Education and Simulation Training of Pediatric Intensive Care Unit Nurses to Care for Open Heart Surgery Patients

2015 ◽  
Vol 35 (3) ◽  
pp. 76-81 ◽  
Author(s):  
Jacqueline M. Campbell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Simulation Training ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Pediatric Intensive Care ◽  
Open Heart ◽  
Intensive Care Unit Nurses

Cardiac Arrest in Infants After Congenital Heart Surgery

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
John F. Rhodes ◽  
Andrew D. Blaufox ◽  
Howard S. Seiden ◽  
Jeremy D. Asnes ◽  
Ronda P. Gross ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Pediatric Intensive Care ◽  
Congenital Heart Surgery ◽  
Inotropic Support

Background —The survival rate to discharge after a cardiac arrest in a patient in the pediatric intensive care unit is reported to be as low as 7%. The survival rates and markers for survival strictly regarding infants with cardiac arrest after congenital heart surgery are unknown. Methods and Results —Infants in our pediatric cardiac intensive care unit database were identified who had a postoperative cardiac arrest between January 1994 and June 1998. Parameters from the perioperative, prearrest, and resuscitation periods were analyzed for these patients. Comparisons were made between survivors and nonsurvivors. Of 575 infants who underwent congenital heart surgery, 34 (6%) sustained a documented cardiac arrest; of these, 14 (41%) survived to discharge. Perioperative parameters, ventricular physiology, and primary rhythm at the time of arrest did not influence outcome. Prearrest blood pressure was lower in nonsurvivors than in survivors ( P <0.001). A high level of inotropic support prearrest was associated with death ( P =0.06). Survivors had a shorter duration of resuscitation ( P <0.001) and higher minimal arterial pH ( P <0.02) and received a smaller total dose of medication during the resuscitation. Although survivors had an overall shorter duration of resuscitation, 5 of 22 patients (23%) survived to discharge despite resuscitation of >30 minutes. Conclusions —The outcome of cardiac arrest in infants after congenital heart surgery was better than that for pediatric intensive care unit populations as a whole. Univentricular physiology did not increase the risk of death after cardiac arrest. Infants with more hemodynamic compromise before the arrest as demonstrated with lower mean arterial blood pressure and higher inotropic support were less likely to survive. The use of predetermined resuscitation end points in this subpopulation may not be justified.

Cardiothoracic Surgery and Postoperative Intensive Care

2019 ◽  
pp. 417-423
Author(s):  
Juan G. Ripoll Sanz ◽  
Robert A. Ratzlaff
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Care ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Cardiothoracic Surgery ◽  
Open Heart ◽  
Postoperative Intensive Care ◽  
Main Factor

Cardiothoracic surgical (CTS) critical care responsibilities have progressively shifted away from surgeons and toward intensivists in the past several decades. CTS patients present unique challenges, and optimal patient care in the intensive care unit is a main factor for the prevention of deaths after any type of open heart surgery.

Effect of Albumin Addition to Cardiopulmonary Bypass Prime on Outcomes in Children Undergoing Open-Heart Surgery (EACPO Study)—A Randomized Controlled Trial

2020 ◽  
pp. 215013512095908
Author(s):  
Abdul Rauf ◽  
Reena K. Joshi ◽  
Neeraj Aggarwal ◽  
Mridul Agarwal ◽  
Manendra Kumar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Controlled Study ◽  
Risk Category ◽  
Open Heart ◽  
Oncotic Pressure ◽  
Randomized Controlled

Background: There is a paucity of literature regarding the association of high oncotic priming solutions for pediatric cardiopulmonary bypass (CPB) and outcomes, and no consensus exists regarding the composition of optimal CPB priming solution. This study aimed to examine the impact of high oncotic pressure priming by the addition of 20% human albumin on outcomes. Methods: Double-blinded, randomized controlled study was done in the pediatric cardiac intensive care unit of a tertiary care hospital. Consecutive children with congenital heart diseases admitted for open-heart surgery were randomized into two groups, where the study group received an additional 20% albumin to conventional blood prime before CPB initiation. Results: We enrolled 39 children in the high oncotic prime (added albumin) group and 37 children in the conventional prime group. In the first 24-hour postoperative period, children in the albumin group had significantly lower occurrence of hypotension (28.2% vs 54%, P = .02), requirement of fluid boluses (25.6% vs 54%, P = .006), and lactate clearance time (6 vs 9 hours, P < .001). Albumin group also had significantly higher platelet count (×103/µL) at 24 hours (112 vs 91, P = .02). There was no significant difference in intra-CPB hemodynamic parameters and incidence of acute kidney injury. In subgroup analysis based on risk category, significantly decreased intensive care unit stay (4 vs 5 days, P = .04) and hospital stay (5 vs 7 days, P = .002) were found in the albumin group in low-risk category. Conclusion: High oncotic pressure CPB prime using albumin addition might be beneficial over conventional blood prime, and our study does provide a rationale for further studies.

scholarly journals Risk Factors for Candidemia After Open Heart Surgery: Results From a Multicenter Case–Control Study

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Daniele Roberto Giacobbe ◽  
Antonio Salsano ◽  
Filippo Del Puente ◽  
Ambra Miette ◽  
Antonio Vena ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Surgery ◽  
Case Control Study ◽  
Open Heart Surgery ◽  
Case Control ◽  
Open Heart ◽  
Previous Therapy ◽  
Control Study

