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Salvi PS, Canner JK, Coons B, Cowles RA, Engwall-Gill AJ, Kunisaki SM, Penikis AB, Schneider E, Sferra SR, Solomon DG. The impact of undergoing elective pediatric lung resection during respiratory syncytial virus peak season on patient outcomes: A nationwide retrospective analysis. Pediatr Pulmonol 2024; 59:1346-1353. [PMID: 38353176 DOI: 10.1002/ppul.26914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 04/30/2024]
Abstract
OBJECTIVES Observational data to support delaying elective pediatric thoracic surgery during peak respiratory viral illness season is lacking. This study evaluated whether lung surgery during peak viral season is associated with differences in postoperative outcomes and resource utilization. METHODS A retrospective observational cohort study was performed using the Pediatric Health Information System (PHIS). Patients with a congenital lung malformation (CLM) who underwent elective lung resection between 1 January 2016 and 29 February 2020 were included. Respiratory syncytial virus (RSV) incidence was used as a proxy for respiratory viral illness circulation. Monthly hospital-specific RSV incidence was calculated from PHIS data, and peak RSV season was defined by Centers for Disease Control data. Multivariable regression models were built to identify predictors of postoperative mechanical ventilation, which was the main outcome measure, as well as secondary outcomes including 30-day readmission after lung resection, postoperative length of stay (LOS) and hospital billing charges. RESULTS Of 1542 CLM patients identified, 344 (22.3%) underwent lung resection during peak RSV season. 38% fewer operations were performed per month during peak RSV season than during off-peak months (p < .001). Children who underwent surgery during peak RSV season did not differ from the off-peak group in terms of age at operation, race, or comorbid conditions (i.e., congenital heart disease, newborn respiratory distress, and preoperative pneumonia). There was no association between hospital-specific RSV incidence at the time of surgery and postoperative mechanical ventilation, postoperative LOS, 30-day readmission rate or hospital billing charges. DISCUSSION Performing elective lung surgery in children with CLMs during peak viral season is not associated with adverse surgical outcomes or increased utilization of healthcare resources.
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Affiliation(s)
- Pooja S Salvi
- Division of Pediatric Surgery, New Haven, Connecticut, USA
| | - Joseph K Canner
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Barbara Coons
- Division of Pediatric Surgery, New Haven, Connecticut, USA
| | | | | | | | | | - Eric Schneider
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Shelby R Sferra
- Division of General Pediatric Surgery, Baltimore, Maryland, USA
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Lee J, Sabati A, Mirea L, Alaeddine M, Velez DA. Congenital heart surgery outcomes in patients with positive respiratory viral swabs. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00001-1. [PMID: 38191072 DOI: 10.1016/j.jtcvs.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/05/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To examine whether or not viral positive patients experienced worse outcomes and assess differences in surgical outcomes between viral-positive patients with and without viral symptoms within 30 days of surgery. METHODS This retrospective study reviewed charts of pediatric patients who underwent congenital heart surgery and routine viral testing at a single institution over a consecutive 3-year period (2017-2019). Patients with a history of heart transplants, pacemaker changes, or implants, and mediastinal washouts were excluded from the study. Surgical outcomes were compared by viral status and viral symptoms, using the Fisher exact and Wilcoxon rank sum tests. RESULTS Among 1041 patients, 374 patients underwent routine preoperative viral testing, with 107 patients testing positive and 267 testing negative for viral swabs before surgery. There were no significant differences observed in surgical outcomes by viral status, including no differences in mortality. Among the 107 patients with positive viral swabs before surgery, comparisons between 24 patients with viral symptoms and 83 without symptoms within 30 days of surgery detected no significant differences in mortality or complication rates. However, symptomatic versus asymptomatic patients had significantly longer postoperative stay (23.4 vs 13.4 days; P = .02) and intubation time (9.8 vs 4.9 hours; P = .004). CONCLUSIONS Patients who test positive before congenital heart surgery and are asymptomatic beyond the incubation period may proceed to surgery with no further delay. Patients who are viral positive and symptomatic have a longer postoperative stay and intubation time. A prospective study is needed to assess the importance of routine viral testing.
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Affiliation(s)
- Joy Lee
- University of Arizona College of Medicine, Phoenix, Ariz
| | - Arash Sabati
- Department of Cardiology, Heart Center, Phoenix Children's Hospital, Phoenix, Ariz
| | - Lucia Mirea
- Department of Clinical Research, Phoenix Children's Hospital, Phoenix, Ariz
| | - Mohamad Alaeddine
- Department of Cardiothoracic Surgery, Heart Center, Phoenix Children's Hospital, Phoenix, Ariz.
| | - Daniel A Velez
- Department of Cardiothoracic Surgery, Heart Center, Phoenix Children's Hospital, Phoenix, Ariz
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Leister N, Commotio S, Menzel C, Yücetepe S, Ulrichs C, Wendt S, Dedden C, Trieschmann U, Hannes T. Human metapneumovirus infection in the cardiac paediatric ICU before and during COVID-19 pandemic: a retrospective cohort analysis. Cardiol Young 2023; 33:1517-1522. [PMID: 35920053 PMCID: PMC9379262 DOI: 10.1017/s1047951122002645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This study investigates the hygiene standards in the context of the COVID-19 pandemic and their impact on the perioperative incidence of human metapneumovirus as well as the typical symptom burden of human metapneumovirus-infected children with CHDs. MATERIALS AND METHODS Between March 2018 and July 2021, all patients of a cardiac paediatric ICU of a German university hospital were included in this retrospective cohort analysis. RESULTS A total of 589 patients with CHD were included in the analysis. Three hundred and fifty-two patients (148 females and 204 males) were admitted before the introduction of social distancing and face masks between March 2018 and 15 April 2020 (cohort A). Two hundred and thirty-seven patients (118 females and 119 males) were admitted after the introduction between April 16 and July 2021 (cohort B). In cohort A, human metapneumovirus was detected in 11 out of 352 patients (3.1%) during their stay at cardiac paediatric ICU. In cohort B, one patient out of 237 (0.4%) tested positive for human metapneumovirus. Patients who tested positive for human metapneumovirus stayed in cardiac paediatric ICU for a median of 17.5 days (range, 2-45 days). Patients without a detected human metapneumovirus infection stayed in the cardiac paediatric ICU for a median of 4 days (range, 0.5-114 days). Nine out of 12 (75%) human metapneumovirus-positive patients showed atelectasis. CONCLUSION Perioperative human metapneumovirus infections prolong cardiac paediatric ICU stay in children with CHD. In affected patients, pulmonary impairment with typical symptoms appears. Under certain circumstances, a complication-rich perioperative infection with human metapneumovirus could be prevented in paediatric cardiac high-risk patients by prophylactic hygiene intervention.
