ABSTRACT
OBJECTIVE: Although interest in nasal continuous positive airway pressure (nCPAP) to avoid intubation is increasing, there is limited data regarding patient selection and outcome. We sought to determine the baseline parameters associated with failure. STUDY DESIGN: In all, 938 cases of elective nCPAP use were extracted from our registry. Two primary end points, Treatment Failure (need for intubation) and Bad Outcome (death, need for respiratory support at 40 weeks post conceptual age, grade 4 intraventricular hemorrhage or periventricular leucomalacia), and 12 potentially predictive baseline parameters were prospectively defined and evaluated using logistic regression. RESULT: Intubation occurred in 31%, and Bad Outcome occurred in 11%. Besides estimated gestational age (EGA), only a few variables were significant predictors in the multivariate models: Intubation (PaO(2)/FiO(2)<150 or pH< 7.25) and Bad Outcome (FiO(2), low weight for EGA). The relative risk doubled between infants of 34 and 26 weeks EGA and increased by about 50% for those meeting the other criteria. CONCLUSION: We hope these findings will help those using elective nCPAP to refine their practice and those considering its use in establishing reasonable guidelines, as well as be useful for designing clinical research.
Subject(s)
Continuous Positive Airway Pressure/adverse effects , Infant, Very Low Birth Weight , Respiratory Distress Syndrome, Newborn/therapy , Blood Gas Analysis , Gestational Age , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Intubation, Intratracheal , Poland/epidemiology , Prospective Studies , Respiratory Distress Syndrome, Newborn/mortality , Risk Factors , Treatment FailureSubject(s)
Cardiology Service, Hospital/organization & administration , Heart Defects, Congenital/surgery , Thoracic Surgery/organization & administration , Education, Medical, Graduate/organization & administration , Europe , Health Facility Environment , Humans , International Cooperation , Quality Assurance, Health Care/methods , Thoracic Surgery/education , WorkloadSubject(s)
Cryopreservation/methods , Cytokines/blood , Heart Valve Prosthesis Implantation/methods , Heart Valves/immunology , Transplantation, Homologous/immunology , ABO Blood-Group System , Adolescent , Antibiotic Prophylaxis , Blood Transfusion , Child , Child, Preschool , Cytokines/biosynthesis , DNA/genetics , DNA/immunology , Histocompatibility Testing , Humans , Infant , Isoantibodies/blood , Palliative Care , Tissue Donors , Treatment OutcomeSubject(s)
HLA Antigens/immunology , Heart Defects, Congenital/surgery , Heart Valves , Immunoglobulin G/immunology , Isoantibodies/blood , Organ Preservation/methods , Transplantation, Homologous/immunology , Adolescent , Child , Child, Preschool , Cryopreservation , Heart Defects, Congenital/classification , Heart Valves/transplantation , HumansABSTRACT
An International Nomenclature for Congenital Heart Surgery was officially adopted at the Annual Meeting of the EACTS in Glasgow, UK on September 6, 1999. This nomenclature was achieved following 1 year's work of the International Nomenclature and Data Base Committee for Congenital Heart Surgery of the Society of Thoracic Surgeons. This international group included members from the STS, AATS, AHA and EACTS and associated surgeons and cardiologists from United States, Canada, Australia and Europe. The Nomenclature includes a minimal data set of 21 items and lists of 150 diagnoses, 200 procedures, 32 complications and 28 extra cardiac anomalies and preoperative risk factors. It will serve as a basis for the Pediatric European Cardiac Surgical Registry (http://www.pediatric. ecsur.org). The outcome of such an International Nomenclature represents an important event for the medical community in charge of treating patients with congenital heart diseases. It will allow scientific exchanges on an international scale and promote multicenter evaluation of congenital heart surgery. Nevertheless, this Nomenclature is only the first step. Further collection of validated data at the Pediatric ECSUR Data Base requires ethical belief, time consumption and financial resources. Comparison of results, according to pathologies, across centers and countries will help define, in the future, official European standards of Quality of Care available for health care organizations, public scrutiny and governmental agencies.
Subject(s)
Cardiac Surgical Procedures/classification , Heart Defects, Congenital/surgery , Terminology as Topic , Humans , International Cooperation , Quality Assurance, Health Care/standardsABSTRACT
The authors present an analysis of pre-, intra- and postoperative risk factors of late ventricular arrhythmias in 100 children in 5-12 years after total correction of the tetralogy of Fallot. Complex arrhythmias (III-V class according to Lown classification) were found in 19% of patients. Risk factors were: in the pre- and intraoperative period--marked endocardial fibrosis of the right ventricular outflow tract, long bypass time (> 180 min) and aortic cross-clamp (> 90 min), in the post-operative period-left ventricular dysfunction in echocardiographic examination and age > 10 years at time of the study. Complex ventricular arrhythmias were more frequent in patients with associated supraventricular arrhythmias and with progressive bundle branch block.
Subject(s)
Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/surgery , Heart Ventricles/physiopathology , Heart Ventricles/surgery , Tetralogy of Fallot/physiopathology , Tetralogy of Fallot/surgery , Child , Child, Preschool , Electrocardiography , Female , Functional Laterality , Humans , Male , Risk FactorsABSTRACT
Between January 1971 and March 1987, surgery was performed in 26 infants with interrupted aortic arch. At operation the 14 boys and 12 girls weighted between 1.71 and 4.23 kg (mean +/- SD = 3.1 +/- 0.63 kg) and ranged in age from 2 to 90 days (13 +/- 18 days). The interruption was distal to the left subclavian artery in 4 (15%), between the left carotid and subclavian arteries in 20 (77%) and between the brachiocephalic (innominate) and left carotid arteries in 2 (8%). Associated complex cardiac lesions in 8 patients included complete transposition (2), common arterial trunk (2), aortopulmonary window (2), double inlet left ventricle (1) and tricuspid atresia (1). The remaining patients had an isolated ventricular septal defect. The arch was reconstructed with a prosthetic conduit in 14 patients; by a direct anastomosis in 6; using the subclavian artery in 3; and with the pulmonary trunk and the arterial duct in 2. Twenty patients (77%) underwent palliative surgery as the first stage of management, and banding of the pulmonary trunk was also performed in 16 of these. Five patients (19%) underwent primary complete repair of the interruption and intracardiac anomalies. One patient (4%) died soon after thoracotomy for palliative surgery. Of the 15 (57%, 70% confidence limits CL = 46-69%) early deaths, 7 occurred in patients with complex associated defects and 4 occurred when single stage repair was attempted. Survival following first-stage palliative surgery for arch interruption with isolated ventricular septal defect was 64% (9/14) [70% CL = 47-79%]. All of these patients subsequently underwent complete repair. Chi-squared and t-tests showed the year of operation and the type of operation (two-stage repair) to be associated with improved survival. It is concluded that a two-stage repair of interrupted aortic arch offers a reasonable alternative to primary complete correction and will lead to satisfactory subsequent repair in most cases.