Peri-operative management of paediatric patients undergoing cardiac surgery--focus on respiratory aspects of care.
Children requiring cardiac surgery present particular challenges in peri-operative respiratory management. The wide variety of conditions and operations and their varied impact on respiratory function makes dialogue with related medical staff essential. In most circumstances, cardiac performance is the main determinant of respiratory outcomes. Changing cardiologic and surgical approaches have combined to diminish the severity and frequency of pulmonary hypertensive issues and new treatment modalities are simplifying the intensive care approach. Patients with Down's syndrome and 22q11 deletion syndrome present particular issues related to anatomy, physiology and respiratory function. Certain conditions, including tetralogy of Fallot and cavopulmonary connections, present unique circumstances where respiratory management, sometimes including extubation, may assist in optimisation of cardiac performance. These and other conditions highlight the complexities of cardiopulmonary interactions. Cardiac performance remains the principal determinant of outcome after paediatric cardiac surgery and has the biggest impact on respiratory function.
Schell
David N
DN
Helen MacMillan Paediatric Intensive Care, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. Davids1@chw.edu.au
Winlaw
David S
DS
D002302:Cardiac Output; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002648:Child; D006801:Humans; D019990:Perioperative Care; D010791:Phrenic Nerve / Q000293:injuries; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology; D011184:Postoperative Period