Abstract Background Candida species are among the most frequent causative agents of health care–associated bloodstream infections, with mortality &gt;40% in critically ill patients. Specific populations of critically ill patients may present peculiar risk factors related to their reason for intensive care unit admission. The primary objective of the present study was to assess the predictors of candidemia after open heart surgery. Methods This retrospective, matched case–control study was conducted in 8 Italian hospitals from 2009 to 2016. The primary study objective was to assess factors associated with the development of candidemia after open heart surgery. Results Overall, 222 patients (74 cases and 148 controls) were included in the study. Candidemia developed at a median time (interquartile range) of 23 (14–36) days after surgery. In multivariable analysis, independent predictors of candidemia were New York Heart Association class III or IV (odds ratio [OR], 23.81; 95% CI, 5.73–98.95; P &lt; .001), previous therapy with carbapenems (OR, 8.87; 95% CI, 2.57–30.67; P = .001), and previous therapy with fluoroquinolones (OR, 5.73; 95% CI, 1.61–20.41; P = .007). Crude 30-day mortality of candidemia was 53% (39/74). Septic shock was independently associated with mortality in the multivariable model (OR, 5.64; 95% CI, 1.91–16.63; P = .002). No association between prolonged cardiopulmonary bypass time and candidemia was observed in this study. Conclusions Previous broad-spectrum antibiotic therapy and high NYHA class were independent predictors of candidemia in cardiac surgery patients with prolonged postoperative intensive care unit stay.

Parent Advocacy Group for Events of Resuscitation

2016 ◽  
Vol 36 (3) ◽  
pp. 58-64 ◽  
Author(s):  
Tracy Ann Pasek ◽  
Jodi Licata
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Advocacy Group ◽  
Family Presence ◽  
Nurse Caring ◽  
Belief Scale ◽  
Intensive Care Unit Nurses

BACKGROUNDThe presence of patients’ families during resuscitation has been an important practice issue. An American Association of Critical-Care Nurses (AACN) practice alert “Family Presence During Resuscitation and Invasive Procedures” supports family members of patients undergoing resuscitation being given the option of bedside presence. Parent Advocacy Group for Events of Resuscitation (PAGER) is an interdisciplinary collaborative in the pediatric intensive care unit.OBJECTIVESTo ensure that patients’ families are provided the option of being with their child during cardiopulmonary resuscitation.METHODSResuscitation data were collected for 12 months by using the AACN practice alert audit tool. The Family Nurse Caring Belief Scale was administered to 150 pediatric intensive care unit nurses. PAGER nurses received crisis education.RESULTSPediatric intensive care unit nurses were supportive of providing the option of family presence during resuscitation. Family Nurse Caring Belief Scale data revealed areas for improvement in family caring practices. PAGER was implemented with positive outcomes for 2 families.CONCLUSIONSPAGER has improved the care of families whose children experience cardiopulmonary resuscitation and should be implemented in pediatric critical care units. PAGER nurses are prepared to serve as role models in providing family-sensitive care during crisis.

scholarly journals Open Cardiac Surgery without Blood and Blood Products Transplantation

2017 ◽  
Vol 20 (6) ◽  
pp. 239 ◽  
Author(s):  
Mehmet Kaplan ◽  
Tolga Can ◽  
Anil Karaagac ◽  
Murat Acarel ◽  
Adlan Olsun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Urine Output ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Morbidity And Mortality ◽  
Open Heart ◽  
Blood Products ◽  
Mortality And Morbidity ◽  
Significant Difference

Background: Blood transfusions are the most common type of tissue and organ transplantation. Perioperative and postoperative transfusions may cause morbidity and mortality and transfusion should based on only hematocrit values but also on hemodynamic and clinical parameters of the patient, which cannot be ignored.Methods: A prospective study was conducted between January 2015 and October 2016 with adult patients undergoing elective open heart surgery. In these patients, a protocol was established, and patients were divided into two groups as transfusion (-) and transfusion (+). In the first 24 hours in the intensive care unit, patients’ drainage, 24-hours urine output, awakening and extubation times, and lactate and bilirubin levels in arterial blood gases were recorded. Thirty-day mortality and morbidity, and hemodynamic and clinical data were compared between these two groups.Results: We have performed a total of 138 cases; no blood and blood products were transfused in 71% (n = 98), and in 29.0% (n = 40) blood and blood products were transfused. Thirty-day mortality and morbidity (arrhythmia, infectious and pulmonary morbidity, myocardial infarction, cerebrovascular accident, renal dysfunction, sternal revision) were compared between these two groups and no statistically significant difference was observed. Patients’ awakening, extubation time, cardiopulmonary bypass period, cross-clamp time, and days in intensive care unit and hospital were compared, and there was no statistically significant difference between the two groups. Conclusion: In this study, we conclude that open heart surgery without blood transfusion may be accomplished with decent peri/postoperative management. The patients who did not receive any blood or blood products were not compromised clinically or hemodynamically. No extra morbidity and mortality were seen in the non-transfusion group. Transfusion decision was based on clinical and hemodynamic parameters such as persistent hypotension or tachycardia, hyperlactatemia, low urine output, and anemic symptoms. 

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