Pediatric Cardiac Intensive Care Unit

Petah Tikva, Israel

Pediatric Cardiac Intensive Care Unit

Petah Tikva, Israel

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Pereira S.J.,Pediatric Cardiac Intensive Care Unit | Santos A.O.M.T.,Oswaldo Cruz Foundation | Bouskela E.,State University of Rio de Janeiro
PLoS ONE | Year: 2015

Background and Objective: Apart from its inotropic property, milrinone has vasodilator, anti-inflammatory and antithrombotic effects that could assist in the reversal of septic microcirculatory changes. This paper investigates the effects of milrinone on endotoxemia-related microcirculatory changes and compares them to those observed with the use of norepinephrine. Materials and Methods: After skinfold chamber implantation procedures and endotoxemia induction by intravenous Escherichia coli lipopolysaccharide administration (2 mg.kg-1), male golden Syrian hamsters were treated with two regimens of intravenous milrinone (0.25 or 0.5 μg.kg-1.min-1). Intravital microscopy of skinfold chamber preparations allowed quantitative analysis of microvascular variables. Macro-hemodynamic, biochemical, and hematological parameters and survival rate were also analyzed. Endotoxemic non-treated animals, endotoxemic animals treated with norepinephrine (0.2 μg.kg-1.min-1), and non-endotoxemic hamsters served as controls. Results: Milrinone (0.5 μg.kg-1.min-1) was effective in reducing lipopolysaccharide-induced arteriolar vasoconstriction, capillary perfusion deficits, and inflammatory response, and in increasing survival. Norepinephrine treated animals showed the best mean arterial pressure levels but the worst functional capillary density values among all endotoxemic groups. Conclusion: Our data suggests that milrinone yielded protective effects on endotoxemic animals' microcirculation, showed anti-inflammatory properties, and improved survival. Norepinephrine did not recruit the microcirculation nor demonstrated anti-inflammatory effects. © 2015 de Miranda et al.


Schiller O.,Pediatric Intensive Care Unit | Schiller O.,Tel Aviv University | Dagan O.,Pediatric Cardiac Intensive Care Unit | Dagan O.,Tel Aviv University | And 8 more authors.
Pediatric Cardiology | Year: 2013

Although some evidence suggests benefit of steroid supplementation after pediatric cardiac surgery, data correlating adrenal function with the postoperative course is scarce. This study sought to determine if adrenal insufficiency (AI) after cardiac surgery is associated with a more complicated postoperative course in children. A prospective study was performed during a 6-month period at a pediatric medical center. Included were 119 children, 3 months and older, who underwent heart surgery with cardiopulmonary bypass. Cortisol levels were measured before and 18 h after surgery. Patients were divided into two groups by procedure complexity (low or high), and clinical and laboratory parameters were compared between patients with and without AI within each complexity group. In the low-complexity group, 45 of the 65 patients had AI. The normal adrenal function (NAF) subgroup had greater inotropic support at 12, 24, and 36 h after surgery and a higher lactate level at 12 and 24 h after surgery. There were no significant differences between subgroups in duration of ventilation, sedation, intensive care unit (ICU) stay, or urine output. In the high-complexity group, 27 patients had AI, and 27 did not. There were no significant differences between subgroups in inotropic support or urine output during the first 36 h or in mechanical ventilation, sedation, or ICU stay duration. Children with AI after heart surgery do not have a more complex postoperative course than children with NAF. The adrenal response of individual patients seems to be appropriate for their cardiovascular status. © 2013 Springer Science+Business Media New York.


Ebert T.,Bar - Ilan University | Zolotov Y.,Bar - Ilan University | Eliav S.,Bar - Ilan University | Eliav S.,Israel Defense Forces | And 5 more authors.
Israel Medical Association Journal | Year: 2015

Background: Cannabis has been used throughout history for different purposes but was outlawed in the United States in 1937; many countries followed suit. Although recently reintroduced as a medical treatment in several countries, the use of cannabis in Israel is permitted for some medical purposes but is still controversial, eliciting heated public and professional debate. The few published studies on physicians’ attitudes to medical cannabis found them to be generally unsupportive. Objectives: To examine, for the first time, the experience, knowledge and attitudes of Israeli physicians towards medical cannabis (MC). Methods: A 32 item questionnaire reflected physicians’ demographics, knowledge of and experience with MC and their attitudes to this treatment. Results: Seventy-two physicians participated in this study. Physicians generally agreed that MC treatment could be helpful for chronic and for terminally ill patients (n=61, 79.2%). Oncologists and pain specialists did not agree unanimously that MC can undermine mental health, whereas other physicians did (P < 0.001, df = 4). Physicians who recommended MC in the past (once or more) agreed, more than physicians who did not, with the statement “MC treatment in Israel is accessible to patients who need it” (P < 0.05, df = 2). Conclusions: In contrast to other studies we found partial acceptance of MC as a therapeutic agent. Further in-depth studies are needed to address regulatory and educational needs. © 2015, Israel Medical Association. All right reserved.


