17 research outputs found
Benefits of extracorporeal membrane oxygenation for major blunt tracheobronchial trauma in the paediatric age group
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0353 : Cerebral tissue oxygen saturation monitoring during balloon atrial septostomy in neonates with transposition of the great arteries. Preliminary data
No full textBalloon atrial septostomy (BAS) increases peripheral oxygen saturation in neonates with transposition of the great vessels (TGV). Effect of BAS on cerebral oxygenation remains little known. We aimed to describe the modification of regional cerebral tissue oxygen saturation (rcSaO2) during the catheterization.Methodswe prospectively included 6 neonates with TGV and restrictive inter-atrial shunt who required BAS. BAS was performed in catheterization laboratory by an interventional pediatric cardiologist. rcSaO2 was measured using near-infrared spectroscopy (NIRS) during the whole procedure.ResultsMedian rcSa02 at the beginning of the procedure was 52.5% ranging from 21% to 78%. Median rcSaSaO2 after the BAS was 69.5% ranging from 64% to 94%. The rcSa02 increased significantly immediately after the BAS (p=0.0273 by Wilcoxon signed rank test). Median rcSa02 delta between before and after BAS was 19% ranging from 11 to 43%. The rcSaO2 delta was higher although not significantly when rcSa02 before the BAS was less than 50% (31% vs 16%, p=0.14). Linear regression analysis revealed that the delta of rcSaO2 was significantly inversely related to the rcSa02 at the beginning of the procedure (Delta= –0.45 x rcSaO2av + 45.8, p=0.37, R2=0.70).ConclusionBAS improves cerebral oxygen saturation during the catheterization in neonates with TGV and restrictive inter-atrial shunt. The increase is proportional to the degree of alteration before the procedure
Accuracy of real-time imaging fusion between echocardiography and fluoroscopy in the catheterization laboratory of congenital heart diseases
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0362: Tetralogy of Fallot complete repair: humanitarian chains versus French native children
No full textBackgroundFrench humanitarian chains promote surgery for children with congenital heart diseases coming from developing countries. We assessed the results following complete repair of tetralogy of Fallot (TOF) in relation to the origin of patients.MethodsA 4-years retrospective review of 73 consecutive patients with TOF repair was performed. Children were divided into two groups: French children (group A, n=38) and children from developing countries (group B, n=35).ResultsPreoperative status differed between the two groups. Children from group B were older (0.82 vs 7.18 year-old, p<0.001), with a lower BMI (16 vs 14kg/m2, p<0.001). They were more symptomatic with lower oxygen saturation (90% vs 83%, p=0.007) combined with a higher level of plasmatic hemoglobin (13.1 vs 16.1g/dl, p<0.001). Proportion of preoperative palliative surgery was higher although not significant in group A (18% vs 6%, p=0.156). There wasn’t any irregular form due to coronary abnormality in the two groups. Preoperative echography showed no difference concerning the rate of pulmonary annulus Z-Score < - 3 (39% vs 43%, p=0.956). Results of surgery showed no differences in terms of aortic cross clamping time (65 vs 60 min, p=0.235) or rate of trans-annular patch insertion (37% vs 31%, p=0.810). Postoperative course didn’t significantly differ between the two groups. There was no death, two early reoperations (one for bleeding and one for residual VSD) and one late reintervention for residual supra-valvular stenosis in group A after a median follow-up time of 1.8 years. There was one early death (2.8%) and one early reoperation for bleeding in group B after a median follow-up time of 30 days. All were in sinus rhythm.ConclusionElective surgery for TOF repair carries low risk of morbimortality. Despite worst preoperative status, children from humanitarian chains can be treated safely by complete repair. Palliative surgery must be reserved for children presenting a marked cachexia profile
0410: Right ventricular systolic strain evolution during peri-operative management of congenital heart diseases
No full textBackgroundRV systolic strain evolution during peri-operative management of congenital heart diseases (CHD) is unknown.MethodsIn this prospective study, RV peak systolic strain (PSS) was measured using 2D speckle tracking echocardiography (Qlab10.0 software, Philips) in 39 children undergoing surgery of a CHD (Median age: 17 months, min 6 day-old, max 14.3 year-old). Three measures were performed the day before surgery, few hours after the surgery and before discharge and compared to conventional echocardiographic parameters of RV and left ventricular (LV) function. The relationships between the evolution of RV-PSS, peri-operative parameters and the type of CHD were assessed.ResultsMean RV-PSS at baseline was - 19.5±4.8. RV-PSS was moderately correlated with the heart rate (r=0.49), the LV Tmad (r=-0.48), the TAPSE (r=-0.54) and the tricuspid S’ wave (r=-0.44)(all p<0.05). RV-PSS was decreased in cyanotic CHD (p<0.05), in children with congestive symptoms (p=0.01) and increased in ASD (p=0.02). RV-PSS was higher in RV volume increased condition such as ASD than in RV pressure increased condition such as Fallot tetralogy (p=0.006). RV-PSS decreased after surgery (p<0.0001). Mean difference between pre- and post-operative RV-PSS was 7.5±4.4. The difference was correlated with initial RV-PSS (r=-0.80), the weight (r=0.54), the ultrafiltration rate (r=0.43)(all p<0.05) but not with the duration of aortic clamp, the duration of extracorporeal circulation (n=31), the troponin peak level nor the lactates peak level. A higher difference was associated with a shorter duration of mechanical ventilation (p=0.04) and a shorter stay in intensive care unit (P=0.03). RV-PSS was better at discharge (median 6 days, p=0.0009) but remained lesser than at the initial exam (p<0.0001).ConclusionRV-PSS decrease after surgery of CHD. This decrease seems mainly related to loading condition rather than to RV contractility given its relationship with a faster post-operative evolution
