MECHANICAL VENTILATION MANAGEMENT IN PATIENTS DIAGNOSED WITH COVID-19 WHO UNDERWENT PEDIATRIC OPEN-HEART SURGERY

Ergi̇n Arslanoğlu 1 * , Kenan Abdurrahman Kara 1, Fatih Yigit 1, Ömer Faruk Şavluk 2, Nihat Çine 1, Eylem Tunçer 1, Hakan Ceyran 1
More Detail
1 Pediatric Cardiovascular Surgery Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, İstanbul, Turkey
2 Anaesthesia and Reanimation Department, Kartal Koşuyolu High Speciality Educational and Research Hospital, Istanbul, Turkey
* Corresponding Author
J CLIN MED KAZ, In press.
OPEN ACCESS

ABSTRACT

The new pneumonia pathogen "Covid-19" has been causing the pandemic since December 2019. There has been an increase in the number of cases reported in the pediatric population, particularly in adult patients. In the pediatric population, where asymptomatic transmission is standard, some mandatory protocol changes in preoperative and postoperative mechanical ventilation management must be made concerning pediatric cardiac surgery.
Our study retrospectively reviewed 215 patients operated on in our pediatric cardiac surgery clinic from March 11, 2020, to April 15, 2021. Eleven patients who were asymptomatic preoperatively and had rt-PCR (-) but had rt-PCR (+) in the postoperative period and 15 patients who required emergency surgery and had rt-PCR (+) in the preoperative period were included in the study. The intensive care period of the patients ranged from 2 to 51 days, with an average of 10.61 ± 13.58 days. The duration of stay connected to the ventilator is 1 to 44 days. It was found that the total time spent on a ventilator was 8.11±13.27 days. The average service follow-up time was 9.23±5.54 days, with a range of 0 to 21 days. Three of the patients required ECMO, and all of those who required ECMO died.
Mechanical ventilation management in pediatric patients should be adjusted according to the patient's unique underlying pathophysiology and conducted under the physician's close clinical supervision. While a lung-protective approach is critical in this patient group, where barotrauma occurs frequently, each clinic should handle the process according to its resources and experience.

CITATION

Arslanoğlu E, Kara KA, Yigit F, Şavluk ÖF, Çine N, Tunçer E, et al. MECHANICAL VENTILATION MANAGEMENT IN PATIENTS DIAGNOSED WITH COVID-19 WHO UNDERWENT PEDIATRIC OPEN-HEART SURGERY. J Clin Med Kaz. 2021.

