Objective The impact of genotype on outcomes of infant cardiac operations is not well established. The purpose of this study was to investigate the impact of 22q11.2 deletion (22q11del) on infants with truncus arteriosus communis (TA) and interrupted aortic arch (IAA) undergoing operative correction during infancy. Methods We conducted a retrospective cohort study of all infants who underwent operative correction of TA or IAA at The Children’s Hospital of Philadelphia from 1995 to 2007, comparing peri-operative outcomes (hospital length of stay, intensive care, and mechanical ventilation, risk of cardiac and non-cardiac events, number of consultations, and number of discharge medications) by 22q11del status. Results A total of 104 patients were studied (55 with TA and 49 with IAA), of which 40 (38%) were 22q11del positive. 22q11del status was unknown in 9 cases (7 with TA and 2 with IAA). In patients with known deletion status, those with 22q11del had a longer hospital length of stay and duration of intensive care. Subjects with 22q11del also underwent more frequent operative re-intervention, underwent more consultations, and were prescribed more medications at discharge. There was no significant difference in method of feeding between those with and without 22q11del at discharge. Conclusions 22q11del is associated with perioperative outcomes in infants undergoing operative correction of TA and IAA, with longer hospital stay and greater resource utilization in the perioperative period. These findings inform counseling and risk stratification and warrant further study to identify genotype specific management strategies to improve outcomes.

Background: Positive end-expiratory pressure (PEEP) is used to optimize oxygenation by preventing alveolar collapse. However, PEEP can potentially decrease cardiac output through cardiopulmonary interactions. The effect of PEEP on cardiac output during cardiopulmonary resuscitation (CPR) is not known. Methods: This was a preclinical randomized, controlled, animal study conducted in an animal research facility on 25 Landrace-Yorkshire pigs. After inducing cardiac arrest, CPR was performed with LUCAS 3. During CPR, pigs were ventilated at a PEEP of 0, 5, 10, 15, 20 cmH 2 O (randomly determined via lottery) for 9 min. Cardiac output, obtained via ultrasound dilution, and PaO 2 were measured, and oxygen delivery calculated for each PEEP. Results: A mixed-effects repeated-measures analysis of variance was used to compare the baseline value adjusted mean cardiac output, PaO 2 , and oxygen delivery between PEEP groups. Least significant difference test was used to conduct pairwise comparisons between PEEP groups. To determine optimum PEEP, Gaussian mixture model was applied to the adjusted means of cardiac output and oxygen delivery. Increasing PEEP to 10 and higher resulted in significant declines in cardiac output. A PEEP of 15 and higher resulted in significant declines in oxygen delivery. As PEEP was increased from 0 to 20, PaO 2 increased significantly. Gaussian mixture model identified the 0-5 PEEP group as providing optimal cardiac output and oxygen delivery, with PEEP of 5 providing the highest oxygen delivery. Conclusions: A PEEP of 0-5 resulted in the optimal oxygen delivery and cardiac output during CPR, with PEEP of 5 resulting in higher oxygen delivery, and a slightly lower, statistically insignificant cardiac output than PEEP of 0.

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In critically ill pediatric patients, being overweight or obese was associated with decreased need for intubation and inotropic support compared with normal-weight patients. However, being overweight or obese is neither protective nor a risk factor for mortality or duration of mechanical ventilation.