Safety and efficiency of the new micro-multiplane transoesophageal probe in paediatric cardiology
No full textSummaryBackgroundTransoesophageal echocardiography (TOE) is feasible in neonates using a miniaturized probe, but is not widely used because of low imaging quality.AimsTo assess handling and imaging quality of a new release of a micro-TOE probe in children.MethodsThirty-eight consecutive children, enrolled during February and May 2013, underwent TOE with the Philips S8-3t probe. Insertion, handling and image quality were assessed.ResultsThe 38 children (aged 7days to 12years; weight 3.1–27kg) underwent 75 TOE (30 [40.0%] before cardiac surgery, 31 [41.3%] after cardiac surgery, 4 [5.3%] during a percutaneous procedure, 10 [13.3%] in the intensive care unit). Insertion of the micro-TOE probe was ‘very easy’ in 37/38 patients (97.4%). Handling was better in the lightest children (P=0.001). Image quality was mainly ‘good’ or ‘very good’, with no significant changes between preoperative and postoperative examinations or over time. Total scores (insertion, handling, image quality) were significantly better in the lightest children (P=0.02). Preoperative TOE did not provide additional information over transthoracic echocardiography. Postoperative TOE was useful to assess surgical results, but no residual lesions required extracorporeal circulation return. Micro-TOE was useful during the postoperative care of neonatal surgery with open breastbone to assess the surgical result and ventricular function. It was also useful to guide extracorporeal membrane oxygenation (ECMO) indication and withdrawal; and was a useful guide for percutaneous procedures.ConclusionMicro-multiplane TOE is safe and efficient for use in neonates and children. This minimally invasive tool increases the impact of TOE in paediatric cardiology
0359 : Right ventricular systolic strain evolution during peri-operative management of congenital heart diseases
No full textBackgroundRV systolic strain evolution during peri-operative management of congenital heart diseases (CHD) is unknown.MethodsIn this prospective study, RV peak systolic strain (PSS) was measured using 2D speckle tracking echocardiography (Qlab10.0 software, Philips) in 39 children undergoing surgery of a CHD (Median age: 17 months, min 6 day-old, max 14.3 year-old). Three measures were performed the day before surgery, few hours after the surgery and before discharge and compared to conventional echocardiographic parameters of RV and left ventricular (LV) function. The relationships between the evolution of RV-PSS, peri-operative parameters and the type of CHD were assessed.ResultsMean RV-PSS at baseline was –19.5±4.8. RV-PSS was moderately correlated with the heart rate (r=0.49), the LV Tmad (r=–0.48), the TAPSE (r=–0.54) and the tricuspid S’ wave (r= –0.44)(all p<0.05). RV-PSS was decreased in cyanotic CHD (p<0.05), in children with congestive symptoms (p=0.01) and increased in ASD (p=0.02). RV-PSS was higher in RV volume increased condition such as ASD than in RV pressure increased condition such as Fallot tetralogy (p=0.006). RV-PSS decreased after surgery (p<0.0001). Mean difference between pre- and post-operative RV-PSS was 7.5±4.4. The difference was correlated with initial RV-PSS (r=–0.80), the weight (r=0.54), the ultrafiltration rate (r=0.43)(all p<0.05) but not with the duration of aortic clamp, the duration of extracorporeal circulation, the troponin peak level nor the lactates peak level. A higher difference was associated with a shorter duration of mechanical ventilation (p=0.04) and a shorter stay in intensive care unit (P=0.03). RV-PSS was better at discharge (median 6 days, p=0.0009) but remained lesser than at the initial exam (p<0.0001).ConclusionRV-PSS decrease after surgery of CHD. This decrease seems mainly related to loading condition rather than to RV contractility given its relationship with a faster post-operative evolution
Experts’ guidelines of intubation and extubation of the ICU patient of French Society of Anaesthesia and Intensive Care Medicine (SFAR) and French-speaking Intensive Care Society (SRLF)
No full textInternational audienceBackground: Intubation and extubation of ventilated patients are not risk-free procedures in the intensive care unit (ICU) and can be associated with morbidity and mortality. Intubation in the ICU is frequently required in emergency situations for patients with an unstable cardiovascular or respiratory system. Under these circumstances, it is a high-risk procedure with life-threatening complications (20–50%). Moreover, technical problems can also give rise to complications and several new techniques, such as videolaryngoscopy, have been developed recently. Another risk period is extubation, which fails in approximately 10% of cases and is associated with a poor prognosis. A better understanding of the cause of failure is essential to improve success procedure.Results and conclusion: In constructing these guidelines, the SFAR/SRLF experts have made use of new data on intubation and extubation in the ICU from the last decade to update existing procedures, incorporate more recent advances and propose algorithm