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Affiliation(s)
- Nicolas Leister
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Simone Commotio
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Christoph Menzel
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Sirin Yücetepe
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Christoph Ulrichs
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Stefanie Wendt
- Department of Cardiothoracic Surgery and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Christoph Dedden
- Department of Paediatric Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Uwe Trieschmann
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
| | - Tobias Hannes
- Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
- Department of Paediatric Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany
- Department of Neonatology and Paediatric Intensive Care Medicine, Asklepios Children’s Hospital St. Augustin, Sankt Augustin, Germany
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Abstract
OBJECTIVES Children with chronic critical illness (CCI) are hypothesized to be a high-risk patient population with persistent multiple organ dysfunction and functional morbidities resulting in recurrent or prolonged critical care; however, it is unclear how CCI should be defined. The aim of this scoping review was to evaluate the existing literature for case definitions of pediatric CCI and case definitions of prolonged PICU admission and to explore the methodologies used to derive these definitions. DATA SOURCES Four electronic databases (Ovid Medline, Embase, CINAHL, and Web of Science) from inception to March 3, 2021. STUDY SELECTION We included studies that provided a specific case definition for CCI or prolonged PICU admission. Crowdsourcing was used to screen citations independently and in duplicate. A machine-learning algorithm was developed and validated using 6,284 citations assessed in duplicate by trained crowd reviewers. A hybrid of crowdsourcing and machine-learning methods was used to complete the remaining citation screening. DATA EXTRACTION We extracted details of case definitions, study demographics, participant characteristics, and outcomes assessed. DATA SYNTHESIS Sixty-seven studies were included. Twelve studies (18%) provided a definition for CCI that included concepts of PICU length of stay (n = 12), medical complexity or chronic conditions (n = 9), recurrent admissions (n = 9), technology dependence (n = 5), and uncertain prognosis (n = 1). Definitions were commonly referenced from another source (n = 6) or opinion-based (n = 5). The remaining 55 studies (82%) provided a definition for prolonged PICU admission, most frequently greater than or equal to 14 (n = 11) or greater than or equal to 28 days (n = 10). Most of these definitions were derived by investigator opinion (n = 24) or statistical method (n = 18). CONCLUSIONS Pediatric CCI has been variably defined with regard to the concepts of patient complexity and chronicity of critical illness. A consensus definition is needed to advance this emerging and important area of pediatric critical care research.
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Abud KCO, Machado CM, Vilas Boas LS, Maeda NY, Carvalho ES, Souza MFS, Gaiolla PV, Castro CRP, Pereira J, Rabinovitch M, Lopes AA. Respiratory viruses and postoperative hemodynamics in patients with unrestrictive congenital cardiac communications: a prospective cohort study. Eur J Med Res 2023; 28:38. [PMID: 36670454 PMCID: PMC9852807 DOI: 10.1186/s40001-023-01003-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pulmonary vascular abnormalities pose a risk for severe life-threatening hemodynamic disturbances following surgical repair of congenital cardiac communications (CCCs). In the distal lung, small airways and vessels share a common microenvironment, where biological crosstalks take place. Because respiratory cells infected by viruses express a number of molecules with potential impact on airway and vascular remodeling, we decided to test the hypothesis that CCC patients carrying viral genomes in the airways might be at a higher risk for pulmonary (and systemic) hemodynamic disturbances postoperatively. METHODS Sixty patients were prospectively enrolled (age 11 [7-16] months, median with interquartile range). Preoperative pulmonary/systemic mean arterial pressure ratio (PAP/SAP) was 0.78 (0.63-0.88). The presence or absence of genetic material for respiratory viruses in nasopharyngeal and tracheal aspirates was investigated preoperatively in the absence of respiratory symptoms using real-time polymerase chain reaction (kit for detection of 19 pathogens). Post-cardiopulmonary bypass (CPB) inflammatory reaction was analyzed by measuring serum levels of 36 inflammatory proteins (immunoblotting) 4 h after its termination. Postoperative hemodynamics was assessed using continuous recording of PAP and SAP with calculation of PAP/SAP ratio. RESULTS Viral genomes were detected in nasopharynx and the trachea in 64% and 38% of patients, respectively. Rhinovirus was the most prevalent agent. The presence of viral genomes in the trachea was associated with an upward shift of postoperative PAP curve (p = 0.011) with a PAP/SAP of 0.44 (0.36-0.50) in patients who were positive versus 0.34 (0.30-0.45) in those who were negative (p = 0.008). The presence or absence of viral genomes in nasopharynx did not help predict postoperative hemodynamics. Postoperative PAP/SAP was positively correlated with post-CPB levels of interleukin-1 receptor antagonist (p = 0.026), macrophage migration inhibitory factor (p = 0.019) and monocyte chemoattractant protein-1 (p = 0.031), particularly in patients with virus-positive tracheal aspirates. CONCLUSIONS Patients with CCCs carrying respiratory viral genomes in lower airways are at a higher risk for postoperative pulmonary hypertension, thus deserving special attention and care. Preoperative exposure to respiratory viruses and post-CPB inflammatory reaction seem to play a combined role in determining the postoperative behavior of the pulmonary circulation.
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Affiliation(s)
- Kelly C. O. Abud
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Clarisse M. Machado
- grid.11899.380000 0004 1937 0722Virology Laboratory, Institute of Tropical Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Lucy S. Vilas Boas
- grid.11899.380000 0004 1937 0722Virology Laboratory, Institute of Tropical Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Eloisa S. Carvalho
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Maria Francilene S. Souza
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Paula V. Gaiolla
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Claudia R. P. Castro
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Juliana Pereira
- grid.11899.380000 0004 1937 0722Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo, São Paulo, Brazil
| | - Marlene Rabinovitch
- grid.168010.e0000000419368956Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA USA
| | - Antonio Augusto Lopes
- grid.11899.380000 0004 1937 0722Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
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Heredia-Rodríguez M, Balbás-Álvarez S, Lorenzo-López M, Gómez-Pequera E, Jorge-Monjas P, Rojo-Rello S, Sánchez-De Prada L, Sanz-Muñoz I, Eiros JM, Martínez-Paz P, Gonzalo-Benito H, Tamayo-Velasco Á, Martín-Fernández M, Sánchez-Conde P, Tamayo E, Gómez-Sánchez E. PCR-based diagnosis of respiratory virus in postsurgical septic patients: A preliminary study before SARS-CoV-2 pandemic. Medicine (Baltimore) 2022; 101:e29902. [PMID: 35960076 PMCID: PMC9370242 DOI: 10.1097/md.0000000000029902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Respiratory viruses are part of the normal microbiota of the respiratory tract, which sometimes cause infection with/without respiratory insufficiency and the need for hospital or ICU admission. The aim of this study is to determine the prevalence of respiratory viruses in nontransplanted postoperative septic patients as well as lymphocyte count influence in their presence and its relationship to mortality. 223 nontransplanted postsurgical septic patients were recruited on the Intensive Care Unit (ICU) at Hospital Clínico Universitario de Valladolid prior to the SARS-COV-2 pandemic. Patients were split into 2 groups according to the presence/absence of respiratory viruses. Multivariate logistic regression analysis was used to identify independent factors related to positive respiratory virus PCR test. Respiratory viruses were isolated in 28.7% of patients. 28-day mortality was not significantly different between virus-positive and virus-negative groups. Logistic regression analysis revealed that lymphocyte count ≤ 928/µl is independently associated with a positive PCR result [OR 3.76, 95% CI (1.71-8.26), P = .001] adjusted by platelet count over 128,500/µL [OR 4.27, 95% CI (1.92-9.50) P < .001] and the presence of hypertension [OR 2.69, 95% CI (1.13-6.36) P = .025] as confounding variables. Respiratory viruses' detection by using PCR in respiratory samples of nontransplanted postoperative septic patients is frequent. These preliminary results revealed that the presence of lymphopenia on sepsis diagnosis is independently associated to a positive virus result, which is not related to a higher 28-day mortality.
