Cardiac index monitoring by pulse contour analysis and thermodilution after pediatric cardiac surgery

ObjectivesTo validate a new device (PiCCO system; Pulsion Medical Systems, Munich, Germany), we compared cardiac index derived from transpulmonary thermodilution and from pulse contour analysis in pediatric patients after surgery for congenital heart disease. We performed a prospective clinical study in a pediatric cardiac intensive care unit of a university hospital.MethodsTwenty-four patients who had had cardiac surgery for congenital heart disease (median age 4.2 years, range 1.4-15.2 years) were investigated in the first 24 hours after admission to the intensive care unit. A 3F thermodilution catheter was inserted in the femoral artery. Intracardiac shunts were excluded by echocardiography intraoperatively or postoperatively. Cardiac index derived from pulse contour analysis was documented in each patient 1, 4, 8, 12, 16, 20, and 24 hours after admission to the intensive care unit. Subsequently, a set of three measurements of thermodilution cardiac indices derived by injections into a central venous line was performed and calculated by the PiCCO system.ResultsThe mean bias between cardiac indices derived by thermodilution and those derived by pulse contour analysis over all data points was 0.05 (SD 0.4) L · min · m−2 (95% confidence interval 0.01-0.10). A strong correlation between thermodilution and contour analysis cardiac indices was calculated (Pearson correlation coefficient r = 0.93; coefficient of determination r2 = 0.86).ConclusionsPulse contour analysis is a suitable method to monitor cardiac index over a wide range of indices after surgery for congenital heart disease in pediatric patients. Pulse contour analysis allows online monitoring of cardiac index. The PiCCO device can be recalibrated with the integrated transpulmonary thermodilution within a short time frame

Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis

Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries

Effets des stimulations buccofaciales et du support oral sur la succion et la déglutition du nouveau-né prématuré

Le but de l'étude était d'appliquer, dans le même protocole, chez le prématuré, les programmes de stimulation orale (Stim) et de support oral (Sup), d'évaluer et de comparer leurs effets sur la déglutition par la technique acoustique et sur la succion non nutritive (SNN) par la technique de succiométrie. Sup réduit la période de transition, mais mais pas Stim. Sup est le programme le plus efficace sur l'ingestion et la déglutition : Sup stabilise la mâchoire, aide à la déglutition, rythme déglutition-respiration, développe l'endurance. Stim augmente tous les paramètres de SNN pendant l'alimentation par sonde. Pendant la transition, ces paramètres se stabilisent avec Stim et augmentent avec Sup et ne permettent pas de différencier stim et Sup. Les paramètres de déglutition évalués par la technique acoustique non invasive permettent de différencier Stim et Sup. Ainsi, Sup peut être considéré comme un programme d'entraînement à l'endurance et à la coordination succion-déglutition-respiration.The aim of the study was to perform, in the same protocol, oral stimulation (Stim) and oral support (Sup) programs, to quantify and to compare its effects on swallowing with the non invasive acoustic technique and non nutritive sucking (NSS) with succiometry, in preterm infants. The transition is reduced with Sup but not with Stim. Sup is the most efficient program on feeding performances and swallowing : Sup stabilizes the jaw, is a aid to deglutition, imposes a rythm between swallowing and breathing, enhances endurance. NSS parameters are increased with Stim during the feeding. During transition, these NNS parameters are stabilized with Stim and are enhanced with Sup, but cannot separated Stim and Sup. Swallowing parameters are evaluated with the non invasive acoustic technique and can distinguish Stim and Sup. Moreover, Sup can be applied as a training for endurance and sucking-swallowing-breathing coordination.TOURS-BU Médecine (372612103) / SudocSudocFranceF