scholarly journals Predictors of Prolonged Mechanical Ventilation After Cardiopulmonary Bypass in Infants with Congenital Heart Disease Less than 3 Months Old

2020 ◽  
Author(s):  
Ruonan Wang ◽  
Di Yu ◽  
Liang Zou ◽  
Yaqin Shu ◽  
Xuming Mo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Heart Disease ◽  
Cardiopulmonary Bypass ◽  
Logistic Regression Analysis ◽  
Congenital Heart ◽  
Prolonged Mechanical Ventilation ◽  
Multiple Logistic Regression Analysis

Abstract Objective: To identify the predictors of prolonged mechanical ventilation (PMV) after cardiopulmonary bypass (CPB) in infants with congenital heart disease (CHD) less than 3 months. Methods: From June 2017 to May 2020, a total of 165 infants less than 3 months old with CHD admitted to the Children's Hospital of Nanjing Medical University for CPB were enrolled in this study. The following data were collected including gender, age, weight, Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) score, preoperative levels of thyroid hormones, CPB time, aortic cross-clamping (ACC) time, mechanical ventilation time, ICU mortality and infection. The PMV was defined as the ventilator assisted time > 72h. PMV prediction was assessed by multivariate binary logistic regression analysis. Results: Compared with non-PMV group, PMV group was younger (44.74 ± 25.27 days vs. 35.44 ± 26.91 days, P= 0.001), and most were newborns (41/93 vs. 10/57, P=0.000), with a higher proportion of RACHS-1 (29/93 vs.6/57, P=0.000) and more cases of infection (47/93 vs. 17/57,P= 0.004).PMV group had significantly lower weight than non-PMV group (3.79 ± 0.83Kg vs. 4.28 ± 1.01Kg, P=0.001). In PMV group, CPB (133.74 ± 89.65 vs. 72.30 ± 44.82, P =0.000) and ACC time (52.02 ± 24.80 vs. 36.98 ± 16.63, P =0.000) were both longer. FT4 and TT4 were higher while FT3, TT3 and TSH were lower in PMV group, but only FT3 (4.99 ± 1.67 vs. 5.29 ± 1.23, P =0.017) and TT3 (1.91 ± 0.59 vs. 1.96 ± 0.49, P =0.050) showed significant differences between PMV group and non-PMV group. Conclusion: Multiple logistic regression analysis showed that weight, infection, FT3 and CPB time were independent predictors of PMV after CPB in infants with CHD.

scholarly journals Predictive role of perioperative neutrophil to lymphocyte ratio in pediatric congenital heart disease associated with pulmonary arterial hypertension

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaoqiang Yin ◽  
Mei Xin ◽  
Sheng Ding ◽  
Feng Gao ◽  
Fan Wu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Congenital Heart ◽  
Prolonged Mechanical Ventilation ◽  
Pulmonary Arterial ◽  
Mechanical Ventilation Time

Abstract Background We aimed to explore the relationship between the neutrophil to lymphocyte ratio (NLR) and the early clinical outcomes in children with congenital heart disease (CHD) associated with pulmonary arterial hypertension (PAH) after cardiac surgery. Methods A retrospective observational study involving 190 children from January 2013 to August 2019 was conducted. Perioperative clinical and biochemical data were collected. Results We found that pre-operative NLR was significantly correlated with AST, STB, CR and UA (P < 0.05), while post-operative NLR was significantly correlated with ALT, AST, BUN (P < 0.05). Increased post-operative neutrophil count and NLR as well as decreased lymphocyte count could be observed after cardiac surgery (P < 0.05). Level of pre-operative NLR was significantly correlated with mechanical ventilation time, ICU stay time and total length of stay (P < 0.05), while level of post-operative NLR was only significantly correlated to the first two (P < 0.05). By using ROC curve analysis, relevant areas under the curve for predicting prolonged mechanical ventilation time beyond 24 h, 48 h and 72 h by NLR were statistically significant (P < 0.05). Conclusion For patients with CHD-PAH, NLR was closely related to early post-operative complications and clinical outcomes, and could act as a novel marker to predict the occurrence of prolonged mechanical ventilation.

