RESUMO
The purpose of this prospective study was to determine the safety and efficacy of chloral hydrate sedation in children with known or suspected congenital heart disease. The study population included 405 children with a median age of 13 months (3 weeks to 14 years). Cyanotic heart disease was present in 64 of the children. The median dosage of chloral hydrate given was 77 mg/kg, with a range of 25 to 125 mg/kg. Sedation was achieved in 397 (98%) of the children. The complete study time averaged 2.2 hours (range, 1.6 to 5.2 hours). The time to achieve sedation was 30 minutes or less in 82%, more than 30 but less than 60 minutes in 12%, and more than 60 minutes in 4%; 2% failed to achieve sedation. Children aged 3 years or younger were more likely to be successfully sedated with chloral hydrate (p = 0.003). The type of heart disease did not affect the success of sedation. No child had a clinically significant change in heart rate or blood pressure during sedation; however, oxygen saturation decreased in 24 (6%) of 397 children successfully sedated. Decreases in oxygen saturation occurred more commonly in children with trisomy 21 (7/13) than in children without genetic syndromes (17/384). Vomiting occurred in 23 (6%) of the 405 study subjects, usually immediately after drug administration. Chloral hydrate is a safe and effective agent for sedation of children with known or suspected congenital heart disease who are undergoing echocardiography in the outpatient cardiology clinic.
Assuntos
Hidrato de Cloral/administração & dosagem , Sedação Consciente , Ecocardiografia Doppler , Hipnóticos e Sedativos/administração & dosagem , Adolescente , Fatores Etários , Assistência Ambulatorial , Pressão Sanguínea/efeitos dos fármacos , Criança , Pré-Escolar , Hidrato de Cloral/efeitos adversos , Cianose/diagnóstico por imagem , Síndrome de Down/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipnóticos e Sedativos/efeitos adversos , Lactente , Recém-Nascido , Oxigênio/sangue , Estudos Prospectivos , Segurança , Fatores de Tempo , Ultrassonografia Doppler em Cores , Ultrassonografia Doppler de Pulso , Vômito/induzido quimicamenteRESUMO
We describe two infants with congenital diaphragmatic hernia who underwent extracorporeal membrane oxygenation and in whom the venous cannula was in the left atrium instead of the right. The routine radiograph of the chest failed to demonstrate the malposition. We recommend using the echocardiogram to confirm the position of the cannula or to guide the surgeon during the cannulation of patients with congenital diaphragmatic hernia.
Assuntos
Oxigenação por Membrana Extracorpórea/efeitos adversos , Hérnia Diafragmática/terapia , Hérnias Diafragmáticas Congênitas , Ecocardiografia , Oxigenação por Membrana Extracorpórea/instrumentação , Feminino , Coração/diagnóstico por imagem , Humanos , Recém-Nascido , RadiografiaRESUMO
A blinded, randomized, controlled study was designed to test whether multiple-dose surfactant therapy would improve pulmonary outcome in term infants with respiratory failure, resulting in a shortened period of extracorporeal membrane oxygenation (ECMO). Infants > or = 34 weeks of gestational age in severe respiratory failure and receiving ECMO were stratified by diagnosis and then randomly assigned to the treatment or the control group. Four doses of modified bovine lung surfactant extract (beractant) were administered to the surfactant group (n = 28), and an equal volume of air was administered to the control group (n = 28). Lung compliance was initially low in both groups; after treatment, values were higher with time in the surfactant group (F = 5.40, p = 0.026). The ECMO treatment period was significantly shorter in the surfactant group (mean +/- SD: 107 +/- 33 hours vs 139 +/- 54 hours for the control group; U = 232, p = 0.023). Tracheal aspirate concentrations of surfactant protein A were low in both groups, and then increased steadily to a higher level in the surfactant group (F = 2.58, p = 0.04). The overall incidence of complications after ECMO was decreased in the surfactant group (18% vs 46% for the control group; chi-square value = 5.004, p = 0.025). Radiographic scores, echocardiographic findings, incidence of intracranial or pulmonary hemorrhage and bronchopulmonary dysplasia, time to extubation, duration of oxygen therapy, and duration of hospitalization did not differ between the two groups. Beractant in this population improved pulmonary mechanics, increased surfactant protein A content in tracheal aspirate, decreased time on ECMO duration, and reduced disease complications.
