1
|
Loomba RS, Culichia C, Schulz K, Vogel M, Savorgnan F, Flores S, Bronicki RA. Acute Effects of Vasopressin Arginine Infusion in Children with Congenital Heart Disease: Higher Blood Pressure Does Not Equal Improved Systemic Oxygen Delivery. Pediatr Cardiol 2021; 42:1792-1798. [PMID: 34181038 DOI: 10.1007/s00246-021-02667-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/20/2021] [Indexed: 11/25/2022]
Abstract
The use of vasopressin has been increased in recent years in children after congenital heart surgery. However, there is limited information regarding its effects on cardiac output, systemic oxygen delivery, and myocardial energetics. The purpose of this study is to characterize the effects of vasopressin infusions on hemodynamics and systemic oxygen delivery in children with congenital heart disease. A retrospective, single-center study of patients with congenital heart disease who received vasopressin infusions in a pediatric cardiac intensive care unit between January 2019 and May 2020. The measured values collected for study were systolic and diastolic blood pressure, heart rate, arterial oxygen saturation as determined by pulse oximetry, arterial pH, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, serum lactate, serum sodium, and renal and cerebral oximetry based on near-infrared spectroscopy. The calculated values for this study were the difference between arterial and NIRS oximetry, the reno-cerebral near-infrared spectroscopy gradient and the vasoinotrope score. A Wilcoxon signed-rank test was utilized to compare values of paired continuous variables before and after initiation of the vasopressin infusion. Correlations were assessed using Spearman correlation analyses and stepwise regressions were completed. A total of 26 vasopressin infusions among 20 unique patients were included in the final analyses. Of these 26 vasopressin infusions, 18 were in patients with biventricular circulation and 8 were in patients with functionally univentricular circulation. The median vasopressin infusion dose at initiation was 0.4 (0.1-1) milliunits/kg/min. For the entire cohort 2 h after the initiation of vasopressin, systolic blood pressure increased to 8.4 mmHg, p < 0.01, but no significant correlation was found to markers of systemic oxygen delivery. Similar results were obtained when only those with biventricular circulation were considered. Those with functionally univentricular circulation were not found to have any statistically significant rise in blood pressure. Vasopressin infusions appear to statistically significantly increase systolic blood pressure in children with congenital heart disease who have a biventricular but not functionally univentricular circulation. Even when an increase in systolic blood pressure is present, systemic oxygen delivery did not improve.
Collapse
Affiliation(s)
- Rohit S Loomba
- Department of Pediatrics, Chicago Medical School, Chicago, IL, USA
- Division of Cardiology, Advocate Children's Hospital, Chicago, IL, USA
| | - Corissa Culichia
- Department of Pediatrics, Chicago Medical School, Chicago, IL, USA
| | - Kelci Schulz
- Department of Pediatrics, Chicago Medical School, Chicago, IL, USA
| | - Maggie Vogel
- Department of Pediatrics, Chicago Medical School, Chicago, IL, USA
| | - Fabio Savorgnan
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Section of Critical Care and Cardiology, Texas Children's Hospital, Houston, TX, USA
| | - Saul Flores
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
- Section of Critical Care and Cardiology, Texas Children's Hospital, Houston, TX, USA.
