High-frequency oscillatory ventilation for respiratory failure after congenital heart surgery: a retrospective analysis.

INTRODUCTION: Pulmonary complications such as acute respiratory distress syndrome and refractory respiratory failure have been major causes of morbidity and mortality after cardiac surgery in children. Patients are usually transitioned to either high-frequency oscillatory ventilation (HFOV) or extracorporeal membrane oxygenation (ECMO) as "salvage therapy" when the maximal medical management and controlled mechanical ventilation (CMV) become ineffective. MATERIAL AND METHODS: A retrospective review of paediatric patients who underwent congenital heart surgery and developed cardiorespiratory failure during their stay in a paediatric cardiac ICU, refractory to maximal CMV, was performed in the study. The outcomes assessed were respiratory variables such as SpO 2 , RR, oxygenation index (OI), P/F ratio, and ABG parameters in CMV and HFOV as predictors of survival. RESULTS: Twenty-four children with cardiorespiratory failure were candidates for a transition to either HFOV ( n = 15) or VA ECMO ( n = 9) for refractory hypoxaemia; of these 24 patients, 13 (54.16%) survived. PaO2 showed a significant improvement in the survivors (P = 0.03). Improvement in the PaO 2 /FiO 2 (P/F ratio) after initiation of HFOV was associated with survival ( P < 0.001). pH, PaCO 2 , HCO 3 , FiO 2 , Paw, RR/Amp, SpO 2 , and OI also showed improvements in survivors but these were not statistically significant. The HFOV survivors had longer mechanical ventilation and ICU stay than non-survivors ( P = 0.13). CONCLUSIONS: HFOV was associated with improved gas exchange for paediatric patients who developed post-cardiac surgery refractory respiratory failure. HFOV can be considered as rescue therapy where ECMO has major financial implications.

Favourable outcome in a child with presumed tubercular pancarditis treated with empirical antitubercular therapy.

Cardiac tuberculosis (TB) as an extrapulmonary manifestation of TB is rare. Pericarditis is a common manifestation while myocarditis and endocarditis are less common. Tubercular pancarditis is extremely rare. Endomyocardial involvement of TB is generally clinically silent and present as sudden death due to arrhythmias. It is recommended that empirical antitubercular therapy (ATT) on the basis of clinical suspicion should be avoided in countries where TB is highly prevalent. However, delaying ATT in endomyocardial TB and extensive investigations for demonstration or culture of acid-fast bacilli (AFB) may be associated with morbidity and may lead to catastrophic consequences, especially in a sick child. We present a child with TB pancarditis who presented with congestive cardiac failure and empirical ATT was started after extensive efforts to demonstrate AFB failed and the outcome was good.

Ivabradine as an Adjunct for Refractory Junctional Ectopic Tachycardia Following Pediatric Cardiac Surgery: A Preliminary Study.

OBJECTIVES: Junctional ectopic tachycardia (JET) is a relatively common narrow complex rhythm typically characterized by atrioventricular dissociation or retrograde atrial conduction in a 1:1 pattern. Junctional ectopic tachycardia can be a life-threatening disorder, causing severe hemodynamic compromise and increased morbidity and mortality. The treatment of refractory JET can be very difficult, even with multimodal therapeutic interventions. The purpose of this study was to assess the role of ivabradine in cases of JET refractory to amiodarone and esmolol. METHODS: A total of 480 congenital heart surgeries were carried out at our center in 2017. Twenty (4.16%) patients had postoperative JET. Among these, five infants, aged 7 to 12 months (median: 8 months), had refractory JET. These patients (three tetralogy of Fallot, one ventricular septal defect, one complete atrioventricular septal defect) were treated with oral ivabradine in the dose range of 0.1 to 0.2 mg/kg/12 h as an adjunct to amiodarone. RESULTS: All five patients achieved rate reduction and eventual conversion to sinus rhythm. Mean duration to achieve heart rate of <140 bpm after initiation of ivabradine therapy was 16.8 hours (±7.2 hours), while mean duration to achieve sinus rhythm was 31.6 hours (±13.6 hours). No patient had any recurrence of JET. No patient exhibited any hemodynamic derangement nor side effects attributable to oral ivabradine. CONCLUSION: Oral ivabradine has the potential to be used as an adjunct to amiodarone in the treatment of JET in infants after surgery for congenital heart disease.

Chryseobacterium Indologenes Pneumonitis in an Infant: A Case Report.

Chryseobacterium indologenes, a non-fermentative Gram-negative bacilli distributed widely in nature, is an emerging nosocomial pathogen, inherently resistant to a wide range of antibiotics. There is limited number of C. indologenes infections reported from India. We report a case of C. indologenes associated pneumonia in a three-month-old infant with congenital heart disease. This case highlights the importance of prompt diagnostic workup and targeted antibiotic therapy for its effective management.