Assuntos
Oxigenação por Membrana Extracorpórea , Pulmão/fisiologia , Surfactantes Pulmonares/uso terapêutico , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/terapia , Método Duplo-Cego , Ecocardiografia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Glicoproteínas/análise , Humanos , Recém-Nascido , Intubação Intratraqueal , Pulmão/metabolismo , Complacência Pulmonar/fisiologia , Masculino , Síndrome de Aspiração de Mecônio/complicações , Síndrome da Persistência do Padrão de Circulação Fetal/complicações , Estudos Prospectivos , Proteolipídeos/análise , Proteínas Associadas a Surfactantes Pulmonares , Surfactantes Pulmonares/administração & dosagem , Surfactantes Pulmonares/análise , Radiografia , Insuficiência Respiratória/diagnóstico por imagem , Fatores de TempoRESUMO
To determine the effects of afterload reduction on cardiac performance during partial cardiopulmonary bypass, we administered hydralazine to infants who were either normotensive (n = 11) or hypertensive (n = 12) 1 hour after extracorporeal membrane oxygenation (ECMO) was begun. Load-dependent and load-independent measures of cardiac performance and indexes of cerebral blood flow were measured. Infants in both groups had similar weight, heart rate, blood pressure, and inotropic support before ECMO. Shortening fraction was normal in both groups before ECMO (47 +/- 11% vs 49 +/- 10%; p greater than or equal to 0.05), decreased during ECMO (31 +/- 18% vs 39 +/- 12%; p greater than or equal to 0.05), and did not change after administration of hydralazine (31 +/- 12% vs 37 +/- 8%; p greater than or equal to 0.05). Cardiac output was normal in both groups before ECMO (176 +/- 71 vs 157 +/- 72 ml/kg per minute; p greater than or equal to 0.05), decreased during ECMO (120 +/- 80 vs 105 +/- 64 ml/kg per minute; p greater than or equal to 0.05), and did not change after hydralazine administration. Velocity of circumferential fiber shortening, an index of contractility (circumference per second), was normal in both groups before ECMO (1.96 +/- 0.57 vs 1.90 +/- 0.43 circ/sec; p greater than or equal to 0.05), decreased during ECMO (1.18 +/- 0.83 vs 1.56 +/- 0.58 circ/sec; p greater than or equal to 0.05), and did not change after hydralazine administration. The relationship between velocity of circumferential fiber shortening and wall stress was similar in both groups before ECMO, during ECMO, and after hydralazine administration. The cerebral blood flow resistance index was similar in both groups before ECMO (0.70 +/- 0.16 vs 0.70 +/- 0.20; p greater than or equal to 0.05), decreased during ECMO (0.45 +/- 0.13 vs 0.43 +/- 0.09; p greater than or equal to 0.05), and did not change after administration of hydralazine. We conclude that hydralazine does not improve cardiac performance during ECMO.
Assuntos
Débito Cardíaco/efeitos dos fármacos , Oxigenação por Membrana Extracorpórea , Hidralazina/farmacologia , Recém-Nascido/fisiologia , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Circulação Cerebrovascular/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Humanos , Hidralazina/uso terapêutico , Hipertensão Pulmonar/tratamento farmacológico , Função Ventricular Esquerda/efeitos dos fármacosRESUMO
We performed cardiac evaluations in 59 infants referred for severe lung disease to determine whether cardiac performance was impaired in those requiring extracorporeal membrane oxygenation (ECMO). Infants were divided into two groups: group 1 (n = 25) received conventional therapy and group 2 (n = 34) received ECMO therapy after meeting established criteria. Ventilatory and oxygenation indexes and estimates of right ventricular systolic pressure were measured. Load-dependent and load-independent echocardiographic indexes of cardiac performance were also measured. The infants in the two groups had similar diagnoses, age, weight, inotropic support, ventilator and oxygenation indexes on admission, and survival. Heart rate and estimates of preload and afterload were similar in the two groups. Ventricular shortening fraction was 36.1 +/- 7.6% in group 1 and 40.5 +/- 8.8% in group 2 (p value was not significant). Velocity of circumferential fiber shortening (VCF/sec) was 1.41 +/- 0.35 in group 1 and 1.58 +/- 0.39 in group 2 (p value was not significant). The relationship between wall stress and ventricular shortening was similar in the two groups. There were no differences in cardiac output. Pulmonary artery pressure was estimated to be 56 +/- 13 mm Hg in group 1 and 63 +/- 10 mm Hg in group 2 (p = 0.017). Thus no significant differences were found in load-dependent or load-independent measures of cardiac performance in infants with severe lung disease treated with ECMO or conventional therapy. We conclude that cardiac failure is not the primary cause of clinical deterioration in infants with severe lung disease who require ECMO therapy.