Continuous negative extrathoracic pressure in children after congenital heart surgery
ABSTRACT
Objective: To study the effects of continuous negativeextrathoracic pressure (CNEP) in children after surgery forcongenital heart defects.
Methods: We applied - 3 to - 6 cmH2O CNEP with a cuirassand ventilator to 16 infants and children managed in apaediatric intensive care unit after surgery for congenitalheart defects between July 2003 and July 2004. Changes inhaemodynamics and gas exchange were assessed 1h and 8hafter CNEP application. All patients were breathingspontaneously after successful extubation while receivingCNEP.
Results: Patients were aged 1-34 months (median, 11.5months). Six had undergone right heart bypass surgery(Group A), and 10 had received positive pressure ventilationfor >48h after other types of heart surgery (Group B). Urineoutput increased significantly, by 49% at 1h in Group A, andby 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 inarterial blood pressure were observed after 1h. In Group B,oxygen saturation increased from 96.5% (84%-100%) atbaseline to 99% (87%-100%) and 100% (88%-100%) at1h and 8h, respectively.
Conclusion: Prophylactic application of CNEP immediatelyafter extubation appears to decrease right ventricular loadand improve arterial oxygenation. CNEP might become auseful option in the management of congenital heart surgerypatients.
Crit Care Resusc 2006; 8: 297-301