REFERENCES

  • Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. New Engl J Med 2020;382:1199-207
  • Patel PA, Chandrakasan S, Mickells GE, Yildirim I, Kao CM, Bennett CM. Severe Pediatric COVİD-19-19 Presenting With Respiratory Failure and Severe Thrombocytopenia. Pediatrics. 2020 Jul;146(1):e20201437. doi: 10.1542/peds.2020-1437. Epub 2020 May 4. PMID: 32366611; PMCID: PMC7329259.
  • Matava CT, Kovatsis PG, Lee JK, Castro P, Denning S, Yu J, Park R, Lockman JL, Von Ungern-Sternberg B, Sabato S, Lee LK, Ayad I, Mireles S, Lardner D, Whyte S, Szolnoki J, Jagannathan N, Thompson N, Stein ML, Dalesio N, Greenberg R, McCloskey J, Peyton J, Evans F, Haydar B, Reynolds P, Chiao F, Taicher B, Templeton T, Bhalla T, Raman VT, Garcia-Marcinkiewicz A, Gálvez J, Tan J, Rehman M, Crockett C, Olomu P, Szmuk P, Glover C, Matuszczak M, Galvez I, Hunyady A, Polaner D, Gooden C, Hsu G, Gumaney H, Pérez-Pradilla C, Kiss EE, Theroux MC, Lau J, Asaf S, Ingelmo P, Engelhardt T, Hervías M, Greenwood E, Javia L, Disma N, Yaster M, Fiadjoe JE; PeDI-Collaborative. Pediatric Airway Management in COVİD-19-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society. Anesth Analg. 2020 Jul;131(1):61-73. doi: 10.1213/ANE.0000000000004872. PMID: 32287142; PMCID: PMC7173403.
  • Cura Yayla BC, Özsürekçi Y, Aykaç K, Derin Oygar P, Laçinel Gürlevik S, İlbay S, Kukul MG, Karahan S, Cengiz AB, Ceyhan M. Characteristics and Management of Children with COVİD-19-19 in Turkey. Balkan Med J. 2020 Oct 23;37(6):341-347. doi: 10.4274/balkanmedj.galenos.2020.2020.7.52. Epub 2020 Aug 31. PMID: 32865382; PMCID: PMC7590545.
  • Lazzeri M, Lanza A, Bellini R, Bellofiore A, Cecchetto S, Colombo A, D'Abrosca F, Del Monaco C, Gaudiello G, Paneroni M, Privitera E, Retucci M, Rossi V, Santambrogio M, Sommariva M, Frigerio P. Respiratory physiotherapy in patients with COVİD-19-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis. 2020 Mar 26;90(1). doi: 10.4081/monaldi.2020.1285. PMID: 32236089.
  • Nahshon C, Bitterman A, Haddad R, Hazzan D, Lavie O. Hazardous Postoperative Outcomes of Unexpected COVİD-19-19 Infected Patients: A Call for Global Consideration of Sampling all Asymptomatic Patients Before Surgical Treatment. World J Surg. 2020 Aug;44(8):2477-2481. doi: 10.1007/s00268-020-05575-2. PMID: 32418028; PMCID: PMC7229873.
  • Burton-Papp HC, Jackson AIR, Beecham R, Ferrari M, Nasim-Mohi M, Grocott MPW, Chambers R, Dushianthan A; University Hospital Southampton Critical Care Team; REACT COVİD-19 Investigators. Conscious prone positioning during non-invasive ventilation in COVİD-19-19 patients: experience from a single centre. F1000Res. 2020 Jul 31;9:859. doi: 10.12688/f1000research.25384.1. PMID: 33110499; PMCID: PMC7578762.
  • Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS -CoV -2 Admitted to ICUs of the Lombardy Region, Italy. JAMA 2020;323:1574. https://doi.org/10.1001/jama.2020.5394.
  • Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVİD-19 -19 in the New York City Area. JAMA 2020. https://doi.org/10.1001/jama.2020.6775.
  • Udi J, Lang CN, Zotzmann V, Krueger K, Fluegler A, Bamberg F, Bode C, Duerschmied D, Wengenmayer T, Staudacher DL. Incidence of Barotrauma in Patients With COVİD-19-19 Pneumonia During Prolonged Invasive Mechanical Ventilation - A Case-Control Study. J Intensive Care Med. 2021 Apr;36(4):477-483. doi: 10.1177/0885066620954364. Epub 2020 Sep 22. PMID: 32959730.
  • Lentz S, Roginski MA, Montrief T, Ramzy M, Gottlieb M, Long B. Initial emergency department mechanical ventilation strategies for COVİD-19-19 hypoxemic respiratory failure and ARDS. Am J Emerg Med. 2020 Oct;38(10):2194-2202. doi: 10.1016/j.ajem.2020.06.082. Epub 2020 Jul 4. PMID: 33071092; PMCID: PMC7335247.