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Affiliation(s)
- María Heredia-Rodríguez
- Department of Anaesthesiology and Critical Care, Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Sara Balbás-Álvarez
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Mario Lorenzo-López
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Estefanía Gómez-Pequera
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Pablo Jorge-Monjas
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Silvia Rojo-Rello
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Laura Sánchez-De Prada
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Ivan Sanz-Muñoz
- Department of Microbiology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - José María Eiros
- Department of Microbiology, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Pedro Martínez-Paz
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Hugo Gonzalo-Benito
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Research Unit, Hospital Clínico Universitario de Valladolid, Instituto de Estudios en Ciencias de la Salud de Castilla y León (ICSCyL), Valladolid, Spain
| | - Álvaro Tamayo-Velasco
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Hematology, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Marta Martín-Fernández
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- *Correspondence: Marta Martín-Fernández, Department of Medicine, Dermatology and Toxicology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain (e-mail: )
| | - Pilar Sánchez-Conde
- Department of Anaesthesiology and Critical Care, Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), Salamanca, Spain
- Department of Surgery, Faculty of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Eduardo Tamayo
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
| | - Esther Gómez-Sánchez
- Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Department of Surgery, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain
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Meyer HM, Marange-Chikuni D, Anaesthesia MM, Zühlke L, Roussow B, Human P, Brooks A. Outcomes After Bidirectional Glenn Shunt in a Tertiary-Care Pediatric Hospital in South Africa. J Cardiothorac Vasc Anesth 2022; 36:1573-1581. [PMID: 35151565 DOI: 10.1053/j.jvca.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Large data sets have been published on short- and long-term outcomes following bidirectional Glenn surgery (BDG), or partial cavopulmonary connection, in high-income countries. Data from low-income and middle-income countries are few and often limited to the immediate postoperative period. The primary outcome was any in-hospital postoperative complication, assessed according to predefined criteria, in children who underwent BDG surgery at Red Cross War Memorial Children's Hospital. DESIGN A retrospective cohort study. SETTING A tertiary teaching hospital. PARTICIPANTS The study authors identified 61 children (<18 years of age) who underwent BDG over 8 years. The median age of patients undergoing BDG was 2.5 years (interquartile range, 1.4-5.5 years). INTERVENTIONS BDG surgery. MEASUREMENTS AND MAIN RESULTS Thirty-five patients (57.4%) had a postoperative complication, with some patients (17 of 61, 27.9%) having more than 1 complication. The most frequent complications were infective (29.5%). Univariate analysis found that postoperative complications were associated with the use of nitric oxide (p = 0.004) and a longer duration of anesthesia (p = 0.045) and surgery (p = 0.004). Patients with complications spent longer in the pediatric intensive care unit (ICU) (p < 0.001) and in the hospital (p < 0.012). On multivariate analysis, a priori risk factors based on previous studies were not found to be statistically significant. A total of 37.3% of patients completed their single-ventricle palliation, and 30.5% of patients were lost to follow-up. CONCLUSIONS Important findings were the older age at which the BDG was performed compared to high-income countries, an acceptable mortality rate of 3.3%, infection being the most common complication, the association of a complication with increased ICU and hospital lengths of stay, and the high rate of patients lost to follow-up.
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Affiliation(s)
- Heidi M Meyer
- Division of Paediatric Anaesthesia, Department of Anaesthesia & Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
| | - Danai Marange-Chikuni
- Department of Anaesthesia and Critical Care Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Sally Mugabe Central Hospital, Harare, Zimbabwe
| | - MMed Anaesthesia
- Department of Anaesthesia and Critical Care Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Sally Mugabe Central Hospital, Harare, Zimbabwe
| | - Liesl Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Beyra Roussow
- Division of Paediatric Critical Care, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Paul Human
- Chris Barnard Division of Cardiothoracic Surgery and Cardiovascular Research Unit, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Andre Brooks
- Chris Barnard Division of Cardiothoracic Surgery and Cardiovascular Research Unit, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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8
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Tong C, Liu P, Zhang K, Liu T, Zheng J. A novel nomogram for predicting respiratory adverse events during transport after interventional cardiac catheterization in children. Front Pediatr 2022; 10:1044791. [PMID: 36340703 PMCID: PMC9631021 DOI: 10.3389/fped.2022.1044791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/30/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The rate and predictors of respiratory adverse events (RAEs) during transport discharged from operating room after interventional cardiac catheterization in children remain unclear. This study aimed to investigate the incidence and predictors, and to construct a nomogram for predicting RAEs during transport in this pediatric surgical treatment. METHODS This prospective cohort study enrolled 290 consecutive pediatric patients who underwent ventricular septal defects (VSD), atrial septal defects (ASD), and patent ductus arteriosus (PDA) between February 2019 and December 2020. Independent predictors were used to develop a nomogram, and a bootstrap resampling approach was used to conduct internal validation. Composite RAEs were defined as the occurrence of at least 1 complication regarding laryngospasm, bronchospasm, apnea, severe cough, airway secretions, airway obstruction, and oxygen desaturation. RESULTS The rate of RAEs during transport was 23.1% (67 out of 290). Multivariate analysis identified age (vs. ≤3 years, adjusted odds ratio (aOR) = 0.507, 95% confidence interval (CI), 0.268-0.958, P = 0.036), preoperative upper respiratory tract infections (URI, aOR = 2.335, 95% CI, 1.223-4.460, P = 0.01), type of surgery (vs. VSD, for ASD, aOR = 2.856, 95% CI, 1.272-6.411, P = 0.011; for PDA, aOR = 5.518, 95% CI, 2.425-12.553, P < 0.001), morphine equivalent (vs. ≤0.153 mg/kg, aOR = 2.904, 95% CI, 1.371-6.150, P = 0.005), atropine usage (aOR = 0.463, 95% CI, 0.244-0.879, P = 0.019), and RAEs during extubation to transport (aOR = 5.004, 95% CI, 2.633-9.511, P < 0.001) as independent predictors of RAEs during transport. These six candidate predictors were used to develop a nomogram, which showed a C-statistic value of 0.809 and good calibration (P = 0.844). Internal validation revealed similarly good discrimination (C-statistic, 0.782; 95% CI, 0.726-0.837) and calibration. Decision curve analysis (DCA) also demonstrated the clinical usefulness of the nomogram. CONCLUSION The high rate of RAEs during transport reminds us of the need for more medical care and attention. The proposed nomogram can reliably identify pediatric patients at high risk of RAEs during transport and guide clinicians to make proper transport plans. Our findings have important and meaningful implications for RAEs risk prediction, clinical intervention and healthcare quality control.
