Pleural effusions in children undergoing cardiac surgery

Talwar, Sachin; Agarwala, Sandeep; Mittal, Chander Mohan; Choudhary, Shiv Kumar; Airan, Balram

doi:10.4103/0974-2069.64368

Cited by 30 publications

(37 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Pode-se observar também redução na produção de surfactante e óxido nítrico (7) . O derrame pleural, definido pelo acúmulo anormal de líquido na cavidade pleural, é uma das complicações presentes no pós--operatório das cirurgias cardíacas pediátricas, podendo apre-sentar significância de 25% (14)(15) . Geralmente, acomete crianças portadoras de T 4 F, em que há predomínio da disfunção diastólica do ventrículo direito, que associado à ventilação mecânica pul-monar reduz ainda mais o retorno venoso sistêmico (7) .…”

Section: Discussionunclassified

Evolução Clínica De Pacientes Após Correção Total De Tetralogia De Fallot Em Unidade De Terapia Intensiva Cardiológica Pediátrica

Costa¹,

Marras²,

Furlan³

2016

ACS

View full text Add to dashboard Cite

Introdução: Tetralogia de Fallot compõe o grupo de cardiopatias cianogênicas definida pela existência de quatro defeitos, entre eles, a comunicação interventricular, estenose pulmonar, dextroposição da aorta e hipertrofia do ventrículo direito. Trata-se de uma doença frequente, cuja conduta terapêutica é variável, mostrando bons resultados após correção cirúrgica total. Objetivo: Avaliar a evolução clínica de crianças internadas em uma Unidade de Terapia Intensiva Cardiológica Pediátrica após correção total de Tetralogia de Fallot. Casuística e Métodos: Estudo descritivo com análise quantitativa de pacientes menores de 18 anos de idade, submetidos à cirurgia corretiva de Tetralogia de Fallot, em hospital terciário de São José do Rio Preto, no período de 01 de janeiro de 2011 a 31 de dezembro de 2013. Resultados: Dos 30 pacientes operados no período, 70% (21) apresentaram em seu diagnóstico Tetralogia de Fallot associada a outras doenças cardíacas, sendo a mais frequente a Tetralogia de Fallot com estenose/hipoplasia da valva pulmonar, 66,67% (20) evoluíram com algum tipo de complicação, 26,67% (8) foram a óbito e 63,33% (19) se encontram em bom estado geral e assintomáticos após 30 dias da cirurgia. Conclusão: Apesar do alto índice de complicações e número de mortalidade preocupante, o que se deve à complexidade da doença e perfil da população, o estudo revela que a maioria das crianças submetidas à cirurgia corretiva de Tetralogia de Fallot apresentou prognóstico favorável. Este resultado se deve aos serviços que dispõem de excelentes métodos de diagnóstico e equipe multiprofissional devidamente treinada para a técnica cirúrgica e manejo durante o pós-operatório. O conhecimento do perfil desses pacientes pela equipe multiprofissional e em especial pela enfermagem oportuniza uma abordagem diferenciada e normatizada, o que pode ser determinante para uma intervenção bem sucedida.

show abstract

Section: Discussionunclassified

Evolução Clínica De Pacientes Após Correção Total De Tetralogia De Fallot Em Unidade De Terapia Intensiva Cardiológica Pediátrica

Costa¹,

Marras²,

Furlan³

2016

ACS

View full text Add to dashboard Cite

show abstract

“…2,12,13,15,18,19 Diuretic therapy merits special attention as it has widespread use in paediatric cardiac surgery for the prevention of fluid overload and acute kidney injury. 32,33 In particular, furosemide is conventionally used in children undergoing cardiac surgery to prevent or treat pleural effusion, particularly in some CHD that are at higher risk (i.e. Tetralogy of Fallot, Fontan).…”

Section: Discussionmentioning

confidence: 99%

“…Tetralogy of Fallot, Fontan). 32,33 Despite fluid restriction, a low-dose diuretic is generally recommended in children with PSPS; 25 the role of diuretics in the prevention or treatment of postsurgical pericardial effusion, however, has never been investigated.…”

