We summarize here recent efforts within the field of pediatric cardiac intensive care to optimize outcomes associated with the perioperative management of the child with congenital heart disease.
Recent findingsGoal-directed and protocol-driven therapy targeting optimization of oxygen delivery improves
outcomes in the management of many populations of critically ill patients, and is now increasingly used following congenital heart surgery with a low associated incidence of organ failure and favorable early survival. Restrictive blood product transfusion practices following congenital heart surgery click here are showing promise in reducing donor exposures and transfusion-associated morbidities without a resulting increase in end organ dysfunction. Technological developments are affording noninvasive opportunities for earlier recognition and intervention in the deteriorating child, while also
providing means for support of the failing myocardium, both in an acute setting during cardiopulmonary resuscitation, and among patients with end-stage heart failure requiring longer-term mechanical circulatory support.
SummaryMulti-institutional, prospective evaluation AZD6094 of perioperative management practices, along with patient-specific, integrated electronic health information, provides unique opportunities for investigators to identify and test both processes and technological tools in confronting the most challenging aspects of early postoperative management following congenital heart surgery.”
“Although an increased heart rate (HR) is a strong predictor of poor prognosis in BLZ945 molecular weight cases of chronic heart failure (HF), the clinical value of
HR as a predictor in acute decompensated HF (ADHF) is unclear. Seventy-eight patients with nonischemic dilated cardiomyopathy (NIDCM) with sinus rhythm who were first hospitalized for ADHF from 2002 to 2010 were retrospectively investigated after exclusion of patients with tachycardia-induced cardiomyopathy. The patients were divided into two groups stratified by HR on admission with a median value of 113 beats/min (Group H with HR a parts per thousand yen 113 beats/min; Group L with HR < 113 beats/min). Despite similar backgrounds, including pharmacotherapy for HF, HR changes responding to titration of beta-blocker (BB) therapy and myocardial interstitial fibrosis, left ventricular (LV) ejection fractions improved more significantly 1 year later in Group H than in Group L (57 % +/- 11 % vs. 46 % +/- 12 %, P < 0.001). Cardiac event-free survival rates were also significantly improved in Group H (P = 0.038). Multiple regression analysis revealed that only the peak HR on admission was an independent predictor of LV reverse remodeling (LVRR) 1 year later (beta = 0.396, P = 0.005).