scholarly journals Neurally Adjusted Ventilatory Assist Is Associated with Greater Initial Extubation Success in Postoperative Congenital Heart Disease Patients when Compared to Conventional Mechanical Ventilation

2018 ◽  
Vol 07 (03) ◽  
pp. 147-158 ◽  
Author(s):  
Nasir Mushtaq ◽  
Kellie Brown ◽  
Vanette Littlefield ◽  
Roger Barton ◽  
Shawn Sood
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Median Duration ◽  
Congenital Heart ◽  
Prolonged Mechanical Ventilation ◽  
Ventilator Weaning ◽  
Neurally Adjusted Ventilatory Assist ◽  
Initial Attempt ◽  
Ventilatory Assist

AbstractExtubation failure is associated with considerable morbidity and mortality in postoperative patients with congenital heart disease (CHD). The study purpose was to investigate initial extubation success utilizing neurally adjusted ventilatory assist (NAVA) compared with pressure-regulated volume controlled, synchronized intermittent mandatory ventilation with pressure support (SIMV-PRVC + PS) for ventilatory weaning in patients who required prolonged mechanical ventilation (MV). Also, total days on MV, inotropes, sedation, analgesia, and pediatric intensive care unit (PICU) length of stay (LOS) between both groups were compared. This was a non-randomized pilot study utilizing historical controls (SIMV-PRVC + PS; n = 40) compared with a prospective study population (NAVA; n = 35) in a Level I PICU and was implemented to help future trial designs. All patients (n = 75) required prolonged MV ≥96 hours due to their complex postoperative course. Ventilator weaning initiation and management was standardized between both groups. Ninety-seven percent of the NAVA group was successfully extubated on the initial attempt, while 80% were in the SIMV-PRVC + PS group (p = 0.0317). Patients placed on NAVA were eight times more likely to have successful initial extubation (odds ratio [OR]: 8.50, 95% confidence interval [CI]: 1.01, 71.82). The NAVA group demonstrated a shorter median duration on MV (9.0 vs. 11.0 days, p = 0.032), PICU LOS (9.0 vs. 13.5 days, p < 0.0001), and shorter median duration of days on dopamine (8.0 vs. 11.0 days, p = 0.0022), milrinone (9.0 vs. 12.0 days, p = 0.0002), midazolam (8.0 vs. 12.0 days, p < 0.0001), and fentanyl (9.0 vs. 12.5 days, p < 0.0001) compared with the SIMV-PRVC + PS group. NAVA compared with SIMV-PRVC + PS was associated with a greater initial extubation success rate. NAVA should be considered as a mechanical ventilator weaning strategy in postoperative congenital heart disease (CHD) patients and warrants further investigation.

scholarly journals Inspiratory Muscle Strength Training in Infants With Congenital Heart Disease and Prolonged Mechanical Ventilation: A Case Report

2013 ◽  
Vol 93 (2) ◽  
pp. 229-236 ◽  
Author(s):  
Barbara K. Smith ◽  
Mark S. Bleiweis ◽  
Cimaron R. Neel ◽  
A. Daniel Martin
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Case Report ◽  
Muscle Strength ◽  
Congenital Heart ◽  
Breathing Pattern ◽  
Prolonged Mechanical Ventilation ◽  
Inspiratory Muscle ◽  
Inspiratory Muscle Strength

Background and PurposeInspiratory muscle strength training (IMST) has been shown to improve maximal pressures and facilitate ventilator weaning in adults with prolonged mechanical ventilation (MV). The purposes of this case report are: (1) to describe the rationale for IMST in infants with MV dependence and (2) to summarize the device modifications used to administer training.Case DescriptionTwo infants with congenital heart disease underwent corrective surgery and were referred for inspiratory muscle strength evaluation after repeated weaning failures. It was determined that IMST was indicated due to inspiratory muscle weakness and a rapid, shallow breathing pattern. In order to accommodate small tidal volumes of infants, 2 alternative training modes were devised. For infant 1, IMST consisted of 15-second inspiratory occlusions. Infant 2 received 10-breath sets of IMST through a modified positive end-expiratory pressure valve. Four daily IMST sets separated by 3 to 5 minutes of rest were administered 5 to 6 days per week. The infants' IMST tolerance was evaluated by vital signs and daily clinical reviews.OutcomesMaximal inspiratory pressure (MIP) and rate of pressure development (dP/dt) were the primary outcome measures. Secondary outcome measures included the resting breathing pattern and MV weaning. There were no adverse events associated with IMST. Infants generated training pressures through the adapted devices, with improved MIP, dP/dt, and breathing pattern. Both infants weaned from MV to a high-flow nasal cannula, and neither required subsequent reintubation during their hospitalization.DiscussionThis case report describes pediatric adaptations of an IMST technique used to improve muscle performance and facilitate weaning in adults. Training was well tolerated in 2 infants with postoperative weaning difficulty and inspiratory muscle dysfunction. Further systematic examination will be needed to determine whether IMST provides a significant performance or weaning benefit.

