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Effect of acid-base balance on postoperative course in children with hypoplastic left heart syndrome after the modified Norwood procedure.

Abstract Hypoplastic left heart syndrome (HLHS) is a congenital heart defect that requires 3-stage cardiac surgical treatment and multidirectional specialist care. The condition of newborns in the first postoperative days following the modified Norwood procedure is characterized by considerable hemodynamic instability that may result in a sudden cardiac arrest. It is believed that the most important cause of hemodynamic instability is the fluctuations in redistribution between pulmonary and systemic blood flow.The paper analyzes the postoperative course in 40 neonates with HLHS following the modified Norwood procedure performed under deep hypothermic cardiopulmonary bypass hospitalized in Cardiac Surgical Intensive Care Unit (CSICU) in the years 2014-2015. For all hospitalized children, the arterial blood acid-base balance (ABB) parameters (pH, pO2, pCO2, HCO3, base excess (BE), and lactic acid) were measured 2 times a day during the first 5 postoperative days. The main goal of the studies is to analysis of ABB parameters and their influence on the clinical state of newborns with HLHS. Several descriptors were concerned to describe the neonates clinical state: the date of the surgery (the day of life when the child was operated on), the duration (number of days) of mechanical ventilation employment, the time of hospitalization in intensive care unit, and the total duration of treatment in CSICU.The statistical analysis of the particular ABB parameters revealed a significant dependence (P < .001) between the values of pH, pO2, pCO2, HCO3, BE, lactic acid, and all concerned descriptors of the newborn clinical state.The article shows that monitoring the ABB parameters, proper interpretation of the results, and appropriate modification of pharmacotherapy and respiratory treatment are crucial for therapeutic results and survival rates in neonates with HLHS after the modified Norwood procedure.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start



 

PMID- 28834879
OWN - NLM
STAT- In-Process
DA  - 20170823
LR  - 20170823
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 34
DP  - 2017 Aug
TI  - Effect of acid-base balance on postoperative course in children with hypoplastic 
      left heart syndrome after the modified Norwood procedure.
PG  - e7739
LID - 10.1097/MD.0000000000007739 [doi]
AB  - Hypoplastic left heart syndrome (HLHS) is a congenital heart defect that requires
      3-stage cardiac surgical treatment and multidirectional specialist care. The
      condition of newborns in the first postoperative days following the modified
      Norwood procedure is characterized by considerable hemodynamic instability that
      may result in a sudden cardiac arrest. It is believed that the most important
      cause of hemodynamic instability is the fluctuations in redistribution between
      pulmonary and systemic blood flow.The paper analyzes the postoperative course in 
      40 neonates with HLHS following the modified Norwood procedure performed under
      deep hypothermic cardiopulmonary bypass hospitalized in Cardiac Surgical
      Intensive Care Unit (CSICU) in the years 2014-2015. For all hospitalized
      children, the arterial blood acid-base balance (ABB) parameters (pH, pO2, pCO2,
      HCO3, base excess (BE), and lactic acid) were measured 2 times a day during the
      first 5 postoperative days. The main goal of the studies is to analysis of ABB
      parameters and their influence on the clinical state of newborns with HLHS.
      Several descriptors were concerned to describe the neonates clinical state: the
      date of the surgery (the day of life when the child was operated on), the
      duration (number of days) of mechanical ventilation employment, the time of
      hospitalization in intensive care unit, and the total duration of treatment in
      CSICU.The statistical analysis of the particular ABB parameters revealed a
      significant dependence (P &lt; .001) between the values of pH, pO2, pCO2, HCO3, BE, 
      lactic acid, and all concerned descriptors of the newborn clinical state.The
      article shows that monitoring the ABB parameters, proper interpretation of the
      results, and appropriate modification of pharmacotherapy and respiratory
      treatment are crucial for therapeutic results and survival rates in neonates with
      HLHS after the modified Norwood procedure.
FAU - Gladki, Marcin
AU  - Gladki M
AD  - aDepartment of Pediatric Cardiac Surgery, University Children's Hospital,
      Jagiellonian University bAnaesthesiology and Intensive Care Clinic, University
      Hospital cDepartment of Bioinformatic and Telemedicine, Jagiellonian University, 
      Krakow, Poland.
FAU - Skladzien, Tomasz
AU  - Skladzien T
FAU - Zurek, Rafal
AU  - Zurek R
FAU - Broniatowska, Elzbieta
AU  - Broniatowska E
FAU - Wojcik, Elzbieta
AU  - Wojcik E
FAU - Skalski, Janusz H
AU  - Skalski JH
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/08/24 06:00
MHDA- 2017/08/24 06:00
CRDT- 2017/08/24 06:00
AID - 10.1097/MD.0000000000007739 [doi]
AID - 00005792-201708250-00016 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Aug;96(34):e7739. doi: 10.1097/MD.0000000000007739.