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.

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 The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Deqiang Luo ◽  
Wei Dai ◽  
Lei Lei ◽  
Xueying Cai
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Fluid Responsiveness ◽  
Venous Pressure ◽  
Passive Leg Raising ◽  
Monitoring Methods ◽  
Clinical Value ◽  
Predict Fluid Responsiveness ◽  
Congenital Cardiac Surgery ◽  
Ultrasound Evaluation

Abstract Background There are few non-invasive monitoring methods that can reliably predict fluid responsiveness (FR) in children. Here, we interrogate the value of doppler ultrasound evaluation of passive leg raising (PLR)-induced changes in stroke volume (SV) and cardiac output (CO) as a predictor of FR in children with mechanical ventilation after congenital cardiac surgery. Methods A total of 40 children with mechanical ventilation following congenital cardiac surgery, who required volume expansion (VE) were included in this study. Hemodynamic parameters such as heart rate (HR), mean arterial pressure (MAP), SV, and central venous pressure (CVP) were monitored before and after PLR and VE. Besides, we assessed changes in SV and CO by bedside ultrasound. Patients showing > 10 % increase in SV in response to VE were considered to be responders (26 patients), while the rest (14 patients) were defined as non-responders. Results Our data demonstrated that ΔSV-PLR and ΔCO- PLR were positively correlated with ΔSV-VE (r = 0.683, p < 0.001 and r = 0.374, p = 0.017, respectively), and the area under the ROC curve (AUC) of ΔSV-PLR was 0.879 (95 % CI [0.745 1.000], p < 0.001). The best cut-off value for ΔSV-PLR in predicting FR was 13 %, with its sensitivity and specificity were 81.8 and 86.3 %, respectively. ΔCVP, ΔHR, and ΔMAP were weak predictors of FR in the children. Conclusions Our study demonstrated that SV changes, as evaluated by noninvasive ultrasound combined with PLR, could effectively evaluate FR in children under mechanical ventilation after congenital cardiac surgery.

scholarly journals Echocardiography in the intensive care unit: an essential tool for diagnosis, monitoring and guiding clinical decision-making

Imaging ◽  
2021 ◽  
Author(s):  
Hatem Soliman-Aboumarie ◽  
Maria Concetta Pastore ◽  
Eftychia Galiatsou ◽  
Luna Gargani ◽  
Nicola Riccardo Pugliese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Response To Therapy ◽  
Circulatory Support ◽  
Positive Pressure ◽  
Essential Tool

AbstractIn the last years, new trends on patient diagnosis for admission in cardiac intensive care unit (CICU) have been observed, shifting from acute myocardial infarction or acute heart failure to non-cardiac diseases such as sepsis, acute respiratory failure or acute kidney injury. Moreover, thanks to the advances in scientific knowledge and higher availability, there has been increasing use of positive pressure mechanical ventilation which has its implications on the heart. Therefore, there is a growing need for Cardiac intensivists to quickly, noninvasively and repeatedly evaluate various hemodynamic conditions and the response to therapy.Transthoracic critical care echocardiography (CCE) currently represents an essential tool in CICU, as it is used to evaluate biventricular function and complications following acute coronary syndromes, identify the mechanisms of circulatory failure, acute valvular pathologies, tailoring and titrating intravenous treatment or mechanical circulatory support. This could be completed with trans-oesophageal echocardiography (TOE), advanced echocardiography and lung ultrasound to provide a thorough evaluation and monitoring of CICU patients. However, CCE could sometimes be challenging as the acquisition of good-quality images is limited by mechanical ventilation, suboptimal patient position or recent surgery with drains on the chest. Moreover, there are some technical caveats that one should bear in mind while performing CCE in order to optimize its use and avoid misleading findings. The aim of this review is to highlight the key role of CCE, providing an updated overview of its main applications and possible pitfalls in order to facilitate its use in CICU for clinical decision-making.

scholarly journals The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery

2020 ◽  
Author(s):  
Deqiang Luo ◽  
Wei Dai ◽  
Lei Lei ◽  
xueying cai
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Fluid Responsiveness ◽  
Heart Surgery ◽  
Venous Pressure ◽  
Passive Leg Raising ◽  
Monitoring Methods ◽  
Clinical Value ◽  
Congenital Cardiac Surgery ◽  
Ultrasound Evaluation