  • Shalish W, Lakshminrusimha S, Manzoni P, Keszler M, Sant'Anna GM. COVİD-19-19 and Neonatal Respiratory Care: Current Evidence and Practical Approach. Am J Perinatol. 2020 Jun;37(8):780-791. doi: 10.1055/s-0040-1710522. Epub 2020 May 2. PMID: 32359226; PMCID: PMC7356086.
  • Keszler M. Mechanical ventilation strategies. Semin Fetal Neonatal Med. 2017 Aug;22(4):267-274. doi: 10.1016/j.siny.2017.06.003. Epub 2017 Jul 11. PMID: 28709948.
  • Sankar J, Dhochak N, Kabra SK, Lodha R. COVİD-19-19 in Children: Clinical Approach and Management. Indian J Pediatr. 2020 Jun;87(6):433-442. doi: 10.1007/s12098-020-03292-1. Epub 2020 Apr 27. PMID: 32338347; PMCID: PMC7183927.
  • Prata-Barbosa A, Lima-Setta F, Santos GRD, Lanziotti VS, de Castro REV, de Souza DC, Raymundo CE, de Oliveira FRC, de Lima LFP, Tonial CT, Colleti J Jr, Bellinat APN, Lorenzo VB, Zeitel RS, Pulcheri L, Costa FCMD, La Torre FPF, Figueiredo EADN, Silva TPD, Riveiro PM, Mota ICFD, Brandão IB, de Azevedo ZMA, Gregory SC, Boedo FRO, de Carvalho RN, Castro NAASR, Genu DHS, Foronda FAK, Cunha AJLA, de Magalhães-Barbosa MC; Brazilian Research Network in Pediatric Intensive Care, (BRnet-PIC). Pediatric patients with COVİD-19-19 admitted to intensive care units in Brazil: a prospective multicenter study. J Pediatr (Rio J). 2020 Sep-Oct;96(5):582-592. doi: 10.1016/j.jped.2020.07.002. Epub 2020 Aug 4. PMID: 32781034; PMCID: PMC7402103.
  • Matava CT, Kovatsis PG, Lee JK, Castro P, Denning S, Yu J, Park R, Lockman JL, Von Ungern-Sternberg B, Sabato S, Lee LK, Ayad I, Mireles S, Lardner D, Whyte S, Szolnoki J, Jagannathan N, Thompson N, Stein ML, Dalesio N, Greenberg R, McCloskey J, Peyton J, Evans F, Haydar B, Reynolds P, Chiao F, Taicher B, Templeton T, Bhalla T, Raman VT, Garcia-Marcinkiewicz A, Gálvez J, Tan J, Rehman M, Crockett C, Olomu P, Szmuk P, Glover C, Matuszczak M, Galvez I, Hunyady A, Polaner D, Gooden C, Hsu G, Gumaney H, Pérez-Pradilla C, Kiss EE, Theroux MC, Lau J, Asaf S, Ingelmo P, Engelhardt T, Hervías M, Greenwood E, Javia L, Disma N, Yaster M, Fiadjoe JE; PeDI-Collaborative. Pediatric Airway Management in COVİD-19-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society. Anesth Analg. 2020 Jul;131(1):61-73. doi: 10.1213/ANE.0000000000004872. PMID: 32287142; PMCID: PMC7173403.
  • Remy KE, Lin JC, Verhoef PA. High-flow nasal cannula may be no safer than non-invasive positive pressure ventilation for COVİD-19-19 patients. Crit Care. 2020 Apr 23;24(1):169. doi: 10.1186/s13054-020-02892-9. PMID: 32326959; PMCID: PMC7179373.
  • Burton-Papp HC, Jackson AIR, Beecham R, Ferrari M, Nasim-Mohi M, Grocott MPW, Chambers R, Dushianthan A; University Hospital Southampton Critical Care Team; REACT COVİD-19 Investigators. Conscious prone positioning during non-invasive ventilation in COVİD-19-19 patients: experience from a single centre. F1000Res. 2020 Jul 31;9:859. doi: 10.12688/f1000research.25384.1. PMID: 33110499; PMCID: PMC7578762.
  • Alviar CL, Miller PE, McAreavey D, Katz JN, Lee B, Moriyama B, Soble J, van Diepen S, Solomon MA, Morrow DA; ACC Critical Care Cardiology Working Group. Positive Pressure Ventilation in the Cardiac Intensive Care Unit. J Am Coll Cardiol. 2018 Sep 25;72(13):1532-1553. doi: 10.1016/j.jacc.2018.06.074. PMID: 30236315.
  • Dhont S, Derom E, Van Braeckel E, Depuydt P, Lambrecht BN. The pathophysiology of 'happy' hypoxemia in COVİD-19-19. Respir Res. 2020 Jul 28;21(1):198. doi: 10.1186/s12931-020-01462-5. PMID: 32723327; PMCID: PMC7385717.
  • Conti G, Piastra M. Mechanical ventilation for children. Curr Opin Crit Care. 2016 Feb;22(1):60-6. doi: 10.1097/MCC.0000000000000271. PMID: 26645553.
  • Marraro GA, Spada C. Consideration of the respiratory support strategy of severe acute respiratory failure caused by SARS-CoV-2 infection in children. Zhongguo Dang Dai Er Ke Za Zhi. 2020 Mar;22(3):183-194. English. doi: 10.7499/j.issn.1008-8830.2020.03.002. PMID: 32204751; PMCID: PMC7389599.