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Affiliation(s)
- Chaoyang Tong
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Peiwen Liu
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Kan Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Liu
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
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Giffin NA, Guerra G, Robinson J, Joynt C, Rebeyka I, Ben Sivarajan V. Impact of early surgical correction or palliation of congenital heart defects in infants with symptomatic viral respiratory tract infections in the current era. JTCVS OPEN 2021; 6:211-219. [PMID: 36003574 PMCID: PMC9390683 DOI: 10.1016/j.xjon.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study investigates the influence of timing of surgery among infants with congenital heart disease and active respiratory tract infections in a contemporary Western Canadian cohort. METHODS This was a retrospective matched cohort study of infants aged 1 week to 6 months undergoing surgical repair of congenital heart disease between 2014 and 2017. Case patients had active respiratory tract infections preoperatively and were matched to control patients based on primary heart lesion. The primary outcome was time to extubation. RESULTS We identified 20 cases (median age, 3.4 months [range, 2.4-4.3 months]) that were matched to 40 controls (1:2 ratio). In case patients, surgery occurred at a median of 1 day after the positive viral testing. There were no statistically significant differences between cases and controls in time to extubation (59 vs 34 hours [P = .12]), postoperative vasoactive scores at 24 hours (0 vs 0 [P = .53]), 48 hours (0 vs 0 [P = .23]), maximum vasoactive score in postoperative period (5 vs 5.5 [P = .54]), or time to hospital discharge (13 vs 12 days [P = .39]). Case patients had increased duration of total respiratory support (including noninvasive ventilation, 3.5 vs 2 days [P = .02]) and postoperative intensive care unit length of stay (5.5 vs 3 days [P = .01]). CONCLUSIONS Cardiac surgery on infants with congenital heart disease during an acute viral respiratory tract infection may yield a clinically relevant prolongation in time to extubation.
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Affiliation(s)
- Nick A. Giffin
- Division of Pediatric Emergency Medicine, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Gonzalo Guerra
- Pediatric Cardiac Intensive Care Unit, Division of Pediatric Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Joan Robinson
- Divsion of Pediatric Infectious Diseases, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Chloe Joynt
- Division of Neonatology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Ivan Rebeyka
- Division of Pediatric Cardiac Surgery, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - V. Ben Sivarajan
- Pediatric Cardiac Intensive Care Unit, Division of Pediatric Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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Bichell DP. Commentary: Surgery postponed, reason unclear. JTCVS OPEN 2021; 6:220-221. [PMID: 36003586 PMCID: PMC9390625 DOI: 10.1016/j.xjon.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
- David P. Bichell
- Address for reprints: David P. Bichell, MD, Department of Cardiac Surgery, Monroe Carell, Jr. Children's Hospital, Vanderbilt University Medical Center, 5247 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232-9292.
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Vickers DM, Reddy A, Akmyradov C, Brown KM, Boyanton BL, Wright HD, Taylor JA, Childress SH, Hartzell LD, Johnson AB, Key JM, Nolder AR, Richter GT, Wineland AM, Strub GM. Detection of Respiratory Pathogens Does Not Predict Risks After Outpatient Adenotonsillectomy. Laryngoscope 2021; 131:E2074-E2079. [PMID: 33150974 PMCID: PMC8246986 DOI: 10.1002/lary.29236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/18/2020] [Accepted: 10/22/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine whether the presence of detectable upper respiratory infections (URIs) at the time of adenoidectomy/adenotonsillectomy is associated with increased morbidity, complications, and unexpected admissions. STUDY DESIGN Prospective double-blinded cohort. METHODS In this prospective cohort study, nasopharyngeal swabs were obtained intraoperatively from 164 pediatric patients undergoing outpatient adenoidectomy/tonsillectomy with or without pressure equalization tubes (PETs) and were analyzed with PCR for the presence of 22 known URIs, including SARS-CoV-2. Surgeons and families were blinded to the results. At the conclusion of the study, rates of detectable infection were determined and intraoperative and postoperative events (unexpected admissions, length of PACU stay, rates of laryngospasm/bronchospasm, oxygen desaturation, bradycardia, and postoperative presentation to an emergency department) were compared between infected and uninfected patients. RESULTS Of the 164 patients (50% male, 50% female, ages 8 mo-18 y), 136 patients (82.9%) tested positive for one or more URI at the time of surgery. Forty one patients (25.0%) tested positive for three or more URIs concurrently, and 11 (6.7%) tested positive for five or more URIs concurrently. There were no significant differences in admission rates, length of PACU stay, rates of laryngospasm/bronchospasm, oxygen desaturation, bradycardia, or postoperative presentation to an emergency department between positive and negative patients. No patients tested positive for SARS-CoV-2. CONCLUSIONS A recent positive URI test does not confer any additional intraoperative or postoperative risk in the setting of outpatient adenoidectomy/tonsillectomy in healthy patients. There is no utility in preoperative URI testing, and delaying surgery due to a recent positive URI test is not warranted in this population. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2074-E2079, 2021.
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Affiliation(s)
- Donald M. Vickers
- Otolaryngology‐Head and Neck Surgery, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasU.S.A.
| | - Arundathi Reddy
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - Chary Akmyradov
- Center for Pediatric Translational Research BiostatisticsArkansas Children's Research InstituteLittle RockArkansasU.S.A.
| | - Kesley M. Brown
- Otolaryngology‐Head and Neck Surgery, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasU.S.A.
| | - Bobby L. Boyanton
- Otolaryngology‐Head and Neck Surgery, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasU.S.A.
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - Heather D. Wright
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - Jay A. Taylor
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - Sherry H. Childress
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - Larry D. Hartzell
- Otolaryngology‐Head and Neck Surgery, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasU.S.A.
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - Adam B. Johnson
- Otolaryngology‐Head and Neck Surgery, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasU.S.A.
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - James M. Key
- Otolaryngology‐Head and Neck Surgery, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasU.S.A.
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - Abby R. Nolder
- Otolaryngology‐Head and Neck Surgery, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasU.S.A.
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - Gresham T. Richter
- Otolaryngology‐Head and Neck Surgery, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasU.S.A.
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - Andre’ M. Wineland
- Otolaryngology‐Head and Neck Surgery, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasU.S.A.
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
| | - Graham M. Strub
- Otolaryngology‐Head and Neck Surgery, College of MedicineUniversity of Arkansas for Medical SciencesLittle RockArkansasU.S.A.
- Pediatric Otolaryngology, Anesthesiology, Pathology and Laboratory MedicineArkansas Children's HospitalLittle RockArkansasU.S.A.
- Center for Pediatric Translational Research BiostatisticsArkansas Children's Research InstituteLittle RockArkansasU.S.A.
