By Raymond G. Bayer
Univ. of Washington, Seattle. entire textual content targeting the gear wishes of cardiac sufferers and breathing failure pediatric sufferers, Highlights using mechanical aid in nonsurgical ailments, in addition to the optimum administration of perioperative aid in cardiac and pulmonary transplantations in young children. For surgeons, clinicians, and technicians.
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Additional info for Mechanical Support for Cardiac and Respiratory Failure in Pediatric Patients
Sample text
Plasma free hemoglobin is monitored at least daily and should remain below 60 mg/dL. Elevated hemoglobin, especially in conjunction with noise or vibrations in the pump head, may be an indication that mechanical failure is imminent. In this case the pump head can be easily changed with only a very brief period off VAD. Generally, the pump head can be used for 7 days, after which we routinely change it. Occasionally we have replaced a pump head earlier in the presence of signs of imminent failure (see below).
Every center involved with circulatory support in children could cite similar cases, and one might suggest that pediatric patients generally have a greater potential for recovery (without sequelae) than do adults. Therefore, in institutions capable of offering circulatory support, almost any child accepted for open heart surgery will also be a candidate for VAD should the need arise. Is VAD appropriate for resuscitation following cardiac arrest? The main concern is neurological outcome, and the prearrest status is obviously a critical factor for both the brain and the heart.
The capacity for and rapidity of LV hypertrophy may therefore decrease with increasing age. Based on the above information, a two-stage approach has been employed in many pediatric units for babies with TGA and intact ventricular septum presenting beyond 2–3 weeks of age (31). This approach consists of a primary pulmonary artery band plus modified Blalock Taussig shunt to induce LV hypertrophy while maintaining oxygenation. The ASO can be usually performed after a brief period of LV conditioning, usually 2 weeks or less.
