Christoph Camphausen | Macquarie University (original) (raw)
Papers by Christoph Camphausen
Critical care (London, England), 2006
Cardiac surgery using cardiopulmonary bypass produces a generalized systemic inflammatory respons... more Cardiac surgery using cardiopulmonary bypass produces a generalized systemic inflammatory response, resulting in increased postoperative morbidity and mortality. Under these circumstances, a typical pattern of thyroid abnormalities is seen in the absence of primary disease, defined as sick euthyroid syndrome (SES). The presence of postoperative SES mainly in small children and neonates exposed to long bypass times and the pharmacological profile of thyroid hormones and their effects on the cardiovascular physiology make supplementation therapy an attractive treatment option to improve postoperative morbidity and mortality. Many studies have been performed with conflicting results. In this article, we review the important literature on the development of SES in paediatric postoperative cardiac patients, analyse the existing information on thyroid hormone replacement therapy in this patient group and try to summarize the findings for a recommendation.
Pediatric Critical Care Medicine, 2006
To describe the beneficial clinical effect of the use of surfactant in a patient with severe unil... more To describe the beneficial clinical effect of the use of surfactant in a patient with severe unilateral pulmonary hemorrhage after iatrogenic lung injury during corrective surgery for congenital heart defects. Case report. Pediatric cardiac intensive care unit of a tertiary care hospital. An 11-wk-old boy. Intratracheal instillation of 4 mL (100 mg) of surfactant (Survanta) per kilogram of body weight to treat profound and refractory hypoxia and hypercapnia despite high-ventilation pressures, high respiratory rate, and the use of nitric oxide caused by severe pulmonary hemorrhage and atelectasis. The aggressive ventilation variables could be reduced within the following 2 hrs after surfactant use (from Fio2 0.8, peak inspiratory pressure 36 cm, positive end-expiratory pressure 10 cm, respiratory rate 50, tidal volume 63 mL, and nitric oxide 10 ppm to Fio2 0.4, peak inspiratory pressure 28 cm, positive end-expiratory pressure 10, respiratory rate 40, tidal volume 38 mL, and nitric oxide 5 ppm). There was rapid improvement of clinical variables (inotropic support, chest radiograph) as well as oxygenation (Pao2 from 56 to 149 mm Hg), CO2 exchange (Paco2 from 85 to 39 mm Hg), and acidosis (from pH 7.13 to 7.44). The administration of surfactant may be a promising approach to treat severe respiratory failure caused by severe pulmonary hemorrhage.
Pediatric Critical Care Medicine, 2006
The Journal of Thoracic and Cardiovascular Surgery, 2006
The Journal of Thoracic and Cardiovascular Surgery, 2008
Objective: Effects of timing of inception of amiodarone antiarrhythmic treatment after corrective... more Objective: Effects of timing of inception of amiodarone antiarrhythmic treatment after corrective surgery for congenital heart defects are not yet well defined. Methods: In a 10-year prospective observational study, 71 of 2651 patients (2885 procedures, 2106 bypass procedures) received amiodarone for newly detected postoperative atrial (n 5 70) or ventricular (n 5 7) tachyarrhythmia: early treatment (initiation within 60 minutes of arrhythmia detection) and late treatment (after that). From an interim analysis, a treatment protocol was established (32 patients). Inotropic requirements were monitored, as were heart rate, blood pressure, central venous pressure, and sedation requirements. Results: With early treatment (n 5 29), delay before start of amiodarone was 40.7 6 21.9 minutes, versus 227.7 6 228.1 minutes (P , .001) with late treatment (n 5 42). There were significant benefits of early treatment for times to rate (155.9 6 299.8 vs 407.6 6 376.9 minutes, (P , .001) and rhythm control (400.4 6 845 vs 1038.5 6 1158.4 minutes, P , .001), reduction in dose needed for rate control (28.2 6 45.2 vs 66.5 6 137.5 mg, P , .025), and significant reduction in pediatric cardiac intensive care unit stay (3.32 6 1.9 vs 5.26 6 4.27 days, P , .01). There were continuous improvements in heart rate, blood pressure, and filling pressures without additional inotropic requirements or side effects. Conclusion: Early treatment of postoperative tachyarrhythmia with amiodarone according to a standardized treatment protocol is safe and has beneficial effects on arrhythmia control and pediatric cardiac intensive care unit stay.