Abstract Background: There are few non-invasive monitoring methods that can reliably predict FR in children, this article aims to investigate the value of the doppler ultrasound evaluation of passive leg raising (PLR) induced changes in stroke volume (SV) and cardiac output(CO) in predicting the fluid responsiveness (FR) in children with mechanical ventilation after congenital cardiac surgery. Methods: A total of 40 children with mechanical ventilation after congenital cardiac surgery who requiring volume expansion (VE) were eventually included in this observational study. Hemodynamic parameters such as heart rate (HR), blood pressure, SV, and central venous pressure (CVP) were monitored before and after PLR and VE respectively, and changes of SV and CO were assessed by bedside ultrasound as well. The patients showing an increase in SV >10% in response to VE were considered responders (26 patients), and the rest were defined as nonresponders (14 patients). Results: The results showed that ΔSV-PLR and ΔCO- PLR were positively correlated with ΔSV-VE (r = 0.683, P<0.001 and r= 0.374, P = 0.017, respectively), and the area under the ROC curve (AUC) of ΔSV-PLR was 0.879 (95% CI [0.745 1.000], P < 0.001). The best cut-off value of ΔSV-PLR for predicting FR was 13%, with its sensitivity and specificity was 81.8% and 86.3%, respectively. ΔCVP, ΔHR, and ΔMAP were weak predictive FR in children patients. Conclusion: Our study demonstrated that SV changes assessed by noninvasive ultrasound combined with PLR could be a feasible method for evaluating fluid responsiveness in children with congenital cardiac surgery and mechanical ventilation. Keywords: congenital heart surgery; fluid responsiveness; passive leg raising; ultrasound.

Ultrasonographic diagnosis of diaphragm paralysis in a neonate during mechanical ventilation after cardiac surgery

2018 ◽  
Vol 28 (5) ◽  
pp. 776-778
Author(s):  
Yoshihiro Nozaki ◽  
Lisheng Lin ◽  
Yoshiaki Kato
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Positive Pressure Ventilation ◽  
Respiratory Support ◽  
Positive Pressure ◽  
Diaphragm Thickness ◽  
Diaphragm Dysfunction ◽  
Ultrasonographic Diagnosis ◽  
Diaphragm Paralysis ◽  
Fraction Method

AbstractDiaphragm excursion method is unsuitable for diagnosis of diaphragm paralysis during positive pressure ventilation. We diagnosed diaphragm paralysis in a neonate, without interrupting positive pressure respiratory support after cardiac surgery, using the diaphragm thickness fraction, which could be evaluated during mechanical ventilation and was unaffected by bowel gases. The diaphragm thickness fraction method can help diagnose diaphragm dysfunction using only echography.

scholarly journals Cardiac Catheterization in the Early Post-Operative Period After Congenital Cardiac Surgery

2014 ◽  
Vol 7 (12) ◽  
pp. 1437-1443 ◽  
Author(s):  
George T. Nicholson ◽  
Dennis W. Kim ◽  
Robert N. Vincent ◽  
Brian E. Kogon ◽  
Bruce E. Miller ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiac Catheterization ◽  
Congenital Cardiac Surgery ◽  
Post Operative Period

scholarly journals The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery

2020 ◽  
Author(s):  
Deqiang Luo ◽  
Wei Dai ◽  
Lei Lei ◽  
xueying cai
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Fluid Responsiveness ◽  
Venous Pressure ◽  
Passive Leg Raising ◽  
Monitoring Methods ◽  
Clinical Value ◽  
Predict Fluid Responsiveness ◽  
Congenital Cardiac Surgery ◽  
Ultrasound Evaluation

Abstract Background: There are few non-invasive monitoring methods that can reliably predict fluid responsiveness (FR) in children. Here, we interrogate the value of doppler ultrasound evaluation of passive leg raising (PLR)-induced changes in stroke volume (SV) and cardiac output (CO) as a predictor of FR in children with mechanical ventilation after congenital cardiac surgery. Methods: A total of 40 children with mechanical ventilation following congenital cardiac surgery, who required volume expansion (VE) were included in this study. Hemodynamic parameters such as heart rate (HR), mean arterial pressure (MAP), SV, and central venous pressure (CVP) were monitored before and after PLR and VE. Besides, we assessed changes in SV and CO by bedside ultrasound. Patients showing >10% increase in SV in response to VE were considered to be responders (26 patients), while the rest (14 patients) were defined as non-responders. Results: Our data demonstrated that ΔSV-PLR and ΔCO- PLR were positively correlated with ΔSV-VE (r = 0.683, p <0.001 and r = 0.374, p = 0.017, respectively), and the area under the ROC curve (AUC) of ΔSV-PLR was 0.879 (95% CI [0.745 1.000], p < 0.001). The best cut-off value for ΔSV-PLR in predicting FR was 13%, with its sensitivity and specificity were 81.8% and 86.3%, respectively. ΔCVP, ΔHR, and ΔMAP were weak predictors of FR in the children. Conclusion: Our study demonstrated that SV changes, as evaluated by noninvasive ultrasound combined with PLR, could effectively evaluate FR in children under mechanical ventilation following congenital cardiac surgery.

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
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