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Intranasal dexmedetomidine premedication in children with recent upper respiratory tract infection undergoing interventional cardiac catheterisation: A randomised controlled trial. Eur J Anaesthesiol 2021; 37:85-90. [PMID: 31644515 DOI: 10.1097/eja.0000000000001097] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Recent upper respiratory tract infection (URI) is a risk factor for the occurrence of peri-operative respiratory adverse events (PRAE). This risk may be higher in children with congenital heart disease (CHD), particularly in those undergoing interventional cardiac catheterisation. It is therefore essential to adapt the anaesthetic strategy in these children to prevent from the occurrence of PRAE. OBJECTIVE To determine whether intranasal dexmedetomidine (DEX) premedication can reduce the incidence of PRAE in children with recent URI undergoing interventional cardiac catheterisation. DESIGN Randomised controlled trial. SETTING Single-centre study based at a tertiary care centre in Shanghai, China. PATIENTS A total of 134 children with CHD aged 0 to 16 years with recent URI undergoing interventional cardiac catheterisation. INTERVENTIONS Children were randomised to receive either intranasal DEX 1.5 μg kg (DEX group) or intranasal saline (Placebo group) 30 to 45 min before anaesthesia induction. MAIN OUTCOME MEASURES The incidence of PRAE. RESULTS Intranasal DEX significantly reduced the incidence of PRAE (P = 0.001), particularly oxygen desaturation (P = 0.012). Most PRAE were observed during the emergence phase. The incidence of PRAE was comparable among the three types of left-right shunt CHD children in both groups. In children aged less than 3 years, the incidence of PRAE was significantly lower in the DEX group (P = 0.003). In contrast, the incidence of PRAE was comparable between the two groups in children aged at least 3 years. No differences in the incidence of emergence agitation, fever and vomiting between the two groups were noted. CONCLUSION Administration of intranasal DEX 1.5 μg kg 30 to 45 min before induction led to a reduction in the incidence of PRAE in children aged less than 3 years with recent URI undergoing interventional cardiac catheterisation. TRIAL REGISTRATION chictr.org.cn identifier: ChiCTR-RRC-17012519.
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Nabialek TJ, Puppala NK, Riordan A, Ramaraj R, Duong P, Guerrero R. Successful Management of a COVID-19 Positive Infant With Transposition of the Great Arteries. World J Pediatr Congenit Heart Surg 2021; 12:554-556. [PMID: 33736537 DOI: 10.1177/21501351211000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A six-week-old infant presented in extremis and was diagnosed with dextro-transposition of the great arteries, intact ventricular septum, features of left ventricular deconditioning, and abnormal coronary arteries. Treatment with prostaglandin E1 and balloon atrial septostomy was insufficient, necessitating extracorporeal membrane oxygenation (ECMO). Severe acute respiratory syndrome coronavirus-2 was detected. The arterial switch operation was delayed by eight days because of COVID-19. Although stable on ECMO, the infant was treated with remdesivir. Extracorporeal membrane oxygenation was not required postoperatively with chest closure on day 2 and extubation on day 5.
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Affiliation(s)
- Tomasz J Nabialek
- Department of Pediatric Intensive Care, 4593Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Naga K Puppala
- Department of Pediatric Intensive Care, 4593Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Andrew Riordan
- Department of Pediatric Infectious Diseases, 4593Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Ram Ramaraj
- Department of Pediatric Cardiology, 4593Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Phuoc Duong
- Department of Pediatric Cardiology, 4593Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Rafael Guerrero
- Department of Cardiothoracic Surgery, 4593Alder Hey Children's Hospital, Liverpool, United Kingdom
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Sheehan JR, Lyons B, Holt F. The use of Lean Methodology to reduce personal protective equipment wastage in children undergoing congenital cardiac surgery, during the COVID-19 pandemic. Paediatr Anaesth 2021; 31:213-220. [PMID: 33345391 DOI: 10.1111/pan.14102] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic has compounded many existing healthcare delivery challenges including long waiting lists and cost containment. New challenges have arisen, such as demand on supply of personal protective equipment (PPE) and the implications of social distancing on staff, patients, and their families. Despite the pandemic, the need to deliver safe, urgent congenital cardiac surgery has remained. OBJECTIVE To demonstrate how Lean methodology can improve PPE supply chain demand and reduce staff exposure to children with unknown SARS-CoV-2 status undergoing congenital cardiac surgery, during the COVID-19 pandemic. METHODS We implemented the define, measure, analyze, improve, and control method (DMAIC) and Value Stream Maps to eliminate waste steps during testing for SARS-CoV-2 for children undergoing congenital cardiac surgery. RESULTS Following a 3-week period of implementation of this new value stream map, we reduced PPE set usage from 13 to 1 per patient, resulting in an annual saving of over €36,000 and reducing single-use plastic waste by nearly 70 000 pieces per annum. We reduced numbers of staff exposed to patients with an unknown SARS-CoV-2 status from 13 to 1. CONCLUSION The use of Lean methodology can reduce waste of PPE and plastic, resulting in cost savings, while reducing staff exposure when testing patients with congenital cardiac disease for SARS-CoV-2. By preventing admission of SARS-CoV-2-positive patients, we can reduce use of isolation beds and prevent cancellation of surgery, improving patient flow and departmental efficiency. Other departments in our institution are implementing similar admission pathways to allow surgical services to restart during the ongoing pandemic.
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Affiliation(s)
| | - Barry Lyons
- Children's Health Ireland at Crumlin, Dublin, Ireland
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15
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Rhinovirus Detection in the Nasopharynx of Children Undergoing Cardiac Surgery Is Not Associated With Longer PICU Length of Stay: Results of the Impact of Rhinovirus Infection After Cardiac Surgery in Kids (RISK) Study. Pediatr Crit Care Med 2021; 22:e79-e90. [PMID: 33027243 DOI: 10.1097/pcc.0000000000002522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine whether children with asymptomatic carriage of rhinovirus in the nasopharynx before elective cardiac surgery have an increased risk of prolonged PICU length of stay. STUDY DESIGN Prospective, single-center, blinded observational cohort study. SETTING PICU in a tertiary hospital in The Netherlands. PATIENTS Children under 12 years old undergoing elective cardiac surgery were enrolled in the study after informed consent of the parents/guardians. INTERVENTIONS The parents/guardians filled out a questionnaire regarding respiratory symptoms. On the day of the operation, a nasopharyngeal swab was obtained. Clinical data were collected during PICU admission, and PICU/hospital length of stay were reported. If a patient was still intubated 3 days after operation, an additional nasopharyngeal swab was collected. Nasopharyngeal swabs were tested for rhinovirus and other respiratory viruses with polymerase chain reaction. MEASUREMENTS AND MAIN RESULTS Of the 163 included children, 74 (45%) tested rhinovirus positive. Rhinovirus-positive patients did not have a prolonged PICU length of stay (median 2 d each; p = 0.257). Rhinovirus-positive patients had a significantly shorter median hospital length of stay compared with rhinovirus-negative patients (8 vs 9 d, respectively; p = 0.006). Overall, 97 of the patients (60%) tested positive for one or more respiratory virus. Virus-positive patients had significantly shorter PICU and hospital length of stay, ventilatory support, and nonmechanical ventilation. Virus-negative patients had respiratory symptoms suspected for a respiratory infection more often. In 31% of the children, the parents reported mild upper respiratory complaints a day prior to the cardiac surgery, this was associated with postextubation stridor, but no other clinical outcome measures. CONCLUSIONS Preoperative rhinovirus polymerase chain reaction positivity is not associated with prolonged PICU length of stay. Our findings do not support the use of routine polymerase chain reaction testing for respiratory viruses in asymptomatic children admitted for elective cardiac surgery.
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Fernlund E, Eriksson M, Söderholm J, Sunnegårdh J, Naumburg E. Cost-effectiveness of palivizumab in infants with congenital heart disease: a Swedish perspective. JOURNAL OF CONGENITAL CARDIOLOGY 2020. [DOI: 10.1186/s40949-020-00036-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Infants with congenital heart disease (CHD) have an increased risk of morbidity and mortality during a respiratory syncytial virus (RSV) infection. The aim of this study was to estimate the cost-effectiveness of palivizumab as RSV-prophylaxis among infants with CHD, including the effect of delayed heart surgery and asthma.