Intensive Care Medicine, 2005
To describe the beneficial hemodynamic effect of transthoracic external pacing compared with epic... more To describe the beneficial hemodynamic effect of transthoracic external pacing compared with epicardial pacing in a 2 kg premature neonate with congenital complete heart block, hydrops and complex congenital heart disease. Transthoracic epicardial pacing was instituted at a rate of 120 beats/min to treat life-threatening bradycardia (HR 50-60 beats/min), hypotension (BP 45/20 mmHg) and severe lactic acidosis (pH 7.18, lactate 7.5 mmol/l) despite significant catecholamine support. Due to the size of the patient, the external pacing electrodes were placed on the back and front of the patient's chest. To achieve ventricular capture, the electric output had to be increased to 140 mA, resulting in symmetric chest movements. Transthoracic pacing resulted in an immediate improvement of the cardiovascular status, with an adequate blood pressure (BP 60/25 mmHg) and normalization of acid-base-balance. After the insertion of an epicardial pacemaker (paced rate at 140 beats/min), a significantly lower blood pressure was achieved (BP 50/25 mmHg), indicating an additive effect of the rhythmic chest movements to the blood pressure. Unfortunately, third-degree burns were detected on the patients back 1 day after pacemaker insertion. Transthoracic pacing is a life-saving option in an emergency situation, when maximal pharmacological support fails to maintain adequate cardiac output. It may have some additional beneficial effect on blood pressure generation in these patients. To prevent skin injury, the output used needs to be as low as feasible, and the period of pacing as brief as practicable.
Heart, Lung and Circulation, 2011
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), a life threatening arrhythmia induc... more Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), a life threatening arrhythmia induced by sympathetic stimulation in susceptible individuals is often refractory to antiarrhythmic agents. First line of treatment, beta-blockers can be ineffective in up to 50% with implantable cardioverter-defibrillator (ICD) placement for refractory cases. Paradoxically ICD can be arryhthmogenic from shock-associated sympathetic stimulation, initiating more shocks and "electrical storms". This has led to the use of more effective beta blockade offered by left sympathectomy, now performed by minimally invasive video assisted thoracoscopic surgery (VATS). Sympathectomy has been traditionally performed long after ICD placement, after the patient has experienced multiple shocks, thus necessitating two procedures. We report simultaneous ICD insertion and thoracoscopic sympathectomy in a 10 year-old boy with CPVT, and suggest it as a better approach than sequential procedures. To our knowledge this is first such reported case.
Genetics in Medicine, 2013
We sought to identify the demographic, clinical, and psychological factors associated with parent... more We sought to identify the demographic, clinical, and psychological factors associated with parents' attendance at clinical genetics services for congenital heart disease. Methods: A survey assessing access to cardiac genetics services and a range of other variables was sent to the families of 213 children diagnosed with congenital heart disease between the years 2000 and 2009 at the Sydney Children's Hospital, Australia. Results: Of the 114 respondents, 22% had accessed cardiac genetics services. Variables strongly associated with service attendance included presence of a syndrome associated with congenital heart disease (odds ratio = 17.93; P < 0.001) and antenatal diagnosis of congenital heart disease (odds ratio = 4.13; P = 0.02). Most participants (87%) perceived genetic factors as "quite" or "extremely important" in the development of congenital heart disease, and many (73%) believed that receiving information about congenital heart disease and genetics was "quite" or "extremely important"; however, only 36% of participants could recall receiving information of this nature. Forty-two percent of parents reported current concerns about their child's health, and a substantial subset reported levels of depression (26%), anxiety (27%), and stress (32%) warranting clinical attention. Conclusion: There is a strong desire among parents of children with congenital heart disease for greater information about the role of genetic factors; however, most families do not access cardiac genetics services and report limited recall of information gathered from other sources.
