HYPOTHERMIA AND CARDIOTHORACIC THEATRE

Hypothermia And Cardiothoracic Theatre

Hypothermia And Cardiothoracic Theatre

Introduction

Postoperative low cardiac output states are the major cause of postoperative death in infants and children following corrective cardiac surgery for congenital heart defects. In this unit, entire body hypothermia has been used since 2000 in the administration of these reduced yield states when they are refractory to accepted modes of therapy. Twenty cases treated in this way between July 1986 and June 1990 was reconsidered in 1992. The present report reviews the 50 farther cases treated with moderate hypothermia between July 2000 and December 2005. The median (range) age of patients was 8 months (0 days — 16 years) with the median heaviness of 4.1 kg (2.5-33 kg). Following chilling, there was the decrease in heart rate (p < 0.001), an increase in signify arterial pressure (p < 0.001) and the decrease in signify atrial pressure (p < 0.001). Significant increases in pH and urine yield were also observed, the increase in urine yield being larger in the surviving assembly (p = 0.02). The decrease in platelet enumerate appeared (p < 0.001) but white body-fluid cell enumerate stayed unchanged (p = 0.18). Twenty-five of the 50 patients survived to depart hospital. Induced hypothermia does not emerge to be associated with any complications and after the malfunction of all accepted treatment; it seems probable that the method may have been beneficial to conclusion in some patients.(Badeer, 2000,651)

Induced hypothermia is the well-established method used mainly throughout operations engaging cardiopulmonary bypass in alignment to decrease tissue oxygen demand and supply the stage of cellular defense against ischemia. In the postoperative time span, reduced cardiac yield states refractory to accepted remedy extend to cause significant morbidity and mortality.(Goldberg, 2006,92) In a try to heal these patients, induced hypothermia has been used in the postoperative time span and has been described for the remedy of troublesome heart malfunction in young children next surgery for convoluted congenital heart disease, uncontrollable supraventricular tachycardia and respiratory distress syndrome in the child.(Cooper, 2000, 48)

Between July 1990 and December 1995, 1027 infants and young children had corrective cardiac surgery for congenital defects in this unit, 727 (70.8%) needing cardiopulmonary bypass. The 30-day death rate throughout this time span was 4.8%.(Suga, 200, 61) We now report our cumulative know-how with the use of induced hypothermia for the remedy of troublesome heart malfunction unresponsive to accepted treatment in 50 of these patients after surgery for convoluted congenital heart disease.(Pilkington,2003,390)

Methods

Data were taken retrospectively from intensive treatment unit charts. Only patients formally chilled to 32-33 °C in the postoperative time span were encompassed in the study and all patients had been organised conventionally. Patients with the warmth > 37.1 °C on instigation of chilling were not encompassed in the study.

A reduced cardiac yield state was diagnosed by persistent unresponsive hypotension, poor peripheral perfusion, the broadening core/peripheral warmth distinction, oliguria in the presence of usual (or increased) right atrial pressure and the evolving base shortfall, despite optimisation of pharmacological support and biochemical and haematological parameters.(Suga, 200, 61) Inotropic support was instituted in all patients with reduced cardiac yield states and encompassed the use ...