RESUMO
Treatment options for Achromobacter xylosoxidans are limited. Eight cystic fibrosis patients with A. xylosoxidans were treated with 12 cefiderocol courses. Pretreatment in vitro resistance was seen in 3 of 8 cases. Clinical response occurred after 11 of 12 treatment courses. However, microbiologic relapse was observed after 11 of 12 treatment courses, notably without emergence of resistance.
Assuntos
Achromobacter denitrificans , Fibrose Cística , Infecções por Bactérias Gram-Negativas , Adulto , Antibacterianos/uso terapêutico , Cefalosporinas , Criança , Fibrose Cística/complicações , Fibrose Cística/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , CefiderocolRESUMO
As survivable outcomes among patients with complex congenital heart disease (cCHD) have continued to improve over the last several decades, more attention is being dedicated to interventions that impact not just survival but quality of life among patients with cCHD. In particular, patients with cCHD are at risk for impaired neurodevelopmental outcomes. In this review summarizing select presentations given at the 14th Annual Pediatric Cardiac Intensive Care Society's Annual Meeting in 2019, we discuss the neurodevelopmental phenotype of patients with cCHD, patients at greatest risk of impaired development, and three specific modifiable risk factors impacting development.
Assuntos
Cardiopatias Congênitas/complicações , Transtornos do Neurodesenvolvimento/etiologia , Qualidade de Vida , Medição de Risco , Criança , Saúde Global , Cardiopatias Congênitas/psicologia , Humanos , Incidência , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/psicologia , Fatores de RiscoRESUMO
The care of children with hypoplastic left heart syndrome is constantly evolving. Prenatal diagnosis of hypoplastic left heart syndrome will aid in counselling of parents, and selected fetuses may be candidates for in utero intervention. Following birth, palliation can be undertaken through staged operations: Norwood (or hybrid) in the 1st week of life, superior cavopulmonary connection at 4-6 months of life, and finally total cavopulmonary connection (Fontan) at 2-4 years of age. Children with hypoplastic left heart syndrome are at risk of circulatory failure their entire life, and selected patients may undergo heart transplantation. In this review article, we summarise recent advances in the critical care management of patients with hypoplastic left heart syndrome as were discussed in a focused session at the 12th International Conference of the Paediatric Cardiac Intensive Care Society held on 9 December, 2016, in Miami Beach, Florida.
Assuntos
Técnica de Fontan/métodos , Síndrome do Coração Esquerdo Hipoplásico , Cuidados Paliativos , Diagnóstico Pré-Natal/métodos , Pré-Escolar , Feminino , Saúde Global , Humanos , Síndrome do Coração Esquerdo Hipoplásico/diagnóstico , Síndrome do Coração Esquerdo Hipoplásico/epidemiologia , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Lactente , Recém-Nascido , Morbidade/tendências , Gravidez , Taxa de Sobrevida/tendênciasRESUMO
BACKGROUND: Acquired von Willebrand syndrome (AvWS) in the setting of congenital heart disease is an under-recognized cause of bleeding in the pediatric cardiac critical care unit. METHODS: Fourteen patients diagnosed with AvWS admitted to the cardiac intensive care unit at the Children's National Health System between December 2009 and September 2015 were identified with subsequent chart review and case analysis. RESULTS: Of the 14 patients included in this study, 4 patients were on ventricular-assist devices, 6 patients were on extracorporeal membrane oxygenation, and 4 were patients with congenital heart disease not receiving any mechanical circulatory support. All patients identified manifested persistent severe bleeding, despite appropriate management of anticoagulation and blood product administration based on the established protocols. Detailed hemostatic testing including quantitative von Willebrand factor (vWF) multimer analysis revealed decreased high-molecular-weight multimers (HMWMs) and absent ultra-HMWM, consistent with AvWS in all patients. Eight patients received treatment with vWF concentrate, one patient with desmopressin, and five recovered without specific treatment. Bleeding ceased in all but one patient. CONCLUSIONS: Acquired von Willebrand syndrome is an uncommon but important cause of bleeding in pediatric patients with cardiac disease. A high index of clinical suspicion with knowledge of the characteristic clinical scenario in addition to low levels of vWF multimers is required to manage and diagnose AvWS. Although the optimal management of AvWS in this patient population is unclear, vWF concentrates are available and appear to be efficacious for controlling life-threatening bleeding.
Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiopatias Congênitas/cirurgia , Unidades de Terapia Intensiva , Hemorragia Pós-Operatória/etiologia , Doenças de von Willebrand/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Cardiopatias Congênitas/complicações , Coração Auxiliar/efeitos adversos , Humanos , Lactente , Recém-Nascido , Masculino , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/diagnóstico , Doenças de von Willebrand/sangue , Doenças de von Willebrand/diagnóstico , Fator de von Willebrand/metabolismoRESUMO
We present a hybrid technique of left ventricular assist device exclusion after bridge to recovery in a pediatric patient, using percutaneous occlusion of the outflow graft and surgical excision of driveline. This technique has the advantage of avoiding chest reentry and cardiopulmonary bypass.
Assuntos
Cardiomiopatia Dilatada/terapia , Coração Auxiliar , Miocardite/terapia , Dispositivo para Oclusão Septal , Adolescente , Antibióticos Antineoplásicos/efeitos adversos , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/cirurgia , Cardiomiopatia Dilatada/induzido quimicamente , Contraindicações , Remoção de Dispositivo , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Osteossarcoma/tratamento farmacológico , Osteossarcoma/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Procedimentos DesnecessáriosRESUMO
The development of acquired von Willebrand syndrome (AVWS) after placement of a pulsatile-flow left ventricular assist device (LVAD) is rare and only recently recognized. We report the case of a young infant who was diagnosed with ventricular assist device (VAD)-related AVWS following implantation of a Berlin Heart EXCOR Pediatric Ventricular Assist Device (Berlin Heart Inc., The Woodlands, Texas, USA) for treatment of severe heart failure. Despite significant bleeding, the patient was successfully managed with von Willebrand factor-containing concentrate until VAD explantation led to definitive resolution of the AVWS. This case demonstrates that the possibility of this diagnosis should be considered in pediatric patients when extensive, nonsurgical bleeding is encountered after pulsatile-flow VAD implantation.