  
Airway Clearance ◽  
Post Operative Period

Background: Infants undergoing congenital cardiac surgery with cardiopulmonary bypass are at high risk for respiratory complications. As impaired airway mucociliary clearance (MCC) can potentially contribute to pulmonary morbidity, our study objective was to measure airway clearance in infants undergoing congenital cardiac surgery and examine correlation with clinical covariables that may impair airway clearance function.Materials and Methods: Airway clearance in infants was measured over 30 min using inhaled nebulized Technetium 99m sulfur colloid administered either via a nasal cannula or the endotracheal tube in intubated infants. This was conducted bedside with a portable gamma camera. No difficulty was encountered in positioning the gamma camera over the patient, and neither the camera nor the MCC scan interfered with routine medical care or caused any adverse events. Patient and perioperative variables were examined relative to the MCC measurements.Results: We prospectively enrolled 57 infants undergoing congenital cardiac surgery and conducted a single MCC scan per patient. MCC data from 42 patients were analyzable, including five pre-operative, 15 (40.5%) in the immediate post-operative period (days 1–2), and 22 (59.5%) were later post-operative (≥3 days). Pre-operative MCC was inversely proportional to days requiring post-operative mechanical ventilation (p = 0.006) and non-invasive positive pressure ventilation (p = 0.017). MCC was higher at later post-operative days (p = 0.002) with immediate post-operative MCC being lower (3%; 0–13%) than either pre-operative (21%; 4–25%) (p = 0.091) or later post-operative MCC (18%; 0–29%) (p = 0.054). Among the infants with low post-operative MCC, significantly more were pre-mature [5/19 (26%) vs. 0/18 (0%); p = 0.046], were intubated [14/19 (75%) vs. only 7/18 (39%); p = 0.033] and were receiving higher FiO2 (40%, 27–47% vs. 26%, 21–37%; p = 0.015).Conclusions: This is the first study to show that infants undergoing congenital cardiac surgery have impaired MCC. MCC appeared lowest in the immediate post-operative period. Worse MCC was associated with pre-maturity, mechanical ventilation, or receiving higher FiO2. These findings suggest MCC scans should be further explored for informing clinical decision making to improve post-surgical respiratory outcomes. The possible therapeutic benefit of airway clearance maneuvers for infants with poor MCC function should also be investigated.

Application of robotics in congenital cardiac surgery

2003 ◽  
Vol 6 (1) ◽  
pp. 72-83 ◽  
Author(s):  
Jeremy W. Cannon ◽  
Robert D. Howe ◽  
Pierre E. Dupont ◽  
John K. Triedman ◽  
Gerald R. Marx ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Congenital Cardiac Surgery

Recent Advances in Congenital Cardiac Surgery

1988 ◽  
Vol 15 (3) ◽  
pp. 713-719 ◽  
Author(s):  
William I. Norwood ◽  
John D. Pigott
Keyword(s):  
Cardiac Surgery ◽  
Congenital Cardiac Surgery ◽  
Recent Advances
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