| | - Ronald A Bronicki
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Section of Critical Care and Cardiology, Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
2
|
Farias JS, Villarreal EG, Flores S, Mastropietro CW, Vogel M, Schulz K, Culichia C, Iliopoulos ID, Bronicki RA, Loomba RS. Effects of Vasopressin Infusion After Pediatric Cardiac Surgery: A Meta-analysis. Pediatr Cardiol 2021; 42:225-233. [PMID: 33155084 DOI: 10.1007/s00246-020-02496-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
Vasopressin has been used to augment blood pressure; however, cardiovascular effects after cardiac surgery have not been well established. The primary objective of this study was to survey the current literature and quantify the pooled effect of vasopressin on hemodynamic parameters in children after pediatric cardiac surgery. A systematic review was conducted to identify studies characterizing the hemodynamic effects of vasopressin after pediatric cardiac surgery. Studies were assessed and those of satisfactory quality with pre- and post-vasopressin hemodynamics for each patient were included in the final analyses. 6 studies with 160 patients were included for endpoints during the first 2 h of infusions. Patients who received vasopressin infusion had greater mean, systolic, and diastolic blood pressures and lower heart rates at 2 h after initiation. 8 studies with 338 patients were included for the effects at 24 h. Patients who received vasopressin infusion had lower central venous pressures and decreased lactate concentrations 24 h after initiation. A subset analysis for children with functionally univentricular hearts found significant decrease in inotrope score and central venous pressure. A subset analysis for neonates found significant decrease in inotrope score and fluid balance. Vasopressin leads to decrease in heart rate and increase in blood pressure in the first 2 h of initiation. Later effects include decrease in inotrope score, central venous pressure, fluid balance, and in lactate within the first 24 h. Findings vary in neonates and in those with functionally univentricular hearts although beneficial effects are noted in both.
Collapse
Affiliation(s)
- Juan S Farias
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Enrique G Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
- Department of Pediatrics, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico.
| | - Saul Flores
- Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Christopher W Mastropietro
- Riley's Children's Health, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maggie Vogel
- Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Advocate Children's Heart Institute/Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Kelci Schulz
- Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Advocate Children's Heart Institute/Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Corissa Culichia
- Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Advocate Children's Heart Institute/Advocate Children's Hospital, Oak Lawn, IL, USA
| | | | - Ronald A Bronicki
- Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Rohit S Loomba
- Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Advocate Children's Heart Institute/Advocate Children's Hospital, Oak Lawn, IL, USA
| |
Collapse
|
3
|
Ross FJ, Vu EL, Fang ZA, Resheidat A, Mossad EB, Mittnacht AJC. Selected 2019 Highlights in Congenital Cardiac Anesthesia. J Cardiothorac Vasc Anesth 2020; 34:2022-2027. [PMID: 32418836 DOI: 10.1053/j.jvca.2020.04.014] [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: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 11/11/2022]
Abstract
This article is a review of the highlights of pertinent literature published in 2019, which is of interest to the pediatric cardiac anesthesiologist. After a search of the United States National Library of Medicine PubMed database, several topics emerged in which significant contributions were made in 2019. The authors of this manuscript considered the following topics noteworthy and were included in this review: advances in pediatric heart transplantation, blood management in pediatric cardiac surgery, the impact of nutrition on outcomes in congenital heart surgery, and the use of vasopressin in patients after Fontan palliation.
Collapse
Affiliation(s)
- Faith J Ross
- Department of Anesthesiology, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Eric L Vu
- Department of Anesthesiology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Zhe A Fang
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children Toronto, Ontario, Canada
| | - Ashraf Resheidat
- Division of Pediatric Cardiovascular Anesthesia, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Emad B Mossad
- Division of Pediatric Cardiovascular Anesthesia, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Alexander J C Mittnacht
- Department of Anesthesiology, Westchester Medical Center, New York Medical College, Valhalla, NY.
| |
Collapse
|
4
|
Safety and Efficacy of Vasopressin After Fontan Completion: A Randomized Pilot Study. Ann Thorac Surg 2019; 108:1865-1874. [DOI: 10.1016/j.athoracsur.2019.06.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 12/30/2022]
|
5
|
Black ND, Heggie J, Moga R, Silversides C, Chin KJ. Total Hip Replacement in a Patient With a Fontan Circulation: A Case Report. A A Pract 2019; 13:316-318. [PMID: 31343431 DOI: 10.1213/xaa.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anesthetic management of the adult patient with a Fontan circulation is complex and requires understanding of the specific physiology of the individual patient. Long-term survival in this cohort has increased to the point where patients are presenting for noncardiac surgery related to degenerative diseases of aging. We describe the perioperative management of a patient with a Fontan circulation undergoing total hip arthroplasty using combined spinal-epidural anesthesia and discuss the issues requiring special consideration for this surgical procedure in this group of patients.
