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Research paper thumbnail of Predictors of Cardio Pulmonary Resuscitation Outcome in post-operative cardiac children

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of The Effects of cGMP on Fetal Pulmonary Blood Flow and Lung Liquid Production. ♦ 268

Research paper thumbnail of Ventilator-Associated Pneumonia in Children After Cardiac Surgery

Pediatric Cardiology, 2014

Ventilator-associated pneumonia (VAP) is a nosocomially acquired infection that has a significant... more 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.

Research paper thumbnail of Early outcome of tetralogy of Fallot repair in the

Background: Traditional use of trans-annular patch (TAP) to release right ventricular outflow tra... more Background: Traditional use of trans-annular patch (TAP) to release right ventricular outflow tract (RVOT) obstruction during tetralogy of Fallot (TOF) repair may lead to a harmful pulmonary regurgitation. Different approaches have been used to release RVOT obstruction and spare the pulmonary valve (PV) function. In this study, we aim to evaluate the post-operative course of patients who had TOF repair in the current era that emphasizes on protective strategy of releasing RVOT obstruction and preserving PV function.

Research paper thumbnail of Urinary tract infection in children after cardiac surgery: Incidence, causes, risk factors and outcomes in a single-center study

Journal of Infection and Public Health, 2016

Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this c... more Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in 2012, and we divided the patients into two groups: the UTI (UTI group) and the non-UTI (control group). We compared both groups for multiple peri-operative risk factors. We included 413 children in this study. Of these, 29 (7%) had UTIs after cardiac surgery (UTI group), and 384 (93%) were free from UTIs (control group). All UTI cases were catheter-associated UTIs (CAUTIs). A total of 1578 urinary catheter days were assessed in this study, with a CAUTI density rate of 18 per 1000 catheter days. Multivariate logistic regression analysis demonstrated the following risk factors for CAUTI development: duration of urinary catheter placement (p<0.001), presence of congenital abnormalities of kidney and urinary tract (CAKUT) (p<0.0041) and the presence of certain syndromes (Down, William, and Noonan) (p<0.02). Gram-negative bacteria accounted for 63% of the CAUTI. The main causes of CAUTI were Klebsiella (27%), Candida (24%) and Escherichia coli (21%). Resistant organisms caused 34% of CAUTI. Two patients (7%) died in the UTI group compared with the one patient (0.3%) who died in the control group (p<0.05). Based on these findings, we concluded that an increased duration of the urinary catheter, the presence of CAKUT, and the presence of syndromes comprised the main risk factors for CAUTI. Gram-negative organisms were the main causes for CAUTI, and one-third of them found to be resistant in this single-center study.

Research paper thumbnail of Five children with purulent pericarditis and review of the literature

Annals of Tropical Paediatrics International Child Health, Apr 1, 2004

Purulent pericarditis in children is a life-threatening disease that requires early diagnosis and... more Purulent pericarditis in children is a life-threatening disease that requires early diagnosis and immediate intervention. This cardiac emergency is rarely seen in the western world. However, cases of purulent pericarditis are still being reported in developing countries. We describe our experience with five cases of purulent pericarditis in children seen between 1998 and 2002. Haemophilus influenzae bacteria were isolated in all except one case. With active management, all five children survived.

Research paper thumbnail of 51. The use of bedside critical care US to detect occult diaphragmatic paresis in post-operative cardiac children

Journal of the Saudi Heart Association

ABSTRACT

Research paper thumbnail of 30. Predictors for prolonged mechanical ventilation in children undergoing cardiac surgery

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of 81. Upper body arterio-central venous PCO2 gap (UBCO2G) in monitoring sick children with cardiac disease

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of 59. Urinary tract infection in children after cardiac surgery: Incidence, risk factors and outcome

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of 51. The use of bedside critical care US to detect occult diaphragmatic paresis in post-operative cardiac children

Journal of the Saudi Heart Association, 2015

ABSTRACT

Research paper thumbnail of 53. Improved outcome of cardio-pulmonary arrest in post-operative cardiac children resuscitated in critical care setup