Clinical Research in Cardiology, 2008
Intravenous (IV) amiodarone hydrochloride has proven to be a very effective antiarrhythmic treatm... more Intravenous (IV) amiodarone hydrochloride has proven to be a very effective antiarrhythmic treatment option for a variety of ventricular and supraventricular arrhythmias in adults and paediatric patients [13, 40, 53, 57]. These include potentially malignant arrhythmias such as postoperative junctional ectopic tachycardia (JET), atrial flutter and fibrillation with
Zeitschrift für Kardiologie, 2005
A 7-year-old girl presented six hours after ingestion of a yellow oleander seed (Thevetia peruvia... more A 7-year-old girl presented six hours after ingestion of a yellow oleander seed (Thevetia peruviana) with severe emesis, change in colour vision and complete heart block. Initial treatment with phenytoin and isoprenalin infusion led to intermittent supraventricular and ventricular tachycardia. The patient was then treated with two intravenous doses of 190 mg of digoxin-specific Fab antibody fragments (Digibind). Subsequently the patient's rhythm reverted to sinus rhythm and the symptoms resolved within 2 hours. administration of digoxin-specific Fab antibody fragments in an otherwise healthy child after oleander intoxication is safe and without adverse reactions.
Theoretical thesis.Bibliography: pages 113-1161 Introduction -- 2 Literature review -- 3 Data -- ... more Theoretical thesis.Bibliography: pages 113-1161 Introduction -- 2 Literature review -- 3 Data -- 4 Severity score for respiratory distress -- 5 Prediction of length of hospital stay -- 6 Prediction of high-flow therapy -- 7 Comparative effectiveness of high flow and standard therapy -- 8 Performance analysis of non-invasive ventilation (NIV) -- 9 General discussionAcute viral bronchiolitis (AVB) is the most common lower respiratory tract infection during the first year of life and the most frequent reason for hospitalization during infancy, generating extensive cost for healthcare systems. The overall aim of this thesis was to understand and optimise current respiratory therapies for AVB patients who presented to a large tertiary hospital in the USA. The study design was retrospective and observational. It used machine-learning techniques and causal inference algorithms to inform clinical decision making. Specifically, it compared the effectiveness of high-flow nasal cannula (HFNC) ...
Critical care (London, England), 2006
Cardiac surgery using cardiopulmonary bypass produces a generalized systemic inflammatory respons... more Cardiac surgery using cardiopulmonary bypass produces a generalized systemic inflammatory response, resulting in increased postoperative morbidity and mortality. Under these circumstances, a typical pattern of thyroid abnormalities is seen in the absence of primary disease, defined as sick euthyroid syndrome (SES). The presence of postoperative SES mainly in small children and neonates exposed to long bypass times and the pharmacological profile of thyroid hormones and their effects on the cardiovascular physiology make supplementation therapy an attractive treatment option to improve postoperative morbidity and mortality. Many studies have been performed with conflicting results. In this article, we review the important literature on the development of SES in paediatric postoperative cardiac patients, analyse the existing information on thyroid hormone replacement therapy in this patient group and try to summarize the findings for a recommendation.
Pediatric Critical Care Medicine, 2006
To describe the beneficial clinical effect of the use of surfactant in a patient with severe unil... more To describe the beneficial clinical effect of the use of surfactant in a patient with severe unilateral pulmonary hemorrhage after iatrogenic lung injury during corrective surgery for congenital heart defects. Case report. Pediatric cardiac intensive care unit of a tertiary care hospital. An 11-wk-old boy. Intratracheal instillation of 4 mL (100 mg) of surfactant (Survanta) per kilogram of body weight to treat profound and refractory hypoxia and hypercapnia despite high-ventilation pressures, high respiratory rate, and the use of nitric oxide caused by severe pulmonary hemorrhage and atelectasis. The aggressive ventilation variables could be reduced within the following 2 hrs after surfactant use (from Fio2 0.8, peak inspiratory pressure 36 cm, positive end-expiratory pressure 10 cm, respiratory rate 50, tidal volume 63 mL, and nitric oxide 10 ppm to Fio2 0.4, peak inspiratory pressure 28 cm, positive end-expiratory pressure 10, respiratory rate 40, tidal volume 38 mL, and nitric oxide 5 ppm). There was rapid improvement of clinical variables (inotropic support, chest radiograph) as well as oxygenation (Pao2 from 56 to 149 mm Hg), CO2 exchange (Paco2 from 85 to 39 mm Hg), and acidosis (from pH 7.13 to 7.44). The administration of surfactant may be a promising approach to treat severe respiratory failure caused by severe pulmonary hemorrhage.
