Continuous negative extrathoracic pressure in children after congenital heart surgery.
OBJECTIVE
To study the effects of continuous negative extrathoracic pressure (CNEP) in children after surgery for congenital heart defects.


METHODS
We applied - 3 to - 6 cmH2O CNEP with a cuirass and ventilator to 16 infants and children managed in a paediatric intensive care unit after surgery for congenital heart defects between July 2003 and July 2004. Changes in haemodynamics and gas exchange were assessed 1h and 8h after CNEP application. All patients were breathing spontaneously after successful extubation while receiving CNEP.


RESULTS
Patients were aged 1-34 months (median, 11.5 months). Six had undergone right heart bypass surgery (Group A), and 10 had received positive pressure ventilation for >48 h after other types of heart surgery (Group B). Urine output increased significantly, by 49% at 1 h in Group A, and by 65% in Group B. Decreases in central venous pressure, from median (range) of 15 (12-22)mmHg to 12 (10-21) mmHg in Group A, and from 9 (5-13)mmHg to 8.5 (5-12)mmHg in Group B, and tendency to increases in arterial blood pressure were observed after 1h. In Group B, oxygen saturation increased from 96.5% (84%-100%) at baseline to 99% (87%-100%) and 100% (88%-100%) at 1 h and 8 h, respectively.


CONCLUSIONS
Prophylactic application of CNEP immediately after extubation appears to decrease right ventricular load and improve arterial oxygenation. CNEP might become a useful option in the management of congenital heart surgery patients.
Shime
Nobuaki
N
Department of Anesthesiology and Intensive Care, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan. shime@koto.kpu-m.ac.jp
Toida
Chiaki
C
Itoi
Toshiyuki
T
Hashimoto
Satoru
S
D001794:Blood Pressure; D002496:Central Venous Pressure; D002675:Child, Preschool; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D011182:Postoperative Care; D015919:Ventilators, Negative-Pressure