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of Chylothorax

Research paper thumbnail of Early outcome of tetralogy of Fallot repair

Journal of the Saudi Heart Association

Abstract Background: Traditional use of trans-annular patch (TAP) to release right ventricular ou... more Abstract Background: Traditional use of trans-annular patch (TAP) to release right ventricular outflow tract (RVOT) obstruction during tetralogy of Fallot (TOF) repair may lead to a harmful pulmonary regurgitation. Different approaches have been used to release RVOT obstruction and spare the pulmonary valve (PV) function. In this study, we aim to evaluate the post-operative course of patients who had TOF repair in the current era that emphasizes on protective strategy of releasing RVOT obstruction and preserving PV function. Methods: A retrospective study of all TOF cases repaired in our institute between March 2002 and December 2007 was conducted. Cases were classified into two groups; group I included patients that had a TAP, while group II included cases that had simple TOF repair without TAP. Group I was subdivided into two groups, group (A) which include patients who had TAP without a valve. Group (B) includes those who had TAP with a monocuspid valve (Contegra). We compared po...

Research paper thumbnail of Late-presenting complete heart block after pediatric cardiac surgery

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of Post-operative ICU course of infant below 2.2kg undergoing cardiac surgery

Journal of the Saudi Heart Association, 2013

Research paper thumbnail of Critical ULTRASOUND

Research paper thumbnail of Ultrasonography assessment of vocal cords

Journal of the Saudi Heart Association

Objectives: Upper airway obstruction after pediatric cardiac surgery is not uncommon. In the card... more Objectives: Upper airway obstruction after pediatric cardiac surgery is not uncommon. In the cardiac surgical population, an important etiology is vocal cord paresis or paralysis following extubation. In this study, we aimed to evaluate the feasibility and accuracy of ultrasonography (US) assessment of the vocal cords mobility and compare it to fiber-optic laryngoscope (FL). Material and methods: A prospective pilot study has been conducted in Pediatric Cardiac ICU (PCICU) at King Abdulaziz Cardiac Center (KACC) from the 1st of June 2009 till the end of July 2010. Patients who had cardiac surgery and manifested with significant signs of upper airway obstruction were included. Each procedure was performed by different operators who were blinded to each other report. Results of invasive (FL) and non-invasive ultrasonography (US) investigations were compared. Results: Ten patients developed persistent significant upper airway obstruction after cardiac surgery were included in the study...

Research paper thumbnail of Early outcome of tetralogy of Fallot repair in the

Abstract Background: Traditional use of trans-annular patch (TAP) to release right ventricular ou... more Abstract Background: Traditional use of trans-annular patch (TAP) to release right ventricular outflow tract (RVOT) obstruction during tetralogy of Fallot (TOF) repair may lead to a harmful pulmonary regurgitation. Different approaches have been used to release RVOT obstruction and spare the pulmonary valve (PV) function. In this study, we aim to evaluate the post-operative course of patients who had TOF repair in the current era that emphasizes on protective strategy of releasing RVOT obstruction and preserving PV function. Methods: A retrospective study of all TOF cases repaired in our institute between March 2002 and December 2007 was conducted. Cases were classified into two groups; group I included patients that had a TAP, while group II included cases that had simple TOF repair without TAP. Group I was subdivided into two groups, group (A) which include patients who had TAP without a valve. Group (B) includes those who had TAP with a monocuspid valve (Contegra). We compared po...

Research paper thumbnail of Outcome of Norwood and Damus-Kaye-Stansel procedures for univentricular congenital heart anomalies

Saudi medical journal, 2009

To review the experience with Norwood and Damus-Kaye-Stansel (DKS) staged repair in the managemen... more To review the experience with Norwood and Damus-Kaye-Stansel (DKS) staged repair in the management of hypoplastic left heart syndrome (HLHS), or functional single ventricle (FSV) with systemic outflow tract obstruction (SOTO). A retrospective study was conducted from a single center from January 2001 to September 2007 at the Cardiac Sciences Department, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. The cardiac departmental database was reviewed, together with the echocardiographic findings. Demographic data representing age and weight at operation, gender, cardiac anatomy, non-cardiac abnormalities, and operative details were collected. Twenty-eight patients with a diagnosis of HLHS were included in the study. The mean +/- SD for weight was 3.4 +/- 0.85kg and 32 +/- 37 days for age. All infants at our institution who underwent a Norwood or DKS surgery for HLHS, or other forms of FSV with SOTO were included. All included patients under...

