Jun 10, 2018 - 1Children'Hospital of Chongqing Medical University, PICU, Chongqing, China. Aims & Objectives: To summarize the clinical features, ...
Methods
Aims & Objectives:
Retrospective case note audit of fluid administration in the first 7 days after congenital cardiac surgery.
Enteral feeding is still controversial in infants with Congenital Heart Disease (CHD)1. The aim of the study was to look at the incidence of NEC or gut hypo perfusion in post-operative cardiac surgical children who were enterally fed in a large cardiac PICU.
Results During the 2 week audit period a total of 20 patients were included. We grouped patients with RACHS 1&2 scores (n=11), RACHS 3&4 scores (n=9) and RACHS 5&6 scores (n=0). Four patients required peritoneal dialysis; all survived to discharge. Daily fluid balance and cumulative balance (in ml/kg) is shown (table 1). In the RACHS 3&4 group, there was both a higher fluid balance on ‘day 2’ and in cumulative balance.
Methods Retrospective cohort study on a single PICU. Results
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32 children were recruited over a 6 month period between October 2016 and March 2017. Patients had a median age 7 months (IQR 14.1). Most children (62%) were RACHS-1 score 2, 3 (12.5%) or 1 (9.4%), with only 6% RACHS-1 score of 6. 100% (n=32) of children were fed post-operatively. 25/32 (78.1%) patients were fed within the first 24 hours post operatively and the mean time to first feed was 7.9 hours (SD 6.55). No patient had developed NEC. 7/32 (21.9%) experienced some form of feed intolerance, the most common being vomiting (12.5%), abdominal distension (6.3%) and 1 patient (3.1%) had rectal bleeding. 13 (40.6%) had a lactate of > 2mmom/l for at least 1 day. Of the 7 (21.9%) who had feed intolerance 3 (9.4%) had a lactate > 2mmol/l at some point post operatively. No patients received total parenteral nutrition during their stay on ICU.
Conclusions It is difficult to draw conclusions from this small audit. Higher fluid requirements may be associated and required with more complex surgery and greater postoperative instability. The peak in fluid balance on day 2 in RACHS 3&4 group may be due to a peak in the systemic inflammatory response. We did not investigate the trigger to administering fluid which might enable an approach to reducing fluid administration. Nevertheless, in our view, a careful clinical assessment in judging the need for fluid remains important especially given the great variability in postoperative physiology.
P-557 DIAGNOSIS AND MANAGEMENT OF 60 CONGENITAL VASCULAR RINGS IN CHILDREN: A 10-YEAR EXPERIENCE J. Li1 Children’Hospital of Chongqing Medical University, PICU, Chongqing, China
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Aims & Objectives: To summarize the clinical features, diagnosis and treatment of congenital vascular ring (VR) in chldren. Methods Retrospective study of 60 patients with diagnosis of congenital VR. All the children were given CTA, Echocardiography, Gastrointestinal barium meal, Fiberoptic bronchoscopy. Results Sixty cases including 40 males and 20 females, aged from 1 day to 6 years, were enrolled in our study. The most frequent diagnosis was pulmonary artery sling (25 cases, 41.67 %), followed by double aorta arch (21 cases, 35 %). Twentyeight cases (46.7%) combined with heart malformations. Forty five cases (46.7%) combined with tracheobronchial stenosis, 10 cases combined with esophageal stricture. The sensitivity of CTA to diagnose vascular ring was 81.82%, while echocardiographic diagnosis rate was 53.33%. 52 cases (87%) had a history of respiratory symptoms. Forty patient who underwent surgery included left pulmonary artery transplantation(15 cases), double aortic arch devascularization(12 cases), cut off the artery catheter/ligament(12 cases), left subclavian artery occlusion (1 case).Seven patients died in sixty cases. Vascular ring combined with complete tracheal ring was a risk factor in patients undergoing surgery (P