Section: Discussionmentioning

confidence: 99%

Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes

Cantinotti

Spadoni

Assanta

et al. 2014

Journal of Cardiovascular Medicine

View full text Add to dashboard Cite

Postsurgical pericardial syndromes are common complications after cardiac surgery; however, their treatment is not well established yet. We reviewed the accuracy and limits of clinical trials of prophylaxis and treatment of these diseases to identify an evidence-based therapeutic approach. We performed a literature search in the National Library of Medicine using the keywords pericardial effusion, cardiac surgery and paediatric/congenital. The research was then redefined adding separately the keywords postpericardiotomy syndrome, NSAIDs, steroids and colchicine. We found 12 clinical trials (eight for the prophylaxis and four regarding treatment), testing three major agent classes: NSAIDs, corticosteroids and colchicine. Therapy is generally based on NSAID with or without steroids with the adjunct of colchicine for recurrences. Only a few randomized controlled trials (RCTs) in adults support NSAID therapy. Efficacy of steroids has been proved only in small paediatric works, whereas no studies are available for colchicine. Studies furthermore presented some limitations: not univocal endpoints (not allowing for a meta-analysis), a limited sample size, scarce attention to confounders (such as the underlying cardiac disease and diuretic/analgesic regimen). Moreover, different agents were not assessed, nor when to start therapy. More evidence (two wide RCT plus a meta-analysis) supports the role of colchicine for prophylaxis in adults. Prophylaxis with NSAID/corticosteroids instead failed to have significant advantage in children, whereas a few data are available for adults. Evidence for the treatment of postsurgical pericardial syndromes is incomplete, making it difficult to understand when to treat and which agent to employ, especially in children.

show abstract

“…Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. [1][2][3][4] This significant morbidity results from loss of fluid, proteins and immunoglobulins leading to respiratory compromise, malnutrition and immunosuppression with increasing susceptibility to sepsis with prolonged hospital stay. 1,4,5 Its incidence following cardiac surgery varies widely, mostly reported as 0.5% to 5% with some studies reporting much higher values.…”

Section: Introductionmentioning

confidence: 99%

“…

This wide variation in incidence is attributed to heterogeneity in the study population. 3 Although chylothorax is noted to complicate surgery for congenital heart disease most commonly (e.g. Fontan completion, Glenn shunt, repair of transposition of great arteries, heart transplantation) it could also complicate non-cardiac thoracic surgeries (oesophageal, lung or mediastinal).

…”

mentioning

confidence: 99%

Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

et al. 2020

View full text Add to dashboard Cite

Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first employed in managing this. Surgical options are adopted when the effusion is protracted, most recent of which includes diaphragmatic fenestration. A 9-year-old girl is presented who developed recurrent right chylothorax following thoracoscopic excision of a cystic lymphangioma. Following failed conservative therapy, she had thoracic duct ligation and right diaphragmatic fenestration (using fenestrated polytetrafluoroethylene patch) with satisfactory outcome. Aetio-pathologic mechanisms implicated in postoperative chylothorax have been classified into traumatic (iatrogenic injury to the thoracic duct or its branches) and non-traumatic. With initial conservative measures (repeated pleural aspirations and intercostal drainage, medium chain triglyceride/ low fat feeds or alternatively, fasting and total parenteral nutrition) spontaneous closure remains unpredictable. Diaphragmatic fenestration when employed resulted in faster resolution of effusion and earlier commencement of enteral feeding with no significant complication. Diaphragmatic fenestration is effective and safe for treating refractory post-operative chylothorax.

show abstract

Pleural effusions in children undergoing cardiac surgery

Abstract: Persistent pleural effusions are a source of significant morbidity and mortality following surgery in congenital heart disease. In this review, we discuss the etiology, pathophysiology, and management of this common complication.

Cited by 30 publications

References 39 publications

Evolução Clínica De Pacientes Após Correção Total De Tetralogia De Fallot Em Unidade De Terapia Intensiva Cardiológica Pediátrica

Evolução Clínica De Pacientes Após Correção Total De Tetralogia De Fallot Em Unidade De Terapia Intensiva Cardiológica Pediátrica

Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes

Diaphragmatic fenestration an effective treatment for refractory postoperative chylothorax: a case report

Contact Info

Product

Resources

About