Pediatric Critical Care Medicine, 2006
The Journal of Thoracic and Cardiovascular Surgery, 2006
The Journal of Thoracic and Cardiovascular Surgery, 2008
Objective: Effects of timing of inception of amiodarone antiarrhythmic treatment after corrective... more Objective: Effects of timing of inception of amiodarone antiarrhythmic treatment after corrective surgery for congenital heart defects are not yet well defined. Methods: In a 10-year prospective observational study, 71 of 2651 patients (2885 procedures, 2106 bypass procedures) received amiodarone for newly detected postoperative atrial (n 5 70) or ventricular (n 5 7) tachyarrhythmia: early treatment (initiation within 60 minutes of arrhythmia detection) and late treatment (after that). From an interim analysis, a treatment protocol was established (32 patients). Inotropic requirements were monitored, as were heart rate, blood pressure, central venous pressure, and sedation requirements. Results: With early treatment (n 5 29), delay before start of amiodarone was 40.7 6 21.9 minutes, versus 227.7 6 228.1 minutes (P , .001) with late treatment (n 5 42). There were significant benefits of early treatment for times to rate (155.9 6 299.8 vs 407.6 6 376.9 minutes, (P , .001) and rhythm control (400.4 6 845 vs 1038.5 6 1158.4 minutes, P , .001), reduction in dose needed for rate control (28.2 6 45.2 vs 66.5 6 137.5 mg, P , .025), and significant reduction in pediatric cardiac intensive care unit stay (3.32 6 1.9 vs 5.26 6 4.27 days, P , .01). There were continuous improvements in heart rate, blood pressure, and filling pressures without additional inotropic requirements or side effects. Conclusion: Early treatment of postoperative tachyarrhythmia with amiodarone according to a standardized treatment protocol is safe and has beneficial effects on arrhythmia control and pediatric cardiac intensive care unit stay.
Intensive Care Medicine, 2005
To describe the beneficial hemodynamic effect of transthoracic external pacing compared with epic... more To describe the beneficial hemodynamic effect of transthoracic external pacing compared with epicardial pacing in a 2 kg premature neonate with congenital complete heart block, hydrops and complex congenital heart disease. Transthoracic epicardial pacing was instituted at a rate of 120 beats/min to treat life-threatening bradycardia (HR 50-60 beats/min), hypotension (BP 45/20 mmHg) and severe lactic acidosis (pH 7.18, lactate 7.5 mmol/l) despite significant catecholamine support. Due to the size of the patient, the external pacing electrodes were placed on the back and front of the patient&amp;#39;s chest. To achieve ventricular capture, the electric output had to be increased to 140 mA, resulting in symmetric chest movements. Transthoracic pacing resulted in an immediate improvement of the cardiovascular status, with an adequate blood pressure (BP 60/25 mmHg) and normalization of acid-base-balance. After the insertion of an epicardial pacemaker (paced rate at 140 beats/min), a significantly lower blood pressure was achieved (BP 50/25 mmHg), indicating an additive effect of the rhythmic chest movements to the blood pressure. Unfortunately, third-degree burns were detected on the patients back 1 day after pacemaker insertion. Transthoracic pacing is a life-saving option in an emergency situation, when maximal pharmacological support fails to maintain adequate cardiac output. It may have some additional beneficial effect on blood pressure generation in these patients. To prevent skin injury, the output used needs to be as low as feasible, and the period of pacing as brief as practicable.
