Ece SALİHOĞLU, Salih ÖZÇOBANOĞLU, Süleyman ÖZKAN, Mete GÜRSOY

Pediatrik hastalarda cerrahi pulmoner arter kateterlerinin güvenilirliği

Amaç: Bu çalışmada cerrahi pulmoner arter kateteri takılan pediatrik hastaların ameliyat sonrası sonuçları incelendi ve bu kateterlerin güvenilirliği irdelendi. Çalışma planı: Ocak 2010 - Haziran 2012 tarihleri arasında 55 hastaya (26 erkek, 29 kız; ort. yaş 23.7±7.1 ay; dağılım 1-70 ay) cerrahi pulmoner arter kateteri yerleştirildi. Hastaların patoloji, yaş, vücut ağırlığı, pulmoner ve sistemik arter basıncı, ekstübasyon zamanı, kateter çekim zamanı, kanama miktarları, mortalite ve morbiditeleri gibi retrospektif incelemeleri yapıldı.Bulgular: Hastaların ortalama vücut ağırlığı 9.0±2.8 kg idi. Ameliyat öncesi olguların tamamında sistemik basınca eşit pulmoner hipertansiyon vardı. Otuz yedi hastaya pulmoner arter kateter yolu ile iloprost intravenöz infüzyonu uygulandı. Hastaların ortalama ekstübasyon zamanı 24.5±16.6 saat olup pulmoner arter kateteri çekim zamanı ortalaması ise 45.5±19.6 saat olarak gerçekleşti. Hastalarda kateter çekimi sonrası ortalama drenaj 23.7±14.4 mL idi. Hiçbir hastada kanama nedeniyle revizyon gerekmedi. Hastalarda pulmoner arter kateterine bağlı herhangi bir komplikasyon görülmedi.Sonuç: Cerrahi pulmoner arter kateteri yerleştirilmesi hem sürekli basınç izlemi hem de ilaç infüzyonu için kullanılabilen kolay uygulanabilir bir yöntemdir. Bu yöntemin çocuk hastalarda ameliyat sonrası pulmoner hipertansiyon tedavisinin etkin uygulanmasında güvenli ve yardımcı bir yol olduğunu düşünüyoruz.

Safety of surgical pulmonary artery catheters in pediatric patients

Background: This study aims to evaluate the postoperative outcomes of surgical pulmonary artery catheters in pediatric patients and to discuss the safety of these catheters. Methods: Between January 2010 and June 2012, surgical pulmonary artery catheters were implanted in 55 patients (26 boys, 29 girls; mean age 23.7±7.1 months; range 1 to 70 months). A retrospective analysis of the patients for pathology, age, body weight, pulmonary and systemic arterial pressure, extubation time, catheter removal time, the amount of bleeding, mortality and morbidity was performed.Results: The mean body weight of the patients was 9.0±2.8 kg. All patients had preoperative pulmonary hypertension which was equal to systemic pressure. Thirtyseven patients received iloprost intravenous infusion via a pulmonary artery catheter. The mean extubation time was 24.5±16.6 hours, while the mean time for pulmonary artery catheter removal was 45.5±19.6 hours. The mean drainage following catheter removal was 23.7±14.4 mL. None of the patients required any revision due to bleeding. No pulmonary artery catheter-related complication was observed in the patients.Conclusion: Surgical pulmonary artery catheterization is a simple technique which can be used for both continuous pressure monitorization and drug infusion. We conclude that this is a safe and contributing method for an effective management of postoperative pulmonary hypertension in pediatric patients.

PDF

___

1) Olguntürk R. Pediatric pulmonary hypertension and pulmonary arterial hypertension secondary to congenital heart diseases. [Article in Turkish] Anadolu Kardiyol Derg 2010;10 Suppl 1:50-6. doi: 10.5152/akd.2010.119.
2) Flori HR, Johnson LD, Hanley FL, Fineman JR. Transthoracic intracardiac catheters in pediatric patients recovering from congenital heart defect surgery: associated complications and outcomes. Crit Care Med 2000;28:2997-3001.
3) Fasnacht MS, Tolsa JF, Beghetti M; Swiss Society for Pulmonary Arterial Hypertension. The Swiss registry for pulmonary arterial hypertension: the paediatric experience. Swiss Med Wkly 2007;137:510-3.
4) Matsumoto M, Naitoh H, Higashi T, Kurasako T, Takatori M, Tada K, et al. Risk factors for pulmonary hypertensive crisis (PHC) following VSD repair in infants. Masui 1995;44:1208-12. [Abstract]
5) Rimensberger PC, Spahr-Schopfer I, Berner M, Jaeggi E, Kalangos A, Friedli B, et al. Inhaled nitric oxide versus aerosolized iloprost in secondary pulmonary hypertension in children with congenital heart disease: vasodilator capacity and cellular mechanisms. Circulation 2001;103:544-8.
6) Limsuwan A, Wanitkul S, Khosithset A, Attanavanich S, Samankatiwat P. Aerosolized iloprost for postoperative pulmonary hypertensive crisis in children with congenital heart disease. Int J Cardiol 2008;129:333-8.
7) Muralidhar K, Dixit MD, Shetty DP. A safe technique to monitor pulmonary artery pressure during and after paediatric cardiac surgery. Anaesth Intensive Care 1997;25:634-6.
8) Chen LC, Huang PH. Entrapment of a Swan-Ganz catheter. J Chin Med Assoc 2007;70:213-4.
9) Sekkal S, Cornu E, Christidès C, Laskar M, Serhal C, Ghossein Y, et al. Swan-Ganz catheter induced pulmonary artery perforation during cardiac surgery concerning two cases. J Cardiovasc Surg (Torino) 1996;37:313-7.
10) Bossert T, Gummert JF, Bittner HB, Barten M, Walther T, Falk V, et al. Swan-Ganz catheter-induced severe complications in cardiac surgery: right ventricular perforation, knotting, and rupture of a pulmonary artery. J Card Surg 2006;21:292-5.
11) Freeman R, Hjersing N, Burridge A. Catheter tip cultures on open-heart surgery patients: associations with site of catheter and age of patients. Thorax 1981;36:355-9.
12) Dong MF, Ma ZS, Ma SJ, Chai SD, Tang PZ, Yao DK, et al. Effect of prostaglandin E1 on pulmonary arterial hypertension following corrective surgery for congenital heart disease. J Cardiovasc Pharmacol Ther 2012;17:303-7. doi: 10.1177/1074248411429966.