Collapse
Affiliation(s)
- Nicholas D Black
- From the Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Rebecca Moga
- From the Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Candice Silversides
- Cardiology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ki Jinn Chin
- From the Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Sinha L, Ozturk M, Zurakowski D, Yerebakan C, Ramakrishnan K, Matisoff A, Ruth J, Jonas RA, Sinha P. Intra-Extracardiac Versus Extracardiac Fontan Modifications: Comparison of Early Outcomes. Ann Thorac Surg 2018; 107:560-566. [PMID: 30273570 DOI: 10.1016/j.athoracsur.2018.07.080] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 06/20/2018] [Accepted: 07/25/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The intra-extracardiac (IE) Fontan modification has advantages over the lateral tunnel modification. A direct comparison of IE to the extracardiac (EC) modification so far has not been done. This study compared IE to EC Fontan with respect to early postoperative outcomes. METHODS We retrospectively compared outcomes of the Fontan operation using the IE or EC conduit modification between January 2012 and December 2016. IE and EC groups were compared using univariate and multivariable regression analysis. To eliminate the confounding effects of fenestration, repeat intergroup comparison was performed after excluding nonfenestrated patients. RESULTS There were 81 patients grouped according to Fontan modification into the IE group (n = 43) or EC group (n = 38). The Fontan was fenestrated in 100% of the IE group but in only 55% of the EC group (p < 0.001). Cardiopulmonary bypass time was shorter for the IE group (74 vs 103, p < 0.001) The IE patients had median cross-clamp time of 34 minutes, whereas only 2 patients in the EC group required cross-clamping (35 and 95 minutes; p < 0.001). The IE group had significantly shorter median duration of pleural effusion (8 days vs 11 days, p = 0.007) and hospital length of stay (9 days vs 13 days, p = 0.001) than the EC group. Multivariable linear regression analysis revealed that the IE modification was independently associated with reduced duration of pleural effusion (p = 0.004) and hospital length of stay (p = 0.003). Presence of any unfavorable hemodynamics on preoperative assessment was also associated with longer duration of pleural effusion and hospital length of stay for patients with fenestration. CONCLUSIONS The IE Fontan modification may be associated with reduced duration of postoperative pleural effusion and hospital length of stay compared with the EC modification.
Collapse
Affiliation(s)
- Lok Sinha
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Mahmut Ozturk
- Marmara University School of Medicine, Istanbul, Turkey
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Can Yerebakan
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Karthik Ramakrishnan
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Andrew Matisoff
- Department of Anesthesiology, Children's National Health System, Washington, DC
| | - John Ruth
- Department of Anesthesiology, Children's National Health System, Washington, DC
| | - Richard A Jonas
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC
| | - Pranava Sinha
- Department of Cardiovascular Surgery, Children's National Health System, Washington, DC.
| |
Collapse
|
7
|
Abstract
OBJECTIVES Pediatric cardiac intensive care continues to evolve, with rapid advances in knowledge and improvement in clinical outcomes. In the past, the Board of Directors of the Pediatric Cardiac Intensive Care Society created and subsequently updated a list of sentinel references focused on the care of critically ill children with congenital and acquired heart disease. The objective of this article is to provide clinicians with a compilation and brief summary of updated and useful references that have been published since 2012. DATA SELECTION Pediatric Cardiac Intensive Care Society members were solicited via a survey sent out between March 20, 2017, and April 28, 2017, to provide important references that have impacted clinical care. The survey was sent to approximately 523 members. Responses were received from 45 members, of which some included multiple references. DATA EXTRACTION Following review of the list of references, and removing editorials, references were compiled by the first and last author. The final list was submitted to members of the society's Research Briefs Committee, who ranked each publication. DATA SYNTHESIS Rankings were compiled and the references with the highest scores included. Research Briefs Committee members ranked the articles from 1 to 3, with one being highly relevant and should be included and 3 being less important and should be excluded. Averages were computed, and the top articles included in this article. The first (K.C.U.) and last author (K.M.G.) reviewed and developed summaries of each article. CONCLUSIONS This article contains a compilation of useful references for the critical care of children with congenital and acquired heart disease published in the last 5 years. In conjunction with the prior version of this update in 2012, this article may be used as an educational reference in pediatric cardiac intensive care.
Collapse
|