Research paper thumbnail of Predictors of Cardio Pulmonary Resuscitation Outcome in post-operative cardiac children

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of The Effects of cGMP on Fetal Pulmonary Blood Flow and Lung Liquid Production. ♦ 268

Research paper thumbnail of Ventilator-Associated Pneumonia in Children After Cardiac Surgery

Pediatric Cardiology, 2014

Ventilator-associated pneumonia (VAP) is a nosocomially acquired infection that has a significant... more 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.

Research paper thumbnail of Early outcome of tetralogy of Fallot repair in the

Background: Traditional use of trans-annular patch (TAP) to release right ventricular outflow tra... more Background: Traditional use of trans-annular patch (TAP) to release right ventricular outflow tract (RVOT) obstruction during tetralogy of Fallot (TOF) repair may lead to a harmful pulmonary regurgitation. Different approaches have been used to release RVOT obstruction and spare the pulmonary valve (PV) function. In this study, we aim to evaluate the post-operative course of patients who had TOF repair in the current era that emphasizes on protective strategy of releasing RVOT obstruction and preserving PV function.

Research paper thumbnail of Urinary tract infection in children after cardiac surgery: Incidence, causes, risk factors and outcomes in a single-center study

Journal of Infection and Public Health, 2016

Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this c... more Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in 2012, and we divided the patients into two groups: the UTI (UTI group) and the non-UTI (control group). We compared both groups for multiple peri-operative risk factors. We included 413 children in this study. Of these, 29 (7%) had UTIs after cardiac surgery (UTI group), and 384 (93%) were free from UTIs (control group). All UTI cases were catheter-associated UTIs (CAUTIs). A total of 1578 urinary catheter days were assessed in this study, with a CAUTI density rate of 18 per 1000 catheter days. Multivariate logistic regression analysis demonstrated the following risk factors for CAUTI development: duration of urinary catheter placement (p<0.001), presence of congenital abnormalities of kidney and urinary tract (CAKUT) (p<0.0041) and the presence of certain syndromes (Down, William, and Noonan) (p<0.02). Gram-negative bacteria accounted for 63% of the CAUTI. The main causes of CAUTI were Klebsiella (27%), Candida (24%) and Escherichia coli (21%). Resistant organisms caused 34% of CAUTI. Two patients (7%) died in the UTI group compared with the one patient (0.3%) who died in the control group (p<0.05). Based on these findings, we concluded that an increased duration of the urinary catheter, the presence of CAKUT, and the presence of syndromes comprised the main risk factors for CAUTI. Gram-negative organisms were the main causes for CAUTI, and one-third of them found to be resistant in this single-center study.

Research paper thumbnail of Five children with purulent pericarditis and review of the literature

Annals of Tropical Paediatrics International Child Health, Apr 1, 2004

Purulent pericarditis in children is a life-threatening disease that requires early diagnosis and... more Purulent pericarditis in children is a life-threatening disease that requires early diagnosis and immediate intervention. This cardiac emergency is rarely seen in the western world. However, cases of purulent pericarditis are still being reported in developing countries. We describe our experience with five cases of purulent pericarditis in children seen between 1998 and 2002. Haemophilus influenzae bacteria were isolated in all except one case. With active management, all five children survived.

Research paper thumbnail of 51. The use of bedside critical care US to detect occult diaphragmatic paresis in post-operative cardiac children

Journal of the Saudi Heart Association

ABSTRACT

Research paper thumbnail of 30. Predictors for prolonged mechanical ventilation in children undergoing cardiac surgery

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of 81. Upper body arterio-central venous PCO2 gap (UBCO2G) in monitoring sick children with cardiac disease

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of 59. Urinary tract infection in children after cardiac surgery: Incidence, risk factors and outcome

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of 51. The use of bedside critical care US to detect occult diaphragmatic paresis in post-operative cardiac children

Journal of the Saudi Heart Association, 2015

ABSTRACT

Research paper thumbnail of 53. Improved outcome of cardio-pulmonary arrest in post-operative cardiac children resuscitated in critical care setup

