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Current challenges in cardiac intensive care: optimal strategies for mechanical ventilation and timing of extubation

Published online by Cambridge University Press:  01 December 2008

David S. Cooper ,
John M. Costello ,
Ronald A. Bronicki ,
Arabela C. Stock ,
Jeffrey Phillip Jacobs ,
Chitra Ravishankar ,
Troy E. Dominguez  and
Nancy S. Ghanayem
David S. Cooper*
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Divisions of Critical Care and Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Florida Pediatric Associates andCardiac Surgical Associates (CSA), Saint Petersburg and Tampa, Florida, United States of America
John M. Costello
Affiliation:
Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
Ronald A. Bronicki
Affiliation:
Children’s Hospital of Orange County, Orange, California, David Geffen School of Medicine at the University of California, Los Angeles, United States of America
Arabela C. Stock
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Divisions of Critical Care and Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Florida Pediatric Associates andCardiac Surgical Associates (CSA), Saint Petersburg and Tampa, Florida, United States of America
Jeffrey Phillip Jacobs
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Divisions of Critical Care and Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Florida Pediatric Associates andCardiac Surgical Associates (CSA), Saint Petersburg and Tampa, Florida, United States of America
Chitra Ravishankar
Affiliation:
The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
Troy E. Dominguez
Affiliation:
The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
Nancy S. Ghanayem
Affiliation:
Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
*
Correspondence to: David S. Cooper, MD, MPH, The Congenital Heart Institute of Florida (CHIF), Clinical Assistant Professor of Paediatrics, University of South Florida, Florida Pediatric Associates, 880 Sixth Street South, Suite 370, St. Petersburg, FL 33701. Tel: 727-767-4375; E-mail: davidscooper@verizon.net
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Abstract

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Keywords

Cardiopulmonary interactionspulmonary physiologycongenital cardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue S3: Controversies and challenges of Tetralogy of Fallot and other challenges facing paediatric cardiovascular practitioners and their patients , December 2008 , pp. 72 - 83
Copyright
Copyright © Cambridge University Press 2008

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References

1.Hill, LL, Pearl, RG. Flow triggering, pressure triggering, and autotriggering during mechanical ventilation. Crit Care Med 2000; 28: 579–581.CrossRefGoogle ScholarPubMed
2.Kondili, E, Prinianakis, G, Georgopoulos, D, et al. Patient-ventilator interaction. Br J Anaesth 2003; 91: 106–119.CrossRefGoogle ScholarPubMed
3.Thiagarajan, RR, Coleman, DM, Bratton, SL, et al. Inspiratory work of breathing is not decreased by flow-triggered sensing during spontaneous breathing in children receiving mechanical ventilation: a preliminary report. Pediatr Crit Care Med 2004; 5: 375–378.CrossRefGoogle Scholar
4.Sinderby, C, Beck, J, Spahija, J, et al. Inspiratory muscle unloading by neurally adjusted ventilatory assist during maximal inspiratory efforts in healthy subjects. Chest 2007; 131: 711–717.CrossRefGoogle ScholarPubMed