Methods
A simulation model with data from the literature and health care authorities including costs and utilities was developed to estimate costs and health effects over a lifetime for a cohort of CHD infants receiving palivizumab compared to no RSV-prophylaxis.
Results
The prophylaxis treatment incurred a cost of 3664 EUR per treated infant. However, due to cost-savings from primarily avoiding hospitalizations (5145 EUR/treated infant) and avoiding heart complications due to delayed heart surgery (2082 EUR/treated infant), the RSV-prophylaxis treatment resulted in a total cost-saving of 3833 EUR per treated infant. At the same time, the prophylaxis-treated cohort accumulated more life-years and higher quality of life than the non-prophylaxis cohort.
Conclusion
This study confirms that RSV-prophylaxis in severe CHD infants less than one year of age is cost beneficial. Avoiding delayed heart surgeries is an important benefit of prophylaxis and should be taken into consideration.
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17
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Lange B, Tenenbaum T, Wessel LM. [COVID-19 pandemic: management of pediatric surgical patients]. Monatsschr Kinderheilkd 2020; 168:739-743. [PMID: 32836396 PMCID: PMC7359426 DOI: 10.1007/s00112-020-00989-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- B. Lange
- Stabsstelle Krankenhaushygiene, Medizinische Fakultät Mannheim, Universität Heidelberg, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Deutschland
- Kinderchirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - T. Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät Mannheim, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - L. M. Wessel
- Kinderchirurgische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Universitätsmedizin Mannheim, Mannheim, Deutschland
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Viral Respiratory Infection, a Risk in Pediatric Cardiac Surgery: A Propensity-Matched Analysis. Pediatr Crit Care Med 2020; 21:e431-e440. [PMID: 32224825 DOI: 10.1097/pcc.0000000000002308] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES 1) To describe the postoperative course and outcomes of cardiac surgery in children with perioperative viral respiratory infection, 2) to evaluate optimal surgical timing for preoperative viral respiratory infection patients, and 3) to define risk stratification. DESIGN Retrospective study of children undergoing cardiac surgery. Children were tested using a multiplex polymerase chain reaction (respiratory virus polymerase chain reaction) panel capturing seven respiratory viruses. Respiratory virus polymerase chain reaction testing was routinely performed in patients under 2 years old. Those with negative results yet highly suspected of viral respiratory infection after surgeries would be tested again. SETTING A pediatric cardiac surgical ICU of pediatric cardiac surgery department at Fuwai Hospital. PATIENTS Children admitted between January 1, 2014, and December 31, 2016, to perform respiratory virus polymerase chain reaction testing and cardiac surgery were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 2,831 patients had respiratory virus polymerase chain reaction testing, and viruses were detected in 91 patients (3.2%), including 35 preoperative and 56 postoperative. Of the 35 preoperative viral respiratory infection patients, there were 29 viral respiratory infection-resolved (patients for whom surgery was postponed until resolution of viral respiratory infection symptoms and negative respiratory virus polymerase chain reaction) and six viral respiratory infection-unresolved (who underwent cardiac surgery before resolution of symptoms and clearance of carriage) patients. Furthermore, there were seven deaths, including one in the preoperative viral respiratory infection-unresolved group and six in the postoperative viral respiratory infection group. A propensity score matching was performed to correct the selection bias and identify the comparable patient groups. Compared to their matched nonviral respiratory infection patients, viral respiratory infection-resolved patients had similar duration of mechanical ventilation and length of stay, while viral respiratory infection-unresolved patients had longer durations of postoperative mechanical ventilation (p = 0.033), PICU (p = 0.028) and hospital length of stay (p = 0.010), and postoperative viral respiratory infection patients had significantly greater duration of postoperative recovery (p < 0.001) and higher mortality (p < 0.001). Earlier diagnosis of postoperative viral respiratory infection was associated with longer mechanical ventilation duration (r = 0.422; p < 0.001). Palliative cardiac surgery was the only variable significantly associated with mortality in multivariate analysis (odds ratio, 12.0; 95% CI, 1.6-87.5; p = 0.014). CONCLUSIONS The preoperative-unresolved and postoperative viral respiratory infection were associated with prolonged postoperative recovery, increased severity, and mortality in children with cardiac surgeries. Our results suggested the optimal surgical timing may be after the resolution of viral respiratory infection symptoms and carriage unless the perceived benefits of early surgery outweigh the risk of death, prolonged ventilation, and PICU length of stay. Palliative surgeries were associated with increasing mortality.
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Childhood Viral Respiratory Infection and Congenital Heart Disease: Many Questions Remain Unanswered. Pediatr Crit Care Med 2020; 21:694-696. [PMID: 32618866 DOI: 10.1097/pcc.0000000000002372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Testing for Common Respiratory Viruses in Children Admitted to Pediatric Intensive Care: Epidemiology and Outcomes. Pediatr Crit Care Med 2020; 21:e333-e341. [PMID: 32343113 DOI: 10.1097/pcc.0000000000002302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Viral infections are common in children, but there is a lack of data on severe viral infections in critically ill children. We investigated testing for viral infections in children requiring PICU admission and describe the epidemiology and outcomes. DESIGN Multicenter retrospective study. Results of viral testing for nine respiratory viruses using polymerase chain reaction were collected. PARTICIPANTS Children less than 16 years old nonelectively admitted to PICU over a 6-year period. SETTING Two tertiary PICUs in Queensland, Australia. INTERVENTIONS None. MAIN OUTCOME MEASURES Primary outcome was PICU length of stay. Secondary outcomes included need for and duration of intubation and mortality in PICU. Univariate and multivariate regression analyses were performed, adjusting for age, indigenous status, comorbidities, and severity of illness. RESULTS Of 6,426 nonelective admissions, 2,956 (46%) were polymerase chain reaction tested for a virus of which 1,353 (46%) were virus positive. Respiratory syncytial virus was the most common pathogen identified (n = 518, 33%), followed by rhinovirus/enterovirus and adenovirus. Across all patients who underwent polymerase chain reaction testing, identification of a respiratory virus was not significantly associated with longer overall length of stay (multivariate odds ratio, 1.08; 95% CI, 0.99-1.17; p = 0.068) or longer intubation (p = 0.181), whereas the adjusted odds for intubation and mortality were significantly lower (p < 0.01). Subgroup analyses restricted to patients with acute respiratory infections (n = 1,241), bronchiolitis (n = 761), pneumonia (n = 311), confirmed bacterial infection (n = 345), and malignancy (n = 95) showed that patients positive for a virus on testing had significantly longer PICU length of stay (multivariate p < 0.05). In children with pneumonia, identification of a respiratory virus was associated with significantly increased duration of ventilation (p = 0.003). No association between positive test results for multiple viruses and outcomes was observed. CONCLUSION Viral infections are common in critically ill children. Viral infections were associated with lower intubation and mortality rates compared with all children testing negative for viral infections. In several subgroups studied, identification of viral pathogens was associated with longer PICU length of stay while mortality was comparable. Prospective studies are required to determine the benefit of routine testing for respiratory viruses at the time of PICU admission.
