RATIONAL USE OF PROLONGED MECHANICAL VENTILATION AFTER CARDIAC SURGERY IN CHILDREN WITH SERIOUS CONGENITAL HEART DISEASE

Tan LH, Li JH, Zhu XK, Zhang ZW

Affiliated Children's Hospital, Medicine College of Zhejiang University, Hangzhou, China

 

Objective: To discuss the rational use of ventilator after cardiac surgery in children suffering serious congenital heart disease (CHD).

Methods: We retrospective analyzed those patients who required postoperative mechanical ventilation (MV) more than 3 days among 950 cases underwent open-heart surgery from October 1996 to June 1999 in our hospital, and tried to find its causes, following complications and their outcomes.

Results: (1). 62 out of 950 cases (6.25%) required prolonged MV because of acute heart failure,arrhythmia, pulmonary hypertension crisis, hypoxemia, cerebral edema . In this group, 41 patients exubated successfully at first time, some patients needed reintubation: 7 cases were directly extubated and another 6 patients receive tracheotomy after second intubation; 4 patients received tracheotomy after the third intubation; other 4 cases received tracheotomy directly. (2). 39 out of 62 cases (62.9%) developped ventilation-associated pneumonia (VAP). VAP occurred 4.79±2.81 days after operation, culture of tracheal aspirate was positive in 11 cases (28.21%) on 5.67±2.90 postoperative day. Gram-negative bacilli were the most frequent causes of VAP. Using Logistic regression analysis, three factors were associated with the risk of VAP: chronic preoperative pneumonia, low plasma immunologic protein and using Histamine 2-receptor blockade postoperatively (P=0.0001, 0.0059, 0.0007 respectively). Using Nonparametric Tests, prolonging of ventilation frequently caused development of VAP (P<0.001).(3). All 62 cases were discharged, they stayed in ICU at the duration of 14.24+ 12.31 days, weaned from ventilator on 3 ~ 51 postoperative day .

Conclusions: Children with serious CHD required proper MV after cardiac surgery, and can be weaned from ventilator gradually when cardiac function become stable, and it is important to overcome the complications following prolonged ventilation such as VAP and ventilator-dependence etc.

 

 

 

 
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