Pediatric cardiology
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Pediatric cardiology · May 2010
Impact of bloodstream infection on the outcome of children undergoing cardiac surgery.
Bloodstream infections (BSIs) are a main cause of nosocomial infection in the critical care area. The development of BSI affects the surgical outcome and increases intensive care unit (ICU) morbidity and mortality. This prospective cohort study was undertaken to determine the incidence, etiology, risk factors, and outcome of BSI for postoperative pediatric cardiac patients in the pediatric cardiac ICU setup. ⋯ The mortality rate in the BSI group was 11% compared with 2% in the non-BSI group. In our pediatric cardiac ICU, BSI developed in 8.6% of the children undergoing cardiac surgery, mainly caused by a Gram-negative organism. The main risk factors for BSI in the postoperative pediatric cardiac patient were high surgical complexity, open sternum, low body weight, longer duration of central line, and prolonged pediatric cardiac ICU stay.
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Pediatric cardiology · Feb 2010
Cerebral hemodynamics in the presence of decreased systemic venous compliance in patients with Fontan physiology may limit anaerobic exercise capacity.
Patients who have had the Fontan procedure report poor exercise performance. Fontan subjects can tolerate a higher level of sub maximal activity than might be anticipated from VO2, suggesting a different mechanism of exercise limitation. Near-infrared spectroscopy (NIRS) provides a non-invasive, continuous method to monitor regional tissue oxygenation (rSO2) and thereby a window into regional oxygen supply-demand relationships. ⋯ After vAT, the AVDO2 slope is flat for Fontan patients (p = 0.02). There is also a substantially larger rebound of cerebral rSO2 than in normal subjects after QT (p < 0.0001). Reduced anaerobic exercise capacity in Fontan patients may be secondary to limitation of cerebral blood flow, secondary to low systemic venous compliance due to absence of a sub-pulmonary ventricle, and augmented hyperventilatory response during exercise.
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Pediatric cardiology · Jan 2010
Randomized Controlled TrialLimb ischemic preconditioning reduces heart and lung injury after an open heart operation in infants.
Open heart surgery supported by cardiopulmonary bypass is associated with heart and lung ischemia-reperfusion injury (IRI). Limb remote ischemic preconditioning (RIPC) reduces injury caused by ischemia-reperfusion in multiple distant organs. We conducted a prospective clinical trial (randomized and controlled) to test the feasibility and safety of limb RIPC, as well as its protective effects against myocardial and pulmonary IRI for infants undergoing repair of simple congenital heart defects. ⋯ Similarly, the expression of HSP 70 was upregulated in cardiomyocytes from the RIPC group. Limb RIPC can be applied safely and easily in infants, can attenuate systemic inflammatory response syndrome, and can increase systemic tolerance to IRI, imparting a protective effect against myocardial and pulmonary IRI. The expression of HSP 70 has an important role in the mechanism of action for RIPC.
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Pediatric cardiology · Jan 2010
Clinical TrialIntravenous induction of therapeutic hypothermia in the management of junctional ectopic tachycardia: a pilot study.
Therapeutic hypothermia has been used to treat children with postcardiotomy junctional ectopic tachycardia (JET). However, cooling techniques have not been systematically studied. This pilot study investigates the safety and efficacy of intravenous cold saline infusions used to augment surface cooling to achieve a core temperature of 32-34 degrees C for pediatric patients with JET. ⋯ Two deaths, not directly attributable to the cooling protocol, occurred. Intravenous induction of therapeutic hypothermia can be safely and effectively performed for children with JET. Further studies, powered for clinically relevant outcomes, should evaluate this potentially valuable therapeutic method.