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Zhang K, Wang S, Li M, Wu C, Sun L, Zhang S, Bai J, Zhang M, Zheng J. Anesthesia timing for children undergoing therapeutic cardiac catheterization after upper respiratory infection: a prospective observational study. Minerva Anestesiol 2020; 86:835-843. [PMID: 32251574 DOI: 10.23736/s0375-9393.20.14293-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to analyze anesthesia timing and perioperative respiratory adverse event (PRAE) risk factors in children undergoing therapeutic cardiac catheterization after upper respiratory tract infection (URI). METHODS We prospectively included children for elective therapeutic cardiac catheterization. Parents or legal guardians were asked to complete a questionnaire on the child's demographics, tobacco exposure, and URI symptoms. PRAEs (laryngospasm, bronchospasm, coughing, airway secretion, airway obstruction, and oxygen desaturation) as well as details of anesthesia management were recorded. RESULTS Of 332 children, 201 had a history of URI in the preceding eight weeks. The occurrence rate of PRAEs in children with URI≤two weeks reached the highest proportion, which was higher than that in children without URI (66.3% vs. 46.6%, P=0.007). The overall incidence of PRAEs in children with URI in 3-8 weeks was significantly lower than that in children with URI in the recent ≤two weeks (49.0% vs. 66.3%, P=0.007), and similar to that in the control group (49.0% vs. 46.6%). Multivariate analysis showed association between PRAEs and type of congenital heart disease (CHD) (P<0.001), anesthesia timing (P=0.007), and age (P=0.021). Delayed schedule (two weeks after URI) minimized the risk of PRAEs to the level comparable to that observed in children without URI (OR, 1.11; 95% CI: 0.64-1.91; P=0.707). CONCLUSIONS If treatment is not urgent, a pediatric patient at a high risk of PRAEs will be benefit from the postponement of an interventional operation by at least two weeks after URI.
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Affiliation(s)
- Kan Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Siyuan Wang
- Department of Anesthesiology, Health Science Center
| | - Mengqi Li
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Chi Wu
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Liping Sun
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Sen Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Mazhong Zhang
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jijian Zheng
- Department of Anesthesiology, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China - .,Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, School of Medicine and National Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China
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22
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Allen DZ, Worobetz N, Lukens J, Sheehan C, Onwuka A, Dopirak RM, Chiang T, Elmaraghy C. Outcomes intensive care unit placement following pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2020; 129:109736. [PMID: 31704575 DOI: 10.1016/j.ijporl.2019.109736] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Adenotonsillectomy (AT) is the most common surgical procedure for the treatment of sleep related breathing issues in children. While overnight observation in the hospital setting is utilized frequently in children after a AT, ICU setting is commonly used for patients with sleep apnea. This objective of this study is to examine factors associated with the preoperative decision to admit patients to PICU following AT as well as co-morbidities that may justify necessity for higher level of care. METHODS This is a retrospective chart review from the years of 2009-2016. All patients who underwent AT for known sleep-related breathing issues at Nationwide Children's Hospital were eligible for inclusion. A complication was defined as an adverse event such as pulmonary edema, re-intubation, or a bleeding event. Respiratory support was defined as utilizing supplementary oxygen for more than one day, positive pressure ventilation, or intubation. Proportions and medians were used to describe the overall rate of complications/complexities in care, and bivariate statistics were used to evaluate the relationship between patient characteristics and outcomes. Similar methods were used to evaluate factors associated with preoperative referral to the PICU. RESULTS There were 180 patients admitted to hospital in non-ICU setting and 158 patients with a planned PICU stay. The patients with planned PICU stays had higher rates of technological dependence (13% vs. 3%; p = 0.0006), perioperative sleep studies (80% vs. 29%; p < 0.0001), and more severe classifications of OSA (p < 0.0001). Patients with planned ICU placement also had higher rates of apneas, hypopneas, respiratory disturbance indexes, apnea hypopnea indexes, lower oxygen saturation nadirs, and a longer time spent below 90% oxygenation in sleep studies (p < 0.0001). Nearly 45% of the patients with planned ICU stays required respiratory support compared to just 8% of non-PICU patients. Additionally, 32% of the patients with planned ICU stays experienced complications compared to just 8% of the floor population. Complications were associated with younger ages, gastrointestinal comorbidities, technological dependence, viral infections, and a history of reflux. Interestingly, there were no differences in the complication rate by sleep studies findings. Similarly, there were no population level differences between patients who required respiratory support in the ICU and those that did not. Unplanned PICU placement was a rare but significant adverse event (n = 24). None of the hypothesized risk factors were associated with unplanned PICU placement. CONCLUSIONS This study suggest that while our pre-operative referral program for PICU placement is effective in identifying patients needing higher levels of care, the program places many patients in the PICU who did not utilize respiratory support or suffer from complications. We observed some misalignment between characteristics associated with planned ICU stays and actual complications. This suggests that patients with specific clinical histories, not findings on their sleep studies, should be prepared to receive higher levels of care.
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Affiliation(s)
- David Z Allen
- The Ohio State College of Medicine, Columbus, OH, USA
| | - Noah Worobetz
- The Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Cameron Sheehan
- The Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA
| | - Amanda Onwuka
- The Center for Surgical Outcomes and Research, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Tendy Chiang
- The Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles Elmaraghy
- The Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH, USA.
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23
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Zhang D, Lou X, Yan H, Pan J, Mao H, Tang H, Shu Y, Zhao Y, Liu L, Li J, Chen D, Zhang Y, Ma X. Respiratory virus associated with surgery in children patients. Respir Res 2019; 20:126. [PMID: 31208426 PMCID: PMC6580463 DOI: 10.1186/s12931-019-1086-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Viral respiratory infection (VRI) is a common contraindication to elective surgery. Asymptomatic shedding among pediatric surgery patients (PSPs) could potentially lead to progression of symptomatic diseases and cause outbreaks of respiratory diseases. The aim of this study is to investigate the incidence of infection among mild symptomatic PSP group and asymptomatic PSP group after surgical procedure. Methods We collected the induced sputum from enrolled 1629 children (under 18 years of age) with no respiratory symptom prior to pediatric surgery between March 2017 and February 2019. We tested 16 different respiratory virus infections in post-surgery mild symptomatic PSP group and asymptomatic PSP group using a quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR) assay panel. We analyzed symptom data and quantitative viral load to investigate the association between viruses, symptoms and viral quantity in qRT-PCR-positive PSPs. Results Out of 1629 children enrolled, a total of 204 respiratory viruses were present in 171 (10.50%) PSPs including 47 patients with mild symptoms and 124 with no symptoms after surgery. Commonly detected viruses were human rhino/enterovirus (HRV/EV, 42.19%), parainfluenza virus 3 (PIV3, 24.48%), coronavirus (CoV NL63, OC43, HKU1, 11.46%), and respiratory syncytial virus (RSV, 9.9%). PIV3 infection with a higher viral load was frequently found in PSPs presenting with mild symptoms, progressing to pneumonia with radiographic evidence after surgery. HRV/EV were the most commonly detected pathogens in both asymptomatic and mild symptomatic PSPs. CoV (OC43, HKU1) infections with a higher viral load were mostly observed in asymptomatic PSPs progressing to alveolar or interstitial infiltration. Conclusions Our study suggested that PIV3 is a new risk factor for VRI in PSPs. Employing a more comprehensive, sensitive and quantitative method should be considered for preoperative testing of respiratory viruses in order to guide optimal surgical timing.
