Management of pediatric cardiac surgery wound: a literature review.

BACKGROUND: Sternal wound infection is a severe complication of cardiac surgery in the pediatric population (0-18 years old) that can lead to increased morbidity, mortality, and prolonged hospitalization. Health professionals have the ability to perform some interventions during the pre, intra and post-surgery to correctly manage sternal wounds, with the goal of preventing infections. OBJECTIVES: To identify and discuss current best practice in the prevention, incidence, and treatment of infections of the cardiac surgery site in the pediatric population. METHODS: Between February 20th 2021 and February 28th 2021 we consulted the PubMed database adopting full text, 20 years, Humans, English, Child aged 0 to 18 years as criteria. Twenty articles out of sixty-six were considered relevant to this study. These were divided into four themes. RESULTS: All studies highlight the lack of standard guidelines for managing pediatric patients undergoing cardiac surgery. Some centers developed protocols for managing antibiotic prophylaxis supported by measurable interventions; others implemented infection surveillance systems involving families taking care of patients after hospital discharge. DISCUSSIONS: the identification of healthcare-associated infections in the pediatric population after cardiac surgery is useful in all peri-operative phases. The limited and restricted literature connected to single centers, with relatively small sample sizes, the use of a single database. CONCLUSION: There is a lack of standard guidelines. The prevention of site infection ought to the goal of reducing surgical site infections. Building a network between the multidisciplinary staff and the pediatric patient's family improves the infection surveillance system, reducing the incidence of infections.

Survey on Sternal Wound Management in the Italian Pediatric Cardiac Intensive Care Units.

(1) Background: a review of the literature found a lack of standardized pediatric guidelines regarding wound management after cardiac surgery. (2) Objective: the aim of the study is to investigate the cardiac surgical wound management in Italian pediatric cardiac intensive care units. (3) Methods: we sent an online questionnaire to the 13 Italian pediatric cardiac intensive care units. (4) Results: ten pediatric cardiac intensive care units (77%) have a protocol for the management of the cardiac surgical wound. The staff members that mainly have the responsibility for the wound management after cardiac surgery are registered nurses and physicians together both in the pediatric cardiac intensive care units (69%), and when a patient is transferred to another ward (62%). Thirty-eight percent of the pediatric cardiac intensive care units have a protocol used to monitor wound infection, and the staff mostly uses a written shift report (54%) to monitor the infection. (5) Discussion: this is the first survey to investigate the management of the wound after cardiac surgery in Italian pediatric cardiac intensive care units. The small sample size and the fact that the centers involved are only Italian cardiac intensive care units are the limits of this study. (6) Conclusions: in the Italian pediatric cardiac intensive care units it emerged that there is a diversity in the treatments adopted and a lack of specific protocols in the management of the pediatric cardiac surgical wound.

Survey on monitoring analgesia and sedation in the Italian Pediatric Intensive Care Units.

BACKGROUND: Admission in Pediatric Intensive Care Unit requires management and monitoring of analgesia and sedation, in order to reduce their adverse effects, and to prevent withdrawal syndrome and delirium. The aim of this study was to evaluate the management of analgesia and sedation in critically ill children admitted in the Italian Pediatric Intensive Care Units. METHODS: For this survey we have submitted a telematics questionnaire to 24 nursing coordinators of the Pediatric Intensive Care Units or Neonatal Intensive Care Units admitting critically ill children. RESULTS: Twenty Intensive Care Units (ICUs) replied to the questionnaire. The association of benzodiazepines and opioids was the first choice in 92.8% of analgesic and sedative strategies. Seventy percent of ICUs adopted a protocol for analgesic and sedative drugs used before performing invasive and/or painful procedures in critically ill children. Ninety percent of them followed a protocol for the assessment of pain, 75% adopting the Face, Legs, Activity, Cry, Consolability Scale. Sixty percent of ICUs followed a protocol for sedation, 58% used the Comfort Scale to monitor the level of it. Forty percent adopted a protocol for the withdrawal syndrome, 75% of them monitored the patients with the WAT-1 Scale. Ten percent of Pediatric Intensive Care Units followed a protocol for management of delirium; seventy-five percent did not monitor it. CONCLUSIONS: Despite an increasing sensitivity in pain and sedation management over the last five years, knowledge and monitoring of abstinence syndrome and delirium need to be improved.