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of Chylothorax

Research paper thumbnail of Early outcome of tetralogy of Fallot repair

Journal of the Saudi Heart Association

Abstract Background: Traditional use of trans-annular patch (TAP) to release right ventricular ou... more Abstract Background: Traditional use of trans-annular patch (TAP) to release right ventricular outflow tract (RVOT) obstruction during tetralogy of Fallot (TOF) repair may lead to a harmful pulmonary regurgitation. Different approaches have been used to release RVOT obstruction and spare the pulmonary valve (PV) function. In this study, we aim to evaluate the post-operative course of patients who had TOF repair in the current era that emphasizes on protective strategy of releasing RVOT obstruction and preserving PV function. Methods: A retrospective study of all TOF cases repaired in our institute between March 2002 and December 2007 was conducted. Cases were classified into two groups; group I included patients that had a TAP, while group II included cases that had simple TOF repair without TAP. Group I was subdivided into two groups, group (A) which include patients who had TAP without a valve. Group (B) includes those who had TAP with a monocuspid valve (Contegra). We compared po...

Research paper thumbnail of Late-presenting complete heart block after pediatric cardiac surgery

Journal of the Saudi Heart Association, 2015

Research paper thumbnail of Post-operative ICU course of infant below 2.2kg undergoing cardiac surgery

Journal of the Saudi Heart Association, 2013

Research paper thumbnail of Critical ULTRASOUND

Research paper thumbnail of Ultrasonography assessment of vocal cords

Journal of the Saudi Heart Association

Objectives: Upper airway obstruction after pediatric cardiac surgery is not uncommon. In the card... more Objectives: Upper airway obstruction after pediatric cardiac surgery is not uncommon. In the cardiac surgical population, an important etiology is vocal cord paresis or paralysis following extubation. In this study, we aimed to evaluate the feasibility and accuracy of ultrasonography (US) assessment of the vocal cords mobility and compare it to fiber-optic laryngoscope (FL). Material and methods: A prospective pilot study has been conducted in Pediatric Cardiac ICU (PCICU) at King Abdulaziz Cardiac Center (KACC) from the 1st of June 2009 till the end of July 2010. Patients who had cardiac surgery and manifested with significant signs of upper airway obstruction were included. Each procedure was performed by different operators who were blinded to each other report. Results of invasive (FL) and non-invasive ultrasonography (US) investigations were compared. Results: Ten patients developed persistent significant upper airway obstruction after cardiac surgery were included in the study...

Research paper thumbnail of Early outcome of tetralogy of Fallot repair in the

Abstract Background: Traditional use of trans-annular patch (TAP) to release right ventricular ou... more Abstract Background: Traditional use of trans-annular patch (TAP) to release right ventricular outflow tract (RVOT) obstruction during tetralogy of Fallot (TOF) repair may lead to a harmful pulmonary regurgitation. Different approaches have been used to release RVOT obstruction and spare the pulmonary valve (PV) function. In this study, we aim to evaluate the post-operative course of patients who had TOF repair in the current era that emphasizes on protective strategy of releasing RVOT obstruction and preserving PV function. Methods: A retrospective study of all TOF cases repaired in our institute between March 2002 and December 2007 was conducted. Cases were classified into two groups; group I included patients that had a TAP, while group II included cases that had simple TOF repair without TAP. Group I was subdivided into two groups, group (A) which include patients who had TAP without a valve. Group (B) includes those who had TAP with a monocuspid valve (Contegra). We compared po...

Research paper thumbnail of Outcome of Norwood and Damus-Kaye-Stansel procedures for univentricular congenital heart anomalies

Saudi medical journal, 2009

To review the experience with Norwood and Damus-Kaye-Stansel (DKS) staged repair in the managemen... more To review the experience with Norwood and Damus-Kaye-Stansel (DKS) staged repair in the management of hypoplastic left heart syndrome (HLHS), or functional single ventricle (FSV) with systemic outflow tract obstruction (SOTO). A retrospective study was conducted from a single center from January 2001 to September 2007 at the Cardiac Sciences Department, King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. The cardiac departmental database was reviewed, together with the echocardiographic findings. Demographic data representing age and weight at operation, gender, cardiac anatomy, non-cardiac abnormalities, and operative details were collected. Twenty-eight patients with a diagnosis of HLHS were included in the study. The mean +/- SD for weight was 3.4 +/- 0.85kg and 32 +/- 37 days for age. All infants at our institution who underwent a Norwood or DKS surgery for HLHS, or other forms of FSV with SOTO were included. All included patients under...