Improvement in perioperative care in pediatric cardiac surgery by shifting the primary focus of treatment from cardiac output to perfusion pressure: Are beta stimulants still needed?

Autor: Michel Hurni, Stefano Di Bernardo, David Longchamp, Marc-André Bernath, Yann Boegli, Mirko Dolci, Amir-Reza Hosseinpour, Jacques Cotting, Nicole Sekarski, René Prêtre, Mathieu van Steenberghe, Javier Orrit, Marie-Hélène Perez
Rok vydání: 2017
Předmět:
Heart Defects
Congenital
Male
Inotrope
medicine.medical_specialty
Cardiac output
Cardiotonic Agents
Dopamine
medicine.medical_treatment
Blood Pressure
030204 cardiovascular system & hematology
Intensive Care Units
Pediatric
Perioperative Care
03 medical and health sciences
0302 clinical medicine
Interquartile range
Dobutamine
Internal medicine
Intensive care
Hemofiltration
Adrenergic beta-1 Receptor Agonists/administration & dosage
Blood Pressure/drug effects
Blood Pressure/physiology
Cardiac Output/drug effects
Cardiac Output/physiology
Cardiac Surgical Procedures
Cardiotonic Agents/administration & dosage
Child
Child
Preschool
Dobutamine/administration & dosage
Dopamine/administration & dosage
Dose-Response Relationship
Drug
Female
Follow-Up Studies
Heart Defects
Congenital/diagnosis
Heart Defects
Congenital/physiopathology
Heart Defects
Congenital/therapy
Humans
Infant
Perioperative Care/standards
Quality Improvement
Retrospective Studies
diastolic pressure
intensive care
norepinephrine
pediatric cardiac surgery
perfusion pressure
perioperative care
medicine
Radiology
Nuclear Medicine and imaging
030212 general & internal medicine
Cardiac Output
business.industry
General Medicine
Cardiac surgery
Blood pressure
Amputation
Adrenergic beta-1 Receptor Agonists
Anesthesia
Pediatrics
Perinatology and Child Health
Cardiology
Surgery
Cardiology and Cardiovascular Medicine
business
Zdroj: Congenital heart disease, vol. 12, no. 5, pp. 570-577
ISSN: 1747-079X
DOI: 10.1111/chd.12485
Popis: Objective An important aspect of perioperative care in pediatric cardiac surgery is maintenance of optimal hemodynamic status using vasoactive/inotropic agents. Conventionally, this has focused on maintenance of cardiac output rather than perfusion pressure. However, this approach has been abandoned in our center in favor of one focusing primarily on perfusion pressure, which is presented here and compared to the conventional approach. Design A retrospective study. Setting Regional center for congenital heart disease. University Hospital of Lausanne, Switzerland. Patients All patients with Aristotle risk score ≥8 that underwent surgery from 1996 to 2012 were included. Patients operated between 1996 and 2005 (Group 1: 206 patients) were treated according to the conventional approach. Patients operated between 2006 and 2012 (Group 2: 217 patients) were treated according to our new approach. Interventions All patients had undergone surgery for correction or palliation of congenital cardiac defects. Outcome measurements Mortality, duration of ventilation and inotropic treatment, use of ECMO, and complications of poor peripheral perfusion (need for hemofiltration, laparotomy for enterocolitis, amputation). Results The two groups were similar in age and complexity. Mortality was lower in group 2 (7.3% in group 1 vs 1.4% in group 2, P
Databáze: OpenAIRE
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