Diaphragmatic palsy after cardiac surgery in adult and pediatric patients

2019 ◽  
Vol 27 (6) ◽  
pp. 481-485 ◽  
Author(s):  
Khalid Ebrahim Al-Ebrahim ◽  
Ahmed Abdelrahman Elassal ◽  
Osama Saber Eldib ◽  
Ahmed Hassan Abdelsalam Abdalla ◽  
Amr Ragab Abdelaty Allam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Diaphragmatic Paralysis ◽  
Low Cardiac Output ◽  
Diaphragmatic Palsy ◽  
Median Period ◽  
Adults And Children ◽  
One Year

Background Important differences in the mechanism of respiration between adults and children warrant distinction in the management of diaphragmatic paralysis as a complication of cardiac surgery. We describe the management and outcomes of this complication in both groups. Methods We retrospectively analyzed 16 patients (5 adults and 11 children) with diaphragmatic paralysis after cardiac surgery performed between 2008 and 2018. Clinical examination, chest radiography, and confirmation with fluoroscopy in selected cases were our modalities of diagnosis. All adults were managed conservatively, whereas plication was performed in all children. Results The incidence of diaphragmatic paralysis was 0.98% in pediatric patients and 0.43% in adults. The mean age was 2.33 ± 2.59 years in children and 53.2 ± 17.99 years in adults. All adults were symptomatic. All children showed difficulty in weaning from mechanical ventilation after cardiac surgery. The period of mechanical ventilation before plication was 2–6 days (median 4 days). Death occurred as a result of low cardiac output in a 10-year-old boy, and due to respiratory failure in a 30-year-old woman. Children were successfully weaned from mechanical ventilation after diaphragmatic plication. The median time to extubation after plication was 2.5 days (range 1–13 days). The median period of recovery in adults was 52 days (range 32–85 days). All survivors had acceptable outcomes at 6 months to one year. Conclusion Conservative management in adults and early plication in children are viable treatment options for diaphragmatic palsy after cardiac surgery, with acceptable outcomes.

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.

scholarly journals COVID-19, Various Treatment Options and Special Considerations for Dentistry

2020 ◽  
pp. 70-76
Author(s):  
Smita Singh Bhardwaj ◽  
Sami Alduwayhi ◽  
Atul Bhardwaj
Keyword(s):  
Health Professionals ◽  
Pediatric Patients ◽  
Dental Treatment ◽  
Clinical Symptoms ◽  
Treatment Options ◽  
Treatment Protocol ◽  
Health Concerns ◽  
Dental Clinics ◽  
The World ◽  
Adults And Children

Objective: The aim of this article is to analyze the epidemiology of COVID-19, comparison of routes of transmission in children and adults, comparing the clinical symptoms in adults and children, treatment protocol to be followed and possible treatment options during this pandemic. Data Sources: Data is collected from Pubmed, Medline and Embase databases. Discussion from Previous References Used: Few studies have been done to analyze its effect on children comparing the symptoms of adults and children. Also very less work is done to analyze the special precautions taken while doing dental treatment during this pandemic. Conclusion: The widespread effect of Coronavirus (COVID-19) or SARS-CoV-2 has created health concerns in the world. Although efforts have been taken to control the disease, it is still increasing due to the community spread. Health professionals may get patients in their practice with this infection and should prevent its spread. Clinical Significance of this Article: It will help us to differentiate the specific clinical symptoms of adult and pediatric patients coming to dental clinics and the special considerations for them including the emergency dental treatment during COVID-19.

Exotropia in Pediatric Patients

2016 ◽  
pp. 13-23
Keyword(s):  
Clinical Characteristics ◽  
Chart Review ◽  
Pediatric Patients ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Primary Reason ◽  
Average Deviation ◽  
Hyperactivity Disorder ◽  
One Year ◽  
Systemic Condition

Purpose: The purpose of this study is to determine the clinical characteristics of pediatric (under age 13) patients with exotropia in terms of deviation magnitude, frequency, associated systemic and ocular conditions, and treatment options. Methods: A retrospective chart review of pediatric patients with the diagnosis of exotropia, examined in the ophthalmology department of a children’s hospital over a one year period, was conducted. Results: The yield was 787 charts, of which 403 had complete data. The primary reason for examination was eye turn noted (68%). The most common systemic condition associated with exotropia with was attention deficit/hyperactivity disorder (4%) and the most common ocular condition was retinopathy of prematurity (3%). The average deviation was 18.6 prism diopters at distance and 14.9 prism diopters at near. The majority of cases were managed by observation, followed by patching and surgery. Conclusions: Exotropia is a binocular condition that may exist in isolation or in association with systemic conditions. Most cases in this study involved intermittent deviations. Further studies, including longer periods of observation and treatment are needed to determine the natural course and most appropriate clinical management.

