Objective:The objective of the current study was to evaluate the timing of first extubation and compare the outcome of patient extubated early with others; we also evaluated the predictors of early extubation in our cohort.Materials and Methods:This prospective cohort study included children <1 year of age undergoing surgery for congenital heart disease. Timing of first extubation was noted, and patients were dichotomized in the group taking 6 h after completion of surgery as cutoff for early extubation. The outcome of the patients extubated early was compared with those who required prolonged ventilation. Variables were compared between the groups, and predictors of early extubation were evaluated using multivariate logistic regression analysis.Results:One hundred and ninety-four (33.8%) patients were extubated early including 2 extubation in operating room and 406 (70.7%) were extubated within 24 h. Four (0.7%) patients died without extubation. No significant difference in mortality and reintubation was observed between groups. Patient extubated early had a significant lower incidence of sepsis (P = 0.003) and duration of Intensive Care Unit (ICU) stay (P = 0.000). Age <6 months, risk adjustment for congenital heart surgery category ≥3, cardiopulmonary bypass time ≥80 min, aortic cross-clamp time ≥ 60 min, and vasoactive-inotropic score >10 were independently associated with prolonged ventilation.Conclusion:Early extubation in infants postcardiac surgery lowers pediatric ICU stay and sepsis without increasing the risk of mortality or reintubation. Age more than 6 months, less complex of procedure, shorter surgery time, and lower inotropic requirement are independent predictors of early extubation.

Objective: To study the incidence of postoperative cardiac arrhythmias in children undergoing cardiac surgery and to evaluate the risk factors and outcome of these patients. Materials and Methods: This retrospective observational study was conducted in the cardiac pediatric intensive care unit and included children <18 years of age. Children were monitored in the early postoperative period (72 h) for any sustained rhythm abnormality and were classified using standard definition. Details of treatment and their response were assessed. Risk factors for arrhythmias were evaluated using multivariate logistic regression analysis. Results: Five hundred and thirty-six children were included and the prevalence of arrhythmia was 14.4% ( n = 77). The most common arrhythmia was complete heart block (CHB) ( n = 28; 5.2%), followed by junctional ectopic tachycardia (JET) ( n = 25; 4.7%), junctional escape rhythm ( n = 13; 2.4%), supraventricular tachycardia (SVT) ( n = 8; 1.5%), and ventricular tachycardia (VT) ( n = 3; 0.6%). Cardiac pacing was required in all CHB; 8 (28.6%) required a permanent pacemaker. Six (24%) patients with JET responded to conventional measures; 19 (76.0%) patients required amiodarone and 5 (20%) required cooling to 34°C or cardiac pacing. Temporary cardiac pacing was required in 9 (69.2%) cases of junctional escape rhythm. Seven (87.5%) events of SVT responded to adenosine and 1 (12.5%) required cardioversion. Two (66.7%) of VT responded to cardioversion while 1 (33.3%) was refractory. Five (6.5%) patients with arrhythmia died. In the multivariate logistic regression analysis, age <1 year, risk adjustment for congenital heart surgery category ≥3, and cross-clamp time >67 min were independent risk factors. Conclusion: Early postoperative period following cardiac surgery is extremely vulnerable to cardiac arrhythmias. Although majority are self-limiting, some can be life-threatening.

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Cerebrospinal fluid (CSF) diversion procedure has been used for long to treat hydrocephalus in children. The principle of shunting is to establish a communication between the CSF and a drainage cavity (peritoneum, right atrium, and pleura). Ventriculoperitoneal shunt is used most commonly, followed secondly by ventriculopleural shunt (VPLS). Hydrothorax due to excessive CSF accumulation is a rare complication following both the type of shunts and is more frequently seen with VPLS. We report a case of a 6-year-old female child presenting with massive CSF hydrothorax with respiratory failure following VPLS. The aim of the article is to highlight early recognition of this rare and life-threatening condition, which could easily be missed if proper history is not available.

Background: We objective of the current study was to identify the prevalence of AKI and classify them based on Acute Kidney Injury Network (AKIN) staging system. We also evaluated the outcome of patients developing AKI and identified the associated risk factors.Methods: This retrospective study was conducted in pediatric cardiac ICU of a tertiary care hospital. Patient < 18 years who underwent cardiac surgery on cardiopulmonary bypass (CPB) for congenital heart disease were enrolled in the study. AKI was defined as increase in serum creatinine ≥ 0.3 mg/dl within 48 hours or 1.5 times or more from baseline within the first 7 days post-surgery. Results: Nine hundred and twenty children were enrolled in the study. Three hundred and twelve (34%) children developed AKI with 202 (20%) developing stage I, 92 (10%) stage II and 18 (2%) stage III. Resolution was achieved in all the patients and none developed chronic kidney disease. Risk factors for AKI were higher CPB time, higher aortic cross clamp time, significant arrhythmias and higher inotropic requirement at admission. Children with stage 2 and 3 disease had higher odds for requirement of mechanical ventilation > 24 hours and > 72 hours, length of ICU stay > 5 days and in hospital mortality.   Conclusions: AKI following cardiac surgery is common. Although majority of the cases are mild disease and self-limiting it can significantly affect the outcome of these patients.