Introduction: Trisomy 21 is the most common syndrome in children with a 30-50% association with congenital heart disease (CHD). Cardiac surgeries are required in the majority of Down syndrome (DS) with CHD cases. Because of the distinctive abnormalities in their respiratory system, children with DS may require longer positive pressure ventilation after cardiac surgery. The aim of this study is to investigate the incidence and possible risk factors for prolonged mechanical ventilation (PMV) need in DS patients undergoing cardiac surgery.
Methods: We conducted a prospective study on all DS children who underwent cardiac surgery from 2013 to 2016. Demographic and perioperative data were collected including the duration of mechanical ventilation, respiratory risk factors such as previous infection, evidence of pulmonary hypertension during the intensive care unit (ICU) stay, the presence of lung collapse, secretion and wheezy chest, inotropes score, sedation score, arrhythmias, and low cardiac output syndrome. Based on the duration of mechanical ventilation, cases were divided into two groups: the control group, comprising of children who required mechanical ventilation for less than 72 hours, and the PMV group, which consisted of children who required mechanical ventilation for 72 hours or more. Risk factors were compared and analyzed between both groups.
Results: A total of 102 participants fulfilled the inclusion criteria, 90 of whom were assigned to the control group and 12 to the PMV group (11.7%). Compared with the control group, the PMV group had a higher incidence of pulmonary hypertension at a younger age (83% vs. 23%, = 0.012) and 50% of them required chronic treatment for pulmonary hypertension upon home discharge. Pneumonia during ICU stay was encountered more frequently in the PMV group (33.3% vs. 2.2%, = 0.0042). In addition, the PMV group had more frequent signs of low cardiac output syndrome after surgery (25% vs. 2.2%, = 0.019), longer ICU stays (7 ± 0.3 days vs. 15.6 ± 2.1 days, = 0.0001), needed more days of inotropes infusion (7.5 ± 0.4 days vs. 11.1 ± 1.6 days, = 0.0045), and required more sedative and paralytic agents postoperatively (6 ± 0.6 days vs. 8.7 ± 1 days, = 0.022).
Conclusion: Overall, 11.7% of DS patients required prolonged ventilation after cardiac surgery. Pulmonary hypertension was seen more frequently in cases requiring PMV, and half of PMV cases required antipulmonary hypertension medication upon discharge. Early recognition of pulmonary hypertension and proper perioperative management are recommended to avoid serious complication and comorbidity after cardiac surgery.
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http://dx.doi.org/10.1016/j.jsha.2018.01.004 | DOI Listing |
CJC Open
December 2024
Department of Cardiology, Tel Aviv Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Background: Information about left atrial (LA) 2-dimensional (2D) strain parameters in patients with the Omicron variant of COVID-19 is limited. The aim of this study is to evaluate LA strain (LAS) in COVID-19 patients with the Omicron variant and compare it to that of propensity-matched patients with the wild-type (WT) variant.
Methods: A total of 148 consecutive patients who were hospitalized with Omicron COVID-19 underwent an echocardiographic evaluation within the first day after hospital admission and were compared to propensity-matched patients (1:1) with the WT variant.
Front Cardiovasc Med
December 2024
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Background: Coronary artery bypass grafting (CABG) surgery has been a widely accepted method for treating coronary artery disease. However, its postoperative complications can have a significant effect on long-term patient outcomes. A retrospective study was conducted to identify before and after surgery that contribute to postoperative stroke in patients undergoing CABG, and to develop predictive models and recommendations for single-factor thresholds.
View Article and Find Full Text PDFTher Adv Neurol Disord
December 2024
Department of Neurology, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, Augsburg 86156, Germany.
In acetylcholine receptor (AChR) antibody-positive generalized myasthenia gravis (gMG), neonatal Fc-receptor (FcRn) inhibition has broadened the therapeutic spectrum. Myasthenic crisis (MC), heralded by an impending myasthenic crisis (iMC), is a critical condition requiring treatments with rapid onset and sustained efficacy. Currently treatments used for iMC, including intravenous immunoglobulins and plasma exchange/immunoadsorption, have limitations, such as delayed onset of action and potential side effects.
View Article and Find Full Text PDFCase Rep Anesthesiol
December 2024
Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan.
Arteriovenous malformations (AVMs) in the head and neck present significant challenges due to airway management complexities and hemorrhage risks. This case report describes a 15-year-old female with a congenital facial AVM causing dyspnea and obstructive symptoms. The patient required angioembolization of the AVM, but many hospitals deferred the procedure due to the anticipated difficult airway and severe bleeding risks.
View Article and Find Full Text PDFMed J Armed Forces India
December 2024
Professor, Medicine (Unit 4), Christian Medical College, Vellore, Tamilnadu, India.
Background: Pyrethroid insecticides are commonly used insecticides. This study was undertaken to characterize the clinical profile and outcome of deliberate self-harm (DSH) with type 1 and type 2 pyrethroids and identify factors associated with need for hospitalization.
Methods: This retrospective study was conducted in a tertiary care hospital in South India to study the clinical features, treatment, and outcome of patients with pyrethroid poisoning due to DSH.
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