5.Baker, AB, Restall, R, Clark, BW, et al. Effects of varying inspiratory flow waveform and time in intermittent positive pressure ventilation: emphysema. Br J Anaesth 1982; 54: 547–554.CrossRefGoogle ScholarPubMed
6.Davis, K Jr, Branson, RD, Campbell, RS, et al. Comparison of volume control and pressure control ventilation: is flow waveform the difference? J Trauma 1996; 41: 808–814.CrossRefGoogle ScholarPubMed
7.MacIntyre, NR, Ho, LI. Effects of initial flow rate and breath termination criteria on pressure support ventilation. Chest 1991; 99: 134–138.CrossRefGoogle ScholarPubMed
8.Taeed, R, Schwartz, SM, Pearl, JM, et al. Unrecognized pulmonary venous desaturation early after Norwood palliation confounds Qp:Qs assessment and compromises oxygen delivery. Circulation 2001; 103: 2699–2704.CrossRefGoogle ScholarPubMed
9.Lindberg, L, Olsson, AK, Jogi, P, et al. How common is severe pulmonary hypertension after pediatric cardiac surgery? J Thorac Cardiovasc Surg 2002; 123: 1155–1163.CrossRefGoogle ScholarPubMed
10.Schulze-Neick, I, Li, J, Penny, DJ, et al. Pulmonary vascular resistance after cardiopulmonary bypass in infants: effect on postoperative recovery. J Thorac Cardiovasc Surg 2001; 121: 1033–1039.CrossRefGoogle ScholarPubMed
11.Riethmueller, J, Borth-Bruhns, T, Kumpf, M, et al. Recombinant human deoxyribonuclease shortens ventilation time in young, mechanically ventilated children. Pediatr Pulmonol 2006; 41: 61–66.CrossRefGoogle ScholarPubMed
12.DiCarlo, JV, Raphaely, RC, Steven, JM, et al. Pulmonary mechanics in infants after cardiac surgery. Crit Care Med 1992; 20: 22–27.CrossRefGoogle ScholarPubMed
13.Stayer, SA, Diaz, LK, East, DL, et al. Changes in respiratory mechanics among infants undergoing heart surgery. Anesth Analg 2000; 98: 49–55.Google Scholar
14.Gattinoni, L, Vagginelli, F, Chiumello, D, et al. Physiologic rationale for ventilator setting in acute lung injury/acute respiratory distress syndrome patients. Crit Care Med 2003; 31 (Suppl): S300–S304.CrossRefGoogle ScholarPubMed
15.Gattinoni, L, Caironi, P, Carlesso, E. How to ventilate patients with acute lung injury and acute respiratory distress syndrome. Curr Opin Crit Care 2005; 11: 69–76.CrossRefGoogle ScholarPubMed
16.Wrigge, H, Uhlig, U, Baumgarten, G, et al. Mechanical ventilation strategies and inflammatory responses to cardiac surgery: a prospective randomized clinical trial. Intensive Care Med 2005; 31: 1379–1387.CrossRefGoogle ScholarPubMed
17.Wrigge, H, Uhlig, U, Zinserling, J, et al. The effects of different ventilatory settings on pulmonary and systemic inflammatory responses during major surgery. Anesth Analg 2000; 98: 775–781.Google Scholar
18.Kocis, KC, Dekeon, MK, Rosen, HK, et al. Pressure-regulated volume control vs volume control ventilation in infants after surgery for congenital heart disease. Pediatr Cardiol 2001; 22: 233–237.CrossRefGoogle ScholarPubMed
19.Tokioka, H, Nagano, O, Ohta, Y, et al. Pressure support ventilation augments spontaneous breathing with improved thoracoabdominal synchrony in neonates with congenital heart disease. Anesth Analg 1997; 85: 789–793.CrossRefGoogle ScholarPubMed
20.Singh, J, Sinha, SK, Donn, SM. Volume-targeted ventilation of newborns. Clin Perinatol 2007; 34: 93–105.CrossRefGoogle ScholarPubMed
21.Imanaka, H, Takeuchi, M, Tachibana, K, et al. Changes in respiratory pattern during continuous positive airway pressure in infants after cardiac surgery. J Anesth 2004; 18: 241–249.CrossRefGoogle ScholarPubMed
22.Kocis, KC, Meliones, JN, Dekeon, MK, et al. High-frequency jet ventilation for respiratory failure after congenital heart surgery. Circulation 1992; 86 (5 Suppl): 127–132.Google ScholarPubMed