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Affiliation(s)
- Dan Zhang
- NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China.,Institute of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, 310051, Binjiang district, Hangzhou, China
| | - Xiuyu Lou
- Institute of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, 310051, Binjiang district, Hangzhou, China
| | - Hao Yan
- Institute of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, 310051, Binjiang district, Hangzhou, China
| | - Junhang Pan
- Institute of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, 310051, Binjiang district, Hangzhou, China
| | - Haiyan Mao
- Institute of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, 310051, Binjiang district, Hangzhou, China
| | - Hongfeng Tang
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Shu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Zhao
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lei Liu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junping Li
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dong Chen
- Department of Laboratory Medicine, The Sixth People Hospital of Wenzhou, Wenzhou, China
| | - Yanjun Zhang
- Institute of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, 310051, Binjiang district, Hangzhou, China.
| | - Xuejun Ma
- NHC Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China.
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Abstract
Mycoplasma pneumoniae is a common cause of community-acquired pneumonia and may cause life-threatening disease in children. We identified 30 (0.3%) confirmed M. pneumoniae cases by clinical and laboratory criteria in 11,526 pediatric intensive care unit admissions. Outcomes were comparable to patients admitted with other infections (n=3005; P > 0.1). Our findings indicate that empiric antimicrobial coverage for M. pneumoniae infection in pediatric intensive care unit is rarely needed.
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Huff C, Mastropietro CW, Riley C, Byrnes J, Kwiatkowski DM, Ellis M, Schuette J, Justice L. Comprehensive Management Considerations of Select Noncardiac Organ Systems in the Cardiac Intensive Care Unit. World J Pediatr Congenit Heart Surg 2018; 9:685-695. [PMID: 30322370 DOI: 10.1177/2150135118779072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As the acuity and complexity of pediatric patients with congenital cardiac disease have increased, there are many noncardiac issues that may be present in these patients. These noncardiac problems may affect clinical outcomes in the cardiac intensive care unit and must be recognized and managed. The Pediatric Cardiac Intensive Care Society sought to provide an expert review of some of the most common challenges of the respiratory, gastrointestinal, hematological, renal, and endocrine systems in pediatric cardiac patients. This review provides a brief overview of literature available and common practices.
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Affiliation(s)
- Christin Huff
- 1 The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher W Mastropietro
- 2 Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | | | - Jonathan Byrnes
- 1 The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Misty Ellis
- 5 Department of Pediatric Critical Care, University of Louisville, Norton Children's Hospital, Louisville, KY, USA
| | | | - Lindsey Justice
- 1 The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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26
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Zhang S, Ding S, Cai M, Bai J, Zhang M, Huang Y, Zheng J. Impact of upper respiratory tract infections on perioperative outcomes of children undergoing therapeutic cardiac catheterisation. Acta Anaesthesiol Scand 2018; 62:915-923. [PMID: 29569250 DOI: 10.1111/aas.13113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/06/2018] [Accepted: 02/18/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Recent upper respiratory tract infection (URI) is associated with increased incidence of perioperative complications in children undergoing open heart surgery. As a result, surgery is often postponed. However, the effect of recent URI on the incidence of perioperative complications in children undergoing therapeutic cardiac catheterisation is unknown. We investigated the perioperative outcomes of congenital heart disease (CHD) children with recent URI who underwent elective therapeutic catheterisation. METHODS We prospectively included children treated for CHD. Before surgery, parents or legal guardians were interviewed to complete a questionnaire on the child's demographics, history of asthma and passive smoking, and URI symptoms. Recorded perioperative respiratory adverse events (PRAEs) included laryngospasm, bronchospasm, breath holding, oxygen desaturation, and severe cough. Information on postoperative dysphoria, fever, copious sputum, and vomiting was obtained by telephone 24 h after surgery. RESULTS Of 363 included children, 169 had recently (within 2 weeks) had a URI. The URI did not affect the incidence of laryngospasm, bronchospasm, breath holding, fever, or vomiting. The incidence of desaturation, severe cough, dysphoria, and copious sputum were significantly increased. Independent risk factors for PRAEs in children with a recent URI included age, passive smoking, and presence of rhinorrhoea or moist cough. The lengths of stay in the hospital and intensive care unit were not significantly different between groups. CONCLUSION Although recent URI increased the incidence of PRAEs in children undergoing therapeutic cardiac catheterisation, most CHD patients with recent URI can undergo elective therapeutic cardiac catheterisation without serious adverse events or prolonged hospitalisation.
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Affiliation(s)
- S. Zhang
- Pediatric Clinical Pharmacology Laboratory; Shanghai Children's Medical Center; School of Medicine; Shanghai Jiao Tong University; Shanghai China
- Department of Anesthesiology; Shanghai Children's Medical Center; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - S. Ding
- Department of Anesthesiology; The People's Hospital of Gansu Province; Lanzhou China
| | - M. Cai
- Pediatric Clinical Pharmacology Laboratory; Shanghai Children's Medical Center; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - J. Bai
- Department of Anesthesiology; Shanghai Children's Medical Center; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - M. Zhang
- Pediatric Clinical Pharmacology Laboratory; Shanghai Children's Medical Center; School of Medicine; Shanghai Jiao Tong University; Shanghai China
- Department of Anesthesiology; Shanghai Children's Medical Center; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - Y. Huang
- Pediatric Clinical Pharmacology Laboratory; Shanghai Children's Medical Center; School of Medicine; Shanghai Jiao Tong University; Shanghai China
- Department of Anesthesiology; Shanghai Children's Medical Center; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - J. Zheng
- Pediatric Clinical Pharmacology Laboratory; Shanghai Children's Medical Center; School of Medicine; Shanghai Jiao Tong University; Shanghai China
- Department of Anesthesiology; Shanghai Children's Medical Center; School of Medicine; Shanghai Jiao Tong University; Shanghai China
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27
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Abstract
BACKGROUND Perioperative infections have significant consequences for children with congenital heart disease (CHD), which can manifest as acute or chronic infection followed by poor growth and progressive cardiac failure. The consequences include delayed or higher-risk surgery, and increased postoperative morbidity and mortality. METHODS A systematic search for studies evaluating the burden and interventions to reduce perioperative infections in children with CHD was undertaken using PubMed. RESULTS Limited studies conducted in low- to middle-income countries demonstrated the large burden of perioperative infections among children with CHD. Most studies focussed on infections after surgery. Few studies evaluated strategies to prevent preoperative infection or the impact of infection on decision-making around the timing of surgery. Children with CHD have multiple risk factors for infections including delayed presentation, inadequate treatment of cardiac failure, and poor nutrition. CONCLUSIONS The burden of perioperative infections is high among children with CHD, and studies evaluating the effectiveness of interventions to reduce these infections are lacking. As good nutrition, early corrective surgery, and measures to reduce nosocomial infection are likely to play a role, practical steps can be taken to make surgery safer.
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