Schiller O.,Pediatric Intensive Care Unit | Schiller O.,Tel Aviv University | Levy I.,Infectious Diseases Unit | Levy I.,Tel Aviv University | And 8 more authors.
Acta Paediatrica, International Journal of Paediatrics | Year: 2011

Aim: To further characterize apnoea(s) complicating bronchiolitis because of respiratory syncytial virus (RSV), to describe the incidence of this complication and identify possible risk factors for apnoea(s) and its development. Methods: The files of infants admitted to the paediatric intensive care unit (PICU) for RSV bronchiolitis during three bronchiolitis seasons (2004-2007) were reviewed for demographic, clinical and laboratory parameters. Parameters were compared between patients with and without apnoeas. Results: Seventy-nine patients met the study criteria: 43 were admitted to the PICU for central apnoeas and the remainder for respiratory distress or failure. The percentage of infants admitted for apnoea increased during the study period (28.6 to 77.1%, p = 0.004). The overall prevalence of apnoea in this population was 4.3%. Possible risk factors for apnoea(s) were younger age (1.3 vs. 4.3 months, p = 0.002), lower admission weight (3.3 vs. 5 kg, p < 0.001), lower gestational age (35.8 vs. 37.8 weeks, p = 0.01), admission from the emergency room (50% vs. 9.1%, p < 0.001) and lack of hyperthermia (p < 0.001). Respiratory acidosis was found to be a protective factor on logistic regression analysis. Conclusion: The prevalence of apnoea in infants admitted to the PICU for RSV bronchiolitis in our centre may be increasing. Preterm, younger infants with no fever are at relatively high risk of apnoea at presentation, while older infants with fever are at lower risk. © 2010 Foundation Acta Pædiatrica.


PubMed | Oswaldo Cruz Foundation, State University of Rio de Janeiro and Pediatric Cardiac Intensive Care Unit
Type: Journal Article | Journal: PloS one | Year: 2015

Apart from its inotropic property, milrinone has vasodilator, anti-inflammatory and antithrombotic effects that could assist in the reversal of septic microcirculatory changes. This paper investigates the effects of milrinone on endotoxemia-related microcirculatory changes and compares them to those observed with the use of norepinephrine.After skinfold chamber implantation procedures and endotoxemia induction by intravenous Escherichia coli lipopolysaccharide administration (2 mg.kg-1), male golden Syrian hamsters were treated with two regimens of intravenous milrinone (0.25 or 0.5 g.kg-1.min-1). Intravital microscopy of skinfold chamber preparations allowed quantitative analysis of microvascular variables. Macro-hemodynamic, biochemical, and hematological parameters and survival rate were also analyzed. Endotoxemic non-treated animals, endotoxemic animals treated with norepinephrine (0.2 g.kg-1.min-1), and non-endotoxemic hamsters served as controls.Milrinone (0.5 g.kg-1.min-1) was effective in reducing lipopolysaccharide-induced arteriolar vasoconstriction, capillary perfusion deficits, and inflammatory response, and in increasing survival. Norepinephrine treated animals showed the best mean arterial pressure levels but the worst functional capillary density values among all endotoxemic groups.Our data suggests that milrinone yielded protective effects on endotoxemic animals microcirculation, showed anti-inflammatory properties, and improved survival. Norepinephrine did not recruit the microcirculation nor demonstrated anti-inflammatory effects.