23.Meliones, JN, Bove, EL, Dekeon, MK, et al. High-frequency jet ventilation improves cardiac function after the Fontan procedure. Circulation 1991; 84 (5 Suppl): 364–368.Google ScholarPubMed
24.Baden, HP, Li, CM, Hall, D, et al. High-frequency oscillatory ventilation in the management of infants with pulmonary hemorrhage after cardiac surgery. J Cardiothorac Vasc Anesth 1995; 9: 578–580.CrossRefGoogle ScholarPubMed
25.Wernovsky, G, Kuijpers, M, Van Rossem, MC, et al. Postoperative course in the cardiac intensive care unit following the first stage of Norwood reconstruction. Cardiol Young 2007; 17: 652–665.CrossRefGoogle ScholarPubMed
26.Harrison, AMM. Failed extubation after cardiac surgery in young children: Prevalence, pathogenesis, and risk factors. Pediatr Crit Care Med 2002; 3: 148–152.CrossRefGoogle ScholarPubMed
27.Courtney, SE, Barrington, KJ, Courtney, SE, et al. Continuous positive airway pressure and noninvasive ventilation. Clin Perinatol 2000; 34: 73–92.CrossRefGoogle Scholar
28.Chin, K, Takahashi, K, Ohmori, K, et al. Noninvasive ventilation for pediatric patients under 1 year of age after cardiac surgery. J Thorac Cardiovasc Surg 2007; 134: 260–261.CrossRefGoogle ScholarPubMed
29.Hoch, B, Zschocke, A, Barth, H, et al. Bilateral diaphragmatic paralysis after cardiac surgery: ventilatory assistance by nasal mask continuous positive airway pressure. Pediatr Cardiol 2001; 22: 77–79.CrossRefGoogle ScholarPubMed
30.Pinsky, M. Determinants of pulmonary arterial flow variation during respiration. J Appl Physiol 1984; 56: 1237–1245.CrossRefGoogle ScholarPubMed
31.O’Quin, R, Marini, JJ. Pulmonary artery occlusion pressure: Clinical physiology, measurement, and interpretation. Am Rev Resp Dis 1983; 128: 319–326.Google ScholarPubMed
32.Takata, M, Robotham, JL. Ventricular external constraint by the lung and pericardium during positive end-expiratory pressure. Am Rev Resp Dis 1991; 143: 872–875.CrossRefGoogle ScholarPubMed
33.Robotham, JL, Rabson, J, Permutt, S, et al. Left ventricular hemodynamics during respiration. J Appl Physiol 1979; 47: 1295–1303.CrossRefGoogle ScholarPubMed
34.Mathru, M, Rao, TL, El-Etr, AA, et al. Hemodynamic responses to changes in ventilatory pattern in patients with normal and poor left ventricular reserve. Crit Care Med 1982; 10: 423–426.CrossRefGoogle ScholarPubMed
35.Bradley, TD, Holloway, RM, McLaughlin, PR, et al. Cardiac output response to continuous positive airway pressure in congestive heart failure. Am Rev Respir Dis 1992; 145: 377–382.CrossRefGoogle ScholarPubMed
36.Baratz, DM, Westbrook, PR, Shah, PK, et al. Effect of nasal continuous positive airway pressure on cardiac output and oxygen delivery in patients with congestive heart failure. Chest 1992; 102: 1397–1401.CrossRefGoogle ScholarPubMed
37.Lin, M, Yang, YF, Chiang, HT, et al. Reappraisal of continuous positive airway pressure therapy in acute cardiogenic pulmonary edema. Chest 1995; 107: 1379–1386.CrossRefGoogle ScholarPubMed
38.Rasanen, J, Nikki, P, Heikkila, J. Acute myocardial infarction complicated by respiratory failure. Chest 1984; 85: 21–28.CrossRefGoogle ScholarPubMed
39.Hurford, WE, Lynch, KE, Strauss, WH, et al. Myocardial perfusion as assessed by thalium-210 scintigraphy during the discontinuation of mechanical ventilation in ventilator-dependent patients. Anesthesiology 1991; 74: 1007–1016.CrossRefGoogle ScholarPubMed
