Anesthetic Considerations in Pediatric Patients With Acute Decompensated Heart Failure

2021 ◽  
pp. 108925322110449
Author(s):  
Roby Sebastian ◽  
Sana Ullah ◽  
Pablo Motta ◽  
Bibhuti Das ◽  
Luis Zabala
Keyword(s):  
Heart Failure ◽  
Congenital Heart ◽  
Pediatric Patients ◽  
Perioperative Management ◽  
Acute Decompensated Heart Failure ◽  
Clinical Manifestations ◽  
Decompensated Heart Failure ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Anesthetic Considerations

Acute decompensated heart failure (ADHF) in pediatrics is a significant cause for morbidity and mortality in children. Congenital heart disease and cardiomyopathy are the leading etiologies of ADHF. It is common for these children to undergo diagnostic, therapeutic, or surgical procedure under anesthesia, which may be associated with significant morbidity and mortality. The importance of preanesthetic multidisciplinary planning with all involved teams, including anesthesia, cardiology, intensive care, perfusion, and cardiac surgery, cannot be emphasized enough. In order to safely manage these patients, it is imperative for the anesthesiologist to understand the complex pathophysiological interactions between cardiopulmonary systems and anesthesia during these procedures. This review discusses the etiology, pathophysiology, clinical manifestations, and perioperative management of these patients.

The Impact of Amino-Terminal Pro-Brain Natriuretic Peptide Testing on Hospital Length of Stay and Morbidity in Patients With Acute Decompensated Heart Failure

2007 ◽  
Vol 131 (3) ◽  
pp. 473-476
Author(s):  
Sandy M. Green ◽  
Patrick Redmond ◽  
James L. Januzzi ◽  
Samir Aleryani ◽  
Elizabeth Lee-Lewandrowski ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Risk Reduction ◽  
Acute Decompensated Heart Failure ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Decompensated Heart Failure ◽  
Hospital Length ◽  
Morbidity And Mortality ◽  
Hospital Length Of Stay

Abstract Context.—In clinical trials, N-terminal pro-brain natriuretic peptide (NT-proBNP) testing has been shown to be valuable for diagnosis and triage of patients with acute decompensated heart failure. It is not yet clear what benefits might be expected from the initiation of NT-proBNP testing in an everyday clinical setting. Objective.—To determine the effects of NT-proBNP testing on hospital length of stay as well as on 60-day morbidity and mortality in patients with acute decompensated heart failure before and after the test was implemented in the clinical laboratory. Design.—We measured hospital length of stay and 60-day morbidity and mortality rates among patients with acute decompensated heart failure admitted before and after initiation of NT-proBNP testing in our hospital. Differences in demographics between preimplementation and postimplementation groups were compared with the χ2 test for categorical variables and the Wilcoxon rank sum test for continuous variables. Comparison between the hospital length of stay for each group was evaluated using the Mann-Whitney U test. Differences in rates of rehospitalization or death at 60 days following presentation were assessed using χ2 cross-tabulation. Results.—Patients in the postimplementation group had similar clinical features as those in the preimplementation group. The hospital length of stay for patients in the postimplementation study group decreased both with respect to mean (1.86-day reduction) and median (1.3-day reduction) hospital stay (both, P = .03). Additionally, significantly lower rates of death (6.6% absolute risk reduction, P = .01), rehospitalization (12.1% absolute risk reduction, P = .005), and the composite of the 2 rates (18.7% absolute risk reduction, P = .008) were found following initiation of NT-proBNP testing. Conclusions.—Implementation of NT-proBNP testing may result in significant reductions in hospital length of stay as well as improvements in rates of morbidity and mortality in patients with acute decompensated heart failure.

scholarly journals Case Report: Low Dose of Valsartan/Sacubitril Leads to Successful Reversal of Acute Heart Failure in Chemotherapy-Induced Cardiomyopathy

2021 ◽  
Vol 9 ◽  
Author(s):  
Shih-Hsing Lo ◽  
Yi-Ching Liu ◽  
Zen-Kong Dai ◽  
I-Chen Chen ◽  
Yen-Hsien Wu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Acute Heart Failure ◽  
Low Dose ◽  
Pediatric Patients ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Angiotensin Receptor ◽  
Neprilysin Inhibitor ◽  
Receptor Inhibitor

Valsartan/sacubitril is a new agent approved for the treatment of chronic heart failure in adults, with a combination of angiotensin receptor inhibitor and neprilysin inhibitor. However, the benefit of valsartan/sacubitril in pediatric patients is unknown. We herein report its clinical benefit in a case of acute decompensated heart failure in chemotherapy-induced cardiomyopathy. This case suggests that in children with acute heart failure refractory to conventional medications, low dose of sacubitril/valsartan may be an effective therapy.

Assessing Acute Decompensated Heart Failure – Strategies and Tools

2012 ◽  
Vol 8 (2) ◽  
pp. 128
Author(s):  
Ali Vazir ◽  
Martin R Cowie ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Pulse Contour Analysis ◽  
Decompensated Heart Failure ◽  
Rapid Onset ◽  
Clinical Syndrome ◽  
Response To Therapy ◽  
Contour Analysis ◽  
Physiological Variables ◽  
Co Morbidity

Acute heart failure – the rapid onset of, or change in, signs and/or symptoms of heart failure requiring urgent treatment – is a serious clinical syndrome, associated with high mortality and healthcare costs. History, physical examination and early 2D and Doppler echocardiography are crucial to the proper assessment of patients, and will help determine the appropriate monitoring and management strategy. Most patients are elderly and have considerable co-morbidity. Clinical assessment is key to monitoring progress, but a number of clinical techniques – including simple Doppler and echocardiographic tools, pulse contour analysis and impedance cardiography – can help assess the response to therapy. A pulmonary artery catheter is not a routine monitoring tool, but can be very useful in patients with complex physiology, in those who fail to respond to therapy as would be anticipated, or in those being considered for mechanical intervention. As yet, the serial measurement of plasma natriuretic peptides is of limited value, but it does have a role in diagnosis and prognostication. Increasingly, the remote monitoring of physiological variables by completely implanted devices is possible, but the place of such technology in clinical practice is yet to be clearly established.

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