Shaath G.A.,Pediatric Cardiac Intensive Care Unit | Jijeh A.,Pediatric Cardiac Intensive Care Unit | Faruqui F.,Pediatric Cardiac Intensive Care Unit | Bullard L.,Pediatric Cardiac Intensive Care Unit | And 3 more authors.
Pediatric Cardiology | Year: 2014

Ventilator-associated pneumonia (VAP) is a nosocomially acquired infection that has a significant burden on intensive care units (ICUs). We investigated the incidence of VAP in children after cardiac surgery and its impact on morbidity and mortality. A prospective cross-sectional review was performed in the postoperative cardiac patients in pediatric cardiac intensive care unit (PCICU) patients from March 2010 until the end of September 2010. The patients were divided into two groups: the VAP group and the non-VAP group, Demographic data and perioperative risk variables were collected for all patients. One hundred thirty-seven patients were recruited, 65 (48 %) female and 72 (52 %) male. VAP occurred in 9 patients (6.6 %). Average body weights in the VAP and non-VAP groups were 5.9 ± 1.24 and 7.3 ± 0.52 kg, respectively. In our PCICU, the mechanical ventilation (MV) use ratio was 26 % with a VAP-density rate of 29/1000 ventilator days. Univariate analyses showed that the risk variables to develop VAP are as follows: prolonged cardiopulmonary bypass (CPB) time, use of total parenteral nutrition (TPN), and prolonged ICU stay (p < 0.002 for all). Thirty-three percent of VAP patients had Gram-negative bacilli (GNB). VAP Patients require more MV hours, longer stay, and more inhaled nitric oxide. Mortality in the VAP group was 11 % and in the non-VAP group was 0.7 % (p = 0.28). VAP incidence is high in children after cardiac surgery mainly by GNB. VAP increases with longer CPB time, administration of TPN, and longer PCICU stay. VAP increases morbidity in postoperative cardiac patients. © 2013 Springer Science+Business Media.


Jijeh A.M.Z.,Pediatric Cardiac Intensive Care Unit | Shaath G.,Pediatric Cardiac Intensive Care Unit | Kabbani M.S.,Pediatric Cardiac Intensive Care Unit | Elbarbary M.,Pediatric Cardiac Intensive Care Unit | Ismail S.,Pediatric Cardiac Intensive Care Unit
Journal of the Saudi Heart Association | Year: 2014

Introduction: Safely obtaining vascular access in the pediatric population is challenging. This report highlights our real-world experience in developing a safer approach to obtaining vascular access using ultrasound guidance in children and infants with congenital heart disease. Methods: As part of a quality initiative, we prospectively monitored outcomes of all vascular access attempts guided by ultrasound from January 2010 to September 2010. Variables monitored included age, weight, the time from first needle puncture to wire insertion, site of insertion, number of attempts, type of line, and complications. Results: There were 77 attempts (15 arterial and 62 venous) to obtain vascular access in 43 patients. The mean age was 15. months (6. days-11. years; median 2.5. months). The mean weight was 7.2. kg (2-46. kg, median 3.8). Success rates were 93% and 95% for arterial and venous cannulation, respectively. Mean time from first needle puncture to wire insertion was 3.9. min (0.5-15. min, median 2. min). Fifty-five (75%) central line cannulations were successful from the first puncture; 17(23%) were successful from the second puncture; and one case (2%) required three punctures. Thirty patients (45%) weighed less than 3.5. kg. This lower body weight did not affect success rate, which was unexpectedly high (96.6%). There were no associated complications. Conclusion: Ultrasound guided vascular cannulation in critically ill pediatric patients is safe, effective and efficient. This approach had a high success rate, and was associated with zero complications in our setting. © 2014 King Saud University.


PubMed | Pediatric Cardiac Intensive Care Unit
Type: Journal Article | Journal: Journal of the Saudi Heart Association | Year: 2014

Safely obtaining vascular access in the pediatric population is challenging. This report highlights our real-world experience in developing a safer approach to obtaining vascular access using ultrasound guidance in children and infants with congenital heart disease.As part of a quality initiative, we prospectively monitored outcomes of all vascular access attempts guided by ultrasound from January 2010 to September 2010. Variables monitored included age, weight, the time from first needle puncture to wire insertion, site of insertion, number of attempts, type of line, and complications.There were 77 attempts (15 arterial and 62 venous) to obtain vascular access in 43 patients. The mean age was 15months (6days-11years; median 2.5months). The mean weight was 7.2kg (2-46kg, median 3.8). Success rates were 93% and 95% for arterial and venous cannulation, respectively. Mean time from first needle puncture to wire insertion was 3.9min (0.5-15min, median 2min). Fifty-five (75%) central line cannulations were successful from the first puncture; 17(23%) were successful from the second puncture; and one case (2%) required three punctures. Thirty patients (45%) weighed less than 3.5kg. This lower body weight did not affect success rate, which was unexpectedly high (96.6%). There were no associated complications.Ultrasound guided vascular cannulation in critically ill pediatric patients is safe, effective and efficient. This approach had a high success rate, and was associated with zero complications in our setting.

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