40.Lemaire, F, Teboul, JL, Cinotti, L, et al. Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 1988; 69: 171–179.CrossRefGoogle ScholarPubMed
41.Scharf, SM, Bianco, JA, Tow, DE, et al. The effects of large negative intrathoracic pressure on left ventricular function in patients with coronary artery disease. Circulation 1981; 63: 871–875.CrossRefGoogle ScholarPubMed
42.Shekerdemian, LS, Bush, A, Shore, DF, et al. Cardiorespiratory responses to negative pressure ventilation after tetralogy of Fallot repair: A hemodynamic tool for patients with a low-output state. J Am Coll Cardiol 1999; 33: 549–555.CrossRefGoogle ScholarPubMed
43.Bronicki, RA, Herra, M, Domico, M, et al. The cardiovascular effects of converting from positive pressure ventilation to spontaneous negative pressure breathing following repair of tetralogy of Fallot. (submitted).Google Scholar
44.Cullen, S, Shore, D, Redington, A. Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Circulation 1995; 91: 1782–1789.CrossRefGoogle ScholarPubMed
45.Wessel, DL. Commentary: simple gases and complex single ventricles. J Thorac Cardiovasc Surg 1996; 112: 655–657.CrossRefGoogle ScholarPubMed
46.Reddy, VM, Liddicoat, JR, Fineman, JR, et al. Fetal model of single ventricle physiology: hemodynamic effects of oxygen, nitric oxide, carbon dioxide, and hypoxia in the early postnatal period. J Thorac Cardiovasc Surg 1996; 112: 437–449.CrossRefGoogle ScholarPubMed
47.Tabbutt, S, Ramamoorthy, C, Montenegro, LM, et al. Impact of inspired gas mixtures on preoperative infants with hypoplastic left heart syndrome during controlled ventilation. Circulation 2001; 104: I159–164.CrossRefGoogle ScholarPubMed
48.Chang, AC, Zucker, HA, Hickey, PR, et al. Pulmonary vascular resistance in infants after cardiac surgery: role of carbon dioxide and hydrogen ion. Crit Care Med 1995; 23: 568–574.CrossRefGoogle ScholarPubMed
49.Shekerdemian, L, Bohn, D. Cardiovascular effects of mechanical ventilation. Arch Dis Child 1999; 80: 475–480.CrossRefGoogle ScholarPubMed
50.Sano, S, Ishino, K, Kawada, M, et al. Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2003; 126: 504–510.CrossRefGoogle ScholarPubMed
51.Ghanayem, NS, Jaquiss, RD, Cava, JR, et al. Right ventricle-to-pulmonary artery conduit versus Blalock-Taussig shunt: a hemodynamic comparison. Ann Thorac Surg 2006; 82: 1603–1609.CrossRefGoogle ScholarPubMed
52.Cua, CL, Thiagarajan, RR, Gauvreau, K, et al. Early postoperative outcomes in a series of infants with hypoplastic left heart syndrome undergoing stage I palliation operation with either modified Blalock-Taussig shunt or right ventricle to pulmonary artery conduit. Pediatr Crit Care Med 2006; 7: 238–244.CrossRefGoogle ScholarPubMed
53.Bradley, SM, Atz, AM, Simsic, JM. Redefining the impact of oxygen and hyperventilation after the Norwood procedure. J Thorac Cardiovasc Surg 2004; 127: 473–480.CrossRefGoogle ScholarPubMed
54.Williams, DB, Kiernan, PD, Metke, MP, et al. Hemodynamic response to positive end-expiratory pressure following right atrium-pulmonary artery bypass (Fontan procedure). J Thorac Cardiovasc Surg 1984; 87: 856–861.CrossRefGoogle ScholarPubMed
55.Bradley, SM, Simsic, JM, Mulvihill, DM. Hyperventilation impairs oxygenation after bidirectional superior cavopulmonary connection. Circulation 1998; 98: II372–376.Google ScholarPubMed
56.Bradley, SM, Simsic, JM, Mulvihill, DM. Hypoventilation improves oxygenation after bidirectional superior cavopulmonary connection. J Thorac Cardiovasc Surg 2003; 126: 1033–1039.CrossRefGoogle ScholarPubMed
