Pharmaceutical management of decompensated heart failure syndrome in children: Current state of the art and a new approach

Airway management is a fundamental component of care during resuscitation of critically ill and injured children. In addition to predicted anatomic and physiologic differences in children compared with adults, certain conditions can predict potential difficulty during pediatric airway management. This review presents approaches to identifying pediatric patients in whom airway management is more likely to be difficult, and discusses strategies to address such challenges. These strategies include optimization of effective bag-mask ventilation, alternative approaches to laryngoscopy, use of adjunct airway devices, modifications to rapid sequence intubation, and performance of surgical airways in children. The importance of considering systems of care in preparing for potentially difficult pediatric airways is also discussed.

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“…The most common of these and strategies to address them are presented in Table 2. 8,[17][18][19][20][21][22][23][24][25][26][27][28]…”

Section: Physiologic Featuresmentioning

confidence: 99%

“…Although these conditions and management decisions are outside of the scope of this review, it would be remiss not to recognize physiologic processes that pose unique difficulties during the peri-intubation period. The most common of these and strategies to address them are presented in Table 2 8,17–28 …”

Section: The Pediatric Difficult Airwaymentioning

confidence: 99%

Management of the Difficult Airway

2023

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“…The initial treatment line for these patients is inotropic support. A recent review of the pharmaceutical management of decompensated heart failure syndrome in children discusses in detail the indications, mechanism of actions, and dosages of the various available inotropes [80]. At St. Louis Children’s Hospital, the hemodynamically unstable child is started on dopamine, dobutamine or epinephrine as first line of inotropic treatment.…”

Section: At the Bedside: Practical Clinical Approachmentioning

confidence: 99%

Impact of Pulmonary Vascular Resistances in Heart Transplantation for Congenital Heart Disease

Gazit

Canter²

2011

CCR

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Congenital heart disease is one of the major diagnoses in pediatric heart transplantation recipients of all age groups. Assessment of pulmonary vascular resistance in these patients prior to transplantation is crucial to determine their candidacy, however, it is frequently inaccurate because of their abnormal anatomy and physiology. This problem places them at significant risk for pulmonary hypertension and right ventricular failure post transplantation. The pathophysiology of pulmonary vascular disease in children with congenital heart disease depends on their pulmonary blood flow patterns, systemic ventricle function, as well as semilunar valves and atrioventricular valves structure and function. In our review we analyze the pathophysiology of pulmonary vascular disease in children with congenital heart disease and end-stage heart failure, and outline the state of the art pre-transplantation medical and surgical management to achieve reverse remodeling of the pulmonary vasculature by using pulmonary vasodilators and mechanical circulatory support.

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“…The specific inotropic support is targeted at the four determinants of cardiac output: preload, afterload, heart rate, and contractility. A recent review of the pharmaceutical management of decompensated heart failure syndrome in children discusses in detail the indications, mechanism of actions, and dosages of the various available inotropes [26]. At St. Louis Children's Hospital, the hemodynamically unstable child is started on dopamine, dobutamine, or epinephrine as the first line of inotropic treatment.…”

Section: Piccomentioning

confidence: 99%

Perioperative Management of the Pediatric Cardiac Transplantation Patient

Gazit

Fehr

2011

Curr Treat Options Cardio Med

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The major diagnoses carried by children undergoing cardiac transplantation worldwide are congenital heart defects, cardiomyopathies, and retransplantation. The leading diagnosis in infancy is congenital heart disease, whereas cardiomyopathy predominates in older children. In view of this wide spectrum of diagnoses, the perioperative management of these children requires medical, interventional, and surgical expertise in treatment of complex congenital heart defects, end-stage heart failure, and cardiac transplantation. According to the Pediatric Heart Transplantation Survey database, the majority of children listed for cardiac transplantation eventually require higher levels of cardiac support before transplantation. The team caring for these children should be prepared to escalate support in a timely fashion in order to avoid end-organ dysfunction or a catastrophic event that will remove the patient from the cardiac transplantation list. The first step is advanced hemodynamic monitoring in a specialized pediatric cardiac intensive care unit and initiation of inotropic support. Further escalation of care should be based on careful analysis of the hemodynamic profile, end-organ function, and biochemical markers of perfusion and myocardial stress. A patient who continues to deteriorate in spite of inotropic support requires positive pressure ventilation, and if deterioration continues, mechanical circulatory support is initiated. Cardiac transplantation is a challenging operation, and even more so in children with complex congenital heart defects. The abnormal cardiovascular anatomy requires planning and anticipation of possible pitfalls as hypoplasia of the aortic arch, abnormal pulmonary arteries, and abnormal systemic and pulmonary venous connections. The time required to remove adhesions in children with prior cardiac operations increases the ischemic time of the graft and the risk of primary graft dysfunction. Assessment of pulmonary vascular resistance in children with congenital heart defects is problematic, and even children with a normal transpulmonary gradient and pulmonary vascular resistance are at increased risk of postoperative pulmonary hypertension and right ventricular graft failure. The postoperative course is directly linked to the patient's preoperative physical condition and perioperative course. The induction of immunosuppression and the use of plasmapheresis in children with a positive cross-match may lead to further hemodynamic compromise. If severe primary graft dysfunction evolves, early initiation of extracorporeal membranous oxygenator is indicated to avoid irreversible end-organ dysfunction.

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Pharmaceutical management of decompensated heart failure syndrome in children: Current state of the art and a new approach

Cited by 5 publications

References 47 publications

Management of the Difficult Airway

Management of the Difficult Airway

Impact of Pulmonary Vascular Resistances in Heart Transplantation for Congenital Heart Disease

Perioperative Management of the Pediatric Cardiac Transplantation Patient

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