Pulmonary complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease (original) (raw)
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Cardiology in the Young, 2008
A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, relate...
Cardiology in the young, 2008
A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the cardiac system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has prepared and defined a near-exhaustive list of cardiac complications, including intraoperative complications and cardiopulmonary bypass-related complications. These cardiac complications are presented in the following subgroups:1) Cardiac (general)2) Cardiac – Metabolic3) Cardiac – Residual and Recurrent cardiac lesions4) Arrhythmia5) Cardiopulmonary bypass and Mechanical circulatory support, and6) Operative/Procedural.Within each subgroup, complications are presented in alphabetical order. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, quality improvement initiatives, reporting of complications, and comparing strategies for treatment.
2014
BACKGROUND Postoperative disorders of the respiratory system in infants after cardiac surgical procedures entail significant clinical problems, both because they are life threatening and due to their potential adverse effect on the final outcome of the treatment. The main causes of postoperative complications include significant changes in the vascular system, intrathoracic manipulation, potentially leading to the damage of anatomical structures, drainage of the pleural cavities, postoperative immobilization, mechanical respiration and post-perfusion syndrome. The basic clinical symptoms include changes in the pulmonary parenchyma and fluid in the pleural space. The identification of the type of changes and the risk factors related to postoperative pulmonary complications enables optimal adjustment of postoperative care strategies, including directed respiratory physiotherapy[1, 9]. The aim of the study was to identify the most common respiratory complications in patients after pediatric cardiac surgical procedures, to carry out a separate analysis of the group of infants with heart defects associated with Down syndrome and to evaluate the effect of extracorporeal circulation (ECC) time and aortic cross-clamp (ACC) time on pulmonary complications.
What is Operative Morbidity? Defining Complications in a Surgical Registry
During the last 2 decades, mortality after surgery for congenital heart disease has decreased dramatically and is now 4% in several large multicenter studies [1-6]. To allow for complete evaluation of quality of care in the field of congenital heart surgery, alternative methodologies must be developed that go beyond mortality or adjusted mortality to include morbidity assessment. The European Association for Cardio-Thoracic Surgery (EACTS) and The Society of Thoracic Surgeons (STS) Congenital Heart Databases, two of the most widely used tools to report and evaluate quality of care in congenital heart surgery, are the ideal platforms upon which may be developed a systematic characterization of operative morbidity.
Arch Med Sci, 2008
A b s t r a c t Introduction: We aimed to draw a profile of young children undergoing surgical repair for congenital heart disease (CHD), who have prolonged postoperative recovery, and compared this profile with the profile of a shorter postoperative recovery time group. Material and methods: Data of 147 consecutive patients aged younger than 36 months undergoing cardiac surgery for CHD were reviewed, and they were allocated to two groups based on the duration of intensive care unit (ICU) stay equal to or less than 7 days (group I, n=114), and more than 7 days (group II, n=33). R Re es su ul lt ts s: : The patients in group II were significantly younger (10.2±3.9 months vs. 19.9±5.8 months; P<0.001). Aortic cross-clamp times were 39.1±3.6 min in group I, and 50.4±8.7 min in group II (P<0.05). Extubation failures (more than 48 hours) occurred in 3 cases in group I, compared to 29 patients in group II (P<0.0001). A total of 28 patients (7 in group I, and 21 in group II) developed pulmonary complications. These patients contributed to the majority of total ventilator days (69%) as well as ICU stay (58%). Fourteen percent of patients underwent staged operations in group I, compared to 48.5% in group II (P<0.002). Conclusions: Pulmonary complications seem to be one of the most important causes of delayed recovery following cardiac surgery in young children. We suggest that extubation time is a crucial factor for development of pulmonary problems. This factor might be more important for infants who undergo staged operations. Key words: congenital heart disease, infant, postoperative care, surgery.
Pediatric Critical Care Medicine, 2002
arly diagnosis of congenital heart disease by fetal echocardiography, improved perinatal care, innovations in surgical technique and myocardial protection, and better perioperative care have led to more young children surviving cardiac surgery for their underlying congenital heart disease (1, 2). The demand on resources for postoperative cardiac care is expected to increase with the increasing complexity of surgery performed at an earlier age. Among other risk factors, duration of mechanical ventilation is an important factor that determines postoperative recovery and outcome (3). Prolonged ventilation is well documented to be associated with major complications and mortality, hence early extubation after cardiac operations in neonates and children is highly desirable (4-6). Risk factors associated with prolonged mechanical ventilation after cardiac surgery in young children included a high preoperative pulmonary vascular resistance, the need for preoperative ventilation, longer cardiopulmonary bypass and aortic cross-clamp durations, and need for additional surgical interventions (6, 7). Furthermore, ventilator-associated pneumonia had also been shown recently to account for a major delay in extubation after pediatric cardiac surgery (8, 9). Although noninfectious pulmonary complications are also a common occurrence in young children after cardiac surgery and are associated with prolonged stay in the intensive care unit (10), there is a paucity
Pulmonary complications after cardiac surgery
Seminars in cardiothoracic and vascular anesthesia, 2004
Over the past two decades there has been a steady evolution in the practice of adult cardiac surgery with the introduction of "off-pump" surgery. However, respiratory complications remain a leading cause of postcardiac surgical morbidity and can prolong hospital stays and increase costs. The high incidence of pulmonary complications is in part due to the disruption of normal ventilatory function that is inherent to surgery in the thoracic region. Furthermore, patients undergoing such surgery often have underlying illnesses such as intrinsic lung disease (e.g., chronic obstructive pulmonary disease) and pulmonary dysfunction secondary to cardiac disease (e.g., congestive heart failure) that increase their susceptibility to postoperative respiratory problems. Given that many patients undergoing cardiac surgery are thus susceptiple to pulmonary complications, it is remarkable that more patients do not suffer from them during and after cardiac surgery. This is to a large degre...
Definition of important early morbidities related to paediatric cardiac surgery
Cardiology in the young, 2016
Morbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is "generally bad for you", and postoperative morbidity linked to paediatric cardiac surgery encompasses a range of conditions that may impact the patient and are potential targets for quality assurance. As part of a wider study, a multi-disciplinary group of professionals aimed to define a list of morbidities linked to paediatric cardiac surgery that was prioritised by a panel reflecting the views of both professionals from a range of disciplines and settings as well as parents and patients. We present a set of definitions of morbidity for use in routine audit after paediatric cardiac surgery. These morbidities are ranked in priority order as acute neurological event, unplanned re-operation, feeding problems, the need for renal support, major adverse cardiac events or never events, extracorporeal life support, necrotising enterocolitis, surgical site of blood stream infection, a...