Antiarrhythmics, Inotropes, and Vasopressors

2015 ◽  
pp. 237-252
Author(s):  
Bethany R. Tellor ◽  
Keki R. Balsara
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Cardiac Surgery ◽  
Clinical Management ◽  
Treatment Options ◽  
Relevant Literature ◽  
Mechanisms Of Action ◽  
Cardiothoracic Surgery ◽  
Low Cardiac Output ◽  
Surgery Patient

Arrhythmias, low cardiac output syndromes, and low blood pressure are commonly faced complications in the cardiothoracic surgery patient. In order to provide appropriate clinical management, one must identify underlying etiologies while recognizing and understanding available treatment options. The objective of this chapter is to review common agents utilized to manage arrhythmias and maintain hemodynamic stability following cardiac surgery. Mechanisms of action, key clinical pearls and relevant literature pertaining to each agent will be discussed.

scholarly journals Highlights from the Respiratory Failure and Mechanical Ventilation 2020 Conference

2021 ◽  
Vol 7 (1) ◽  
pp. 00752-2020
Author(s):  
Adelaide Withers ◽  
Tiffany Choi Ching Man ◽  
Rebecca D'Cruz ◽  
Heder de Vries ◽  
Christoph Fisser ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Patient Selection ◽  
Treatment Options ◽  
Early Career ◽  
European Respiratory Society ◽  
Diagnostic Strategies ◽  
Adults And Children ◽  
International Experts

The Respiratory Intensive Care Assembly of the European Respiratory Society organised the first Respiratory Failure and Mechanical Ventilation Conference in Berlin in February 2020. The conference covered acute and chronic respiratory failure in both adults and children. During this 3-day conference, patient selection, diagnostic strategies and treatment options were discussed by international experts. Lectures delivered during the event have been summarised by Early Career Members of the Assembly and take-home messages highlighted.

scholarly journals Hypophosphataemia after cardiopulmonary bypass – incidence and clinical significance, a South African perspective

2020 ◽  
pp. 30-36
Author(s):  
LE Grobbelaar ◽  
G Joubert ◽  
BJS Diedericks
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
South African ◽  
Cardioplegic Solution ◽  
Refeeding Syndrome ◽  
Icu Stay ◽  
Cardioactive Drug ◽  
African Perspective ◽  
One Year

Background: Hypophosphataemia is well-known in the intensive care units (ICU), for example, in refeeding syndrome. There is limited research available for hypophosphataemia in the ‘post-cardiac surgery’ population. Objectives: Defining the incidence of hypophosphataemia after cardiopulmonary bypass, in a South African population. Secondary objectives include the clinical implication of hypophosphataemia on duration of mechanical ventilation, ICU stay, and cardioactive drug support; and possible associations between demographic variables, intraoperative variables (including cardioplegic solution), and the postoperative phosphate levels. Methods: This was a single-centre, non-blinded, prospective cohort analytical study at an academic hospital, in patients presenting for open cardiac surgery. Over a one-year period, 101 patients were included. Preoperative variables included all the factors of the EuroSCORE II risk evaluation score. Intraoperative variables recorded were drug and blood product administration, cardioplegic solution and cardiopulmonary bypass-related variables. Postoperatively, serum phosphate levels were taken daily and postoperative care measures, such as duration of cardioactive drug support, mechanical ventilation, and ICU stay, were recorded. Results: The incidence of hypophosphataemia, immediately postoperative, was 12.6% (95% confidence interval [CI] 6.7–21.0%) and peaked on Day 3 at 29.0% (95% CI 20.1–39.4%). New onset hypophosphataemia at any stage during the ICU stay was 52.6% (95% CI 42.1–63.0%). No significant associations between hypophosphataemia and secondary objectives were found. Conclusion: Hypophosphataemia was common with an incidence higher than expected. This did not translate into a clinical effect, as the degree was usually mild (0.66–0.79 mmol/L).G

scholarly journals COVID-19 treatment: a growing (anti)body of evidence

2020 ◽  
pp. 172-174
Author(s):  
K Outhoff
Keyword(s):  
Mechanical Ventilation ◽  
Lower Respiratory Tract ◽  
Standard Care ◽  
Treatment Options ◽  
Invasive Mechanical Ventilation ◽  
Collaborative Group ◽  
Severe Illness ◽  
Adults And Children ◽  
Tract Involvement ◽  
Anti Body

Our lives changed dramatically eight months ago when we went into a hard nationwide lockdown in a bid to limit the transmission of our new spiky foe, SARS-CoV-2. We endured the uncertainties of autumn, and then the winter and the cold July COVID-19 peak. At this time, Oxford University’s RECOVERY Collaborative group first reported on dexamethasone (6 mg daily for 10 days) significantly lowering the 28-day mortality in hospitalised COVID-19 patients on invasive mechanical ventilation or on oxygen alone, by as much as a third and a fifth, respectively. It was hypothesised that glucocorticoids modulate inflammation-mediated lung injury, thus reducing the likely progression to respiratory failure and death in patients with severe illness. This made us perk up because a couple of months earlier, the intravenous antiviral, remdesivir (100 mg), also administered for 10 days, had shown promise in shortening the time to recovery by a median of five days compared to placebo, but not in reducing death in hospitalised COVID-19 patients with lower respiratory tract involvement. The FDA granted remdesivir Emergency Use Authorization (EUA) in May for the treatment of adults and children hospitalised with suspected or laboratory-confirmed COVID-19 based on this meagre evidence, as there were no other treatment options at the time. Meanwhile, dexamethasone, which is relatively cheap, quickly became the standard care in patients requiring oxygen.

Sign in / Sign up

Export Citation Format

Share Document