scholarly journals Post Operative Pulmonary Complications Following Surgery for Congenital Heart Disease

2017 ◽  
Vol 35 (2) ◽  
pp. 52-60
Author(s):  
M Nurul Akhtar Hasan ◽  
M Sharifuzzaman ◽  
Abul Kalam Shamsuddin ◽  
Samir Kumar Biswas ◽  
Jesmin Hossain ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Prolonged Mechanical Ventilation ◽  
Congenital Heart Surgery ◽  
Pulmonary Complications ◽  
Aortic Cross Clamp Time ◽  
Related Factors

Objective: To identify the incidence and related factors for pulmonary complications and its impact on outcome in patients subjected to surgery for congenital heart disease (CHD).Methods: The sample comprised 141 patients of both genders, subjected to surgery for CHD, during 3 months period from 1st July 2014 to 30th September 2014. The data were obtained from newly improvised Congenital Heart Surgery Database.Results: Twenty eight (20%) patients developed some form of pulmonary complications. Age, weight, length and body surface area are significantly low among them (p <0.05). They also have higher Aristotle score & RACHS score, higher CPB time and aortic cross clamp time (p <0.01). Patients who had pulmonary complications had significantly higher (p <0.01) vasoactive inotrope score, prolonged mechanical ventilation, longer post operative ICU stay and post operative hospital stay. There was no mortality.Conclusions: Pulmonary complications are common after surgery for CHD which is more common in small children and complex surgeries. It significantly affects outcome including duration of mechanical ventilation and length of stay but no effect in mortality.J Bangladesh Coll Phys Surg 2017; 35(2): 52-60

scholarly journals Predictors of Prolonged Mechanical Ventilation in Paediatric Patients After Anatomical Correction of Simple Congenital Heart Disease

2021 ◽  
Author(s):  
Huanghe He ◽  
kai Wang ◽  
Yingyuan Zhang ◽  
Hong Liu ◽  
Lunchao Ma ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Clinical Data ◽  
Roc Curve ◽  
Congenital Heart ◽  
Septal Defect ◽  
Prolonged Mechanical Ventilation ◽  
Area Under The Curve ◽  
Paediatric Patients

Abstract Background: We aimed to use preoperative clinical data from paediatric patients with simple congenital heart disease to predict the risk of prolonged mechanical ventilation after surgery. Methods: The clinical data from paediatric patients with simple congenital heart disease who underwent anatomical correction under cardiopulmonary bypass in a single centre during a continuous period were retrospectively collected. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for prolonged mechanical ventilation (>24 h) after surgery, and a mathematical model was established. Then, using data from another centre, we adopted an ROC curve to verify the scalability of the model. Results: A total of 585 paediatric patients were eligible for inclusion in this study. Multivariate logistic regression analysis showed that weight (kg), the size of the ventricular septal defect, the size of the atrial septal defect and the shunt direction of the defect site were significantly correlated with prolonged mechanical ventilation (>24 h) after surgery. The risk prediction model was established and the area under the curve of the model was 0.853 (ROC curve). A set of data from another heart centre, with equivalent inclusion criteria, was used to validate the scalability of the model, and the area under the curve of the accepted validated data was 0.841 (ROC curve). Conclusions: The risk of prolonged mechanical ventilation (>24 h) after surgery in paediatric patients with simple congenital heart disease with anatomical correction assisted by cardiopulmonary bypass can be well predicted by using preoperative clinical data.

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