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.