Heart, Lung and Circulation, 2011
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), a life threatening arrhythmia induc... more Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), a life threatening arrhythmia induced by sympathetic stimulation in susceptible individuals is often refractory to antiarrhythmic agents. First line of treatment, beta-blockers can be ineffective in up to 50% with implantable cardioverter-defibrillator (ICD) placement for refractory cases. Paradoxically ICD can be arryhthmogenic from shock-associated sympathetic stimulation, initiating more shocks and "electrical storms". This has led to the use of more effective beta blockade offered by left sympathectomy, now performed by minimally invasive video assisted thoracoscopic surgery (VATS). Sympathectomy has been traditionally performed long after ICD placement, after the patient has experienced multiple shocks, thus necessitating two procedures. We report simultaneous ICD insertion and thoracoscopic sympathectomy in a 10 year-old boy with CPVT, and suggest it as a better approach than sequential procedures. To our knowledge this is first such reported case.
Genetics in Medicine, 2013
We sought to identify the demographic, clinical, and psychological factors associated with parent... more We sought to identify the demographic, clinical, and psychological factors associated with parents' attendance at clinical genetics services for congenital heart disease. Methods: A survey assessing access to cardiac genetics services and a range of other variables was sent to the families of 213 children diagnosed with congenital heart disease between the years 2000 and 2009 at the Sydney Children's Hospital, Australia. Results: Of the 114 respondents, 22% had accessed cardiac genetics services. Variables strongly associated with service attendance included presence of a syndrome associated with congenital heart disease (odds ratio = 17.93; P < 0.001) and antenatal diagnosis of congenital heart disease (odds ratio = 4.13; P = 0.02). Most participants (87%) perceived genetic factors as "quite" or "extremely important" in the development of congenital heart disease, and many (73%) believed that receiving information about congenital heart disease and genetics was "quite" or "extremely important"; however, only 36% of participants could recall receiving information of this nature. Forty-two percent of parents reported current concerns about their child's health, and a substantial subset reported levels of depression (26%), anxiety (27%), and stress (32%) warranting clinical attention. Conclusion: There is a strong desire among parents of children with congenital heart disease for greater information about the role of genetic factors; however, most families do not access cardiac genetics services and report limited recall of information gathered from other sources.
Clinical Research in Cardiology, 2008
Intravenous (IV) amiodarone hydrochloride has proven to be a very effective antiarrhythmic treatm... more Intravenous (IV) amiodarone hydrochloride has proven to be a very effective antiarrhythmic treatment option for a variety of ventricular and supraventricular arrhythmias in adults and paediatric patients [13, 40, 53, 57]. These include potentially malignant arrhythmias such as postoperative junctional ectopic tachycardia (JET), atrial flutter and fibrillation with
Zeitschrift für Kardiologie, 2005
A 7-year-old girl presented six hours after ingestion of a yellow oleander seed (Thevetia peruvia... more A 7-year-old girl presented six hours after ingestion of a yellow oleander seed (Thevetia peruviana) with severe emesis, change in colour vision and complete heart block. Initial treatment with phenytoin and isoprenalin infusion led to intermittent supraventricular and ventricular tachycardia. The patient was then treated with two intravenous doses of 190 mg of digoxin-specific Fab antibody fragments (Digibind). Subsequently the patient's rhythm reverted to sinus rhythm and the symptoms resolved within 2 hours. administration of digoxin-specific Fab antibody fragments in an otherwise healthy child after oleander intoxication is safe and without adverse reactions.
Theoretical thesis.Bibliography: pages 113-1161 Introduction -- 2 Literature review -- 3 Data -- ... more Theoretical thesis.Bibliography: pages 113-1161 Introduction -- 2 Literature review -- 3 Data -- 4 Severity score for respiratory distress -- 5 Prediction of length of hospital stay -- 6 Prediction of high-flow therapy -- 7 Comparative effectiveness of high flow and standard therapy -- 8 Performance analysis of non-invasive ventilation (NIV) -- 9 General discussionAcute viral bronchiolitis (AVB) is the most common lower respiratory tract infection during the first year of life and the most frequent reason for hospitalization during infancy, generating extensive cost for healthcare systems. The overall aim of this thesis was to understand and optimise current respiratory therapies for AVB patients who presented to a large tertiary hospital in the USA. The study design was retrospective and observational. It used machine-learning techniques and causal inference algorithms to inform clinical decision making. Specifically, it compared the effectiveness of high-flow nasal cannula (HFNC) ...