57.Hoskote, A, Li, J, Hickey, C, et al. The effects of carbon dioxide on oxygenation and systemic, cerebral, and pulmonary vascular hemodynamics after the bidirectional superior cavopulmonary anastomosis. J Am Coll Cardiol 2004; 44: 1501–1509.CrossRefGoogle ScholarPubMed
58.Adatia, I, Atz, AM, Wessel, DL. Inhaled nitric oxide does not improve systemic oxygenation after bidirectional superior cavopulmonary anastomosis. J Thorac Cardiovasc Surg 2005; 129: 217–219.CrossRefGoogle Scholar
59.Shekerdemian, LS, Bush, A, Shore, DF, et al. Cardiopulmonary interactions after the Fontan operation: augmentation of cardiac output using negative pressure ventilation. Circulation 1997; 96: 3934–3942.CrossRefGoogle ScholarPubMed
60.Penny, DJ, Redington, AN. Doppler echocardiographic evaluation of pulmonary blood flow after the Fontan operation: the role of the lungs. Br Heart J 1991; 66: 372–374.CrossRefGoogle ScholarPubMed
61.Viires, N, Aubier, SM, Rassidakis, A, et al. Regional blood flow distribution in dog during induced hypotension and low cardiac output. J Clin Invest 1983; 72: 935–947.CrossRefGoogle ScholarPubMed
62.Kennedy, SK, Weintraub, RM, Skillman, JJ. Cardiorespiratory and sympathoadrenal responses during weaning from controlled ventilation. Surgery 1977; 82: 233–240.Google ScholarPubMed
63.Roussos, C, Macklem, PT. The Respiratory muscles. NEJM 1982; 307: 786–797.CrossRefGoogle ScholarPubMed
64.Aubier, M, Trippenbach, T, Roussos, C. Respiratory muscle fatigue during cardiogenic shock. J Appl Physiol 1981; 51: 499–508.CrossRefGoogle ScholarPubMed
65.Aubier, M, Viires, N, Syllie, G, et al. Respiratory muscle contribution to lactic acidosis in low cardiac output. Am Rev Respir Dis 1982; 126: 648–652.Google ScholarPubMed
66.Epstein, S. Etiology of extubation failure and the predictive value of the rapid shallow breathing index. Am J Respir Crit Care Med 1995; 152: 545.CrossRefGoogle ScholarPubMed
67.Fischer, JE, Allen, P, Fanconi, S. Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia. Intensive Care Med 2000; 26: 942–949.CrossRefGoogle ScholarPubMed
68.Morales, DL, Carberry, KE, Heinle, JS, et al. Extubation in the operating room after Fontan’s procedure: effect on practice and outcomes. Ann Thorac Surg 2008; 86: 576–581.CrossRefGoogle ScholarPubMed
69.Kurachek, SC, Newth, CJ, Quasney, MW, et al. Extubation failure in pediatric intensive care: a multiple-center study of risk factors and outcomes. Crit Care Med 2003; 31: 2657–2664.CrossRefGoogle Scholar
70.Brown, KL, Ridout, DA, Goldman, AP, et al. Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med 2003; 31: 28–33.CrossRefGoogle ScholarPubMed
71.Baisch, SD, Wheeler, WB, Kurachek, SC, et al. Extubation failure in pediatric intensive care incidence and outcomes. Pediatr Crit Care Med 2005; 6: 312–318.CrossRefGoogle Scholar
72.Barash, PG, Lescovich, F, Katz, JD, et al. Early extubation following pediatric cardiothoracic operation: a viable alternative. Ann Thorac Surg 1980; 29: 228–233.CrossRefGoogle ScholarPubMed
73.Kloth, RL, Baum, VC. Very early extubation in children after cardiac surgery. Crit Care Med 2002; 30: 787–791.CrossRefGoogle ScholarPubMed
74.Davis, S, Worley, S, Mee, RB, et al. Factors associated with early extubation after cardiac surgery in young children. Pediatr Crit Care Med 2004; 5: 63–68.CrossRefGoogle ScholarPubMed
75.Manrique, AM, Feingold, B, Di Filippo, S, et al. Extubation after cardiothoracic surgery in neonates, children, and young adults: one year of institutional experience. Pediatr Crit Care Med 2007; 8: 552–555.CrossRefGoogle Scholar