Analysis of the Use of Non-Invasive Lung Ventilation Support in Newborns and Young Children after Cardiac Surgery
Abstract
Background. Non-invasive ventilatory support for artificial lung ventilation (ALV) in infants with congenital heart disease after cardiac surgery helps to reduce the duration of invasive ALV, reduce the number of mechanical and infectious complications, and reduce or eliminate the need for sedation.
The aim. To analyze the experience of using non-invasive ventilatory support after surgical correction of congenital heart disease in infants and compare its effectiveness with invasive mechanical ventilation.
Materials and methods. We conducted a retrospective analysis of the use of non-invasive ALV and its effectiveness compared to invasive mechanical ventilation in children under 1 year of age after cardiac surgery from 2020 to 2022 at the Department of Cardiac Arrest in Newborns and Young Children of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. During this period, 134 patients were operated on (38 children under 1 month old, 96 children under 1 year old). In the postoperative period, 85 children (55.9%) needed prolonged mechanical ventilation (more than 24 hours), of which non-invasive ventilation support was used in 32 patients (37.6%) and invasive ventilation in 53 (62.3%) patients.
Results. The patients on non-invasive ALV (n = 32) had lower weight (p = 0.23), shorter ventilation time (p = 0.56), and the time spent at the intensive care unit (p = 0.61), required less sedation (p = 0.29), and had lower mortality (p = 0.42) compared to the group of children who received only invasive ventilatory support (n = 53), but this difference was not statistically significant. The need for non-invasive ventilation was higher in 9 (28.12%) infants than in 8 (15.09%) other infants and was statistically significant (p < 0.001).
Conclusions. Our study showed that the use of non-invasive ALV can shorten the length of stay at the intensive care unit and the time spent on ventilation, reduce or avoid the use of sedation, and prevent pulmonary complications (infectious and mechanical) with long-term treatment. However, there was no significant difference between non-invasive and invasive ventilation in terms of mortality.
References
- Vervoort D, Zheleva B, Jenkins KJ, Dearani JA. Children at the Heart of Global Cardiac Surgery: An Advocacy Stakeholder Analysis. World J Pediatr Congenit Heart Surg. 2021;12(1): 48-54. https://doi.org/10.1177/2150135120955189
- Shargorodska YeB. [Congenital diseases of the heart among newborns: genetic aspects (literature review)]. Journal of V. N. Karazin` KhNU. 2019;(38):79-95. Ukrainian. https://doi.org/10.26565/2313-6693-2019-38-10
- Sanfilippo F, Palumbo GJ, Bignami E, Pavesi M, Ranucci M, Scolletta S, et al. Acute Respiratory Distress Syndrome in the Perioperative Period of Cardiac Surgery: Predictors, Diagnosis, Prognosis, Management Options, and Future Directions. J Cardiothorac Vasc Anesth. 2022;36(4):1169-1179. https://doi.org/10.1053/j.jvca.2021.04.024
- Fernandez-Zamora MD, Gordillo-Brenes A, Banderas- Bravo E, Arboleda-Sánchez JA, Hinojosa-Pérez R, Aguilar- Alonso E, et al.; ARIAM Andalucía Group. Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery. Respir Care. 2018;63(5):550-557. https://doi.org/10.4187/respcare.04915
- Santarpino G, Bonifazi R, Albanese M, Nicoletti A, Fiore F, Nasso G, et al. Prone Positioning in Postoperative Cardiac Surgery Patients: A Narrative Review. J Cardiothorac Vasc Anesth. 2022;36(8 Pt A):2636-2642. https://doi.org/10.1053/j.jvca.2021.07.045
- Ciociola EC, Kumar KR, Zimmerman KO, Thompson EJ, Harward M, Sullivan LN, et al. Association between preoperative respiratory support and outcomes in paediatric cardiac surgery. Cardiol Young. 2020;30(1):66-73. https://doi.org/10.1017/S1047951119002786
- Bronicki RA, Benitz WE, Buckley JR, Yarlagadda VV, Porta NFM, Agana DO, et al. Respiratory Care for Neonates With Congenital Heart Disease. Pediatrics. 2022 Nov 1;150(Suppl 2):e2022056415H. https://doi.org/10.1542/peds.2022-056415H
- Shehadeh AMH. Non-invasive respiratory support for preterm infants following extubation from mechanical ventilation. A narrative review and guideline suggestion. Pediatr Neonatol. 2020;61(2):142-147. https://doi.org/10.1016/j.pedneo.2019.09.014
- Praud JP. Long-Term Non-invasive Ventilation in Children: Current Use, Indications, and Contraindications. Front Pediatr. 2020 Nov 5;8:584334. https://doi.org/10.3389/fped.2020.584334
- Richards AM. Pediatric Respiratory Emergencies. Emerg Med Clin North Am. 2016;34(1):77-96. https://doi.org/10.1016/j.emc.2015.08.006
- Bello G, De Pascale G, Antonelli M. Noninvasive Ventilation. Clin Chest Med. 2016;37(4):711-721. https://doi.org/10.1016/j.ccm.2016.07.011
- Pelosi P, Ball L, Barbas CSV, Bellomo R, Burns KEA, Einav S, et al. Personalized mechanical ventilation in acute respiratory distress syndrome. Crit Care. 2021 Jul 16;25(1):250. https://doi.org/10.1186/s13054-021-03686-3
- Öztürk E, Tanıdır İC, Yıldız O, Yükçü B, Ergün S, Haydın S, et al. Ultrasonographic postoperative evaluation of diaphragm function of patients with congenital heart defects. Turk Gogus Kalp Damar Cerrahisi Derg. 2020;28(1):70-75. https://doi.org/10.5606/tgkdc.dergisi.2020.18458
- Pieczkoski SM, Margarites AGF, Sbruzzi G. Noninvasive Ventilation During Immediate Postoperative Period in Cardiac Surgery Patients: Systematic Review and Meta-Analysis. Braz J Cardiovasc Surg. 2017;32(4):301-311. https://doi.org/10.21470/1678-9741-2017-0032
- Mahmood SS, Pinsky MR. Heart-lung interactions during mechanical ventilation: the basics. Ann Transl Med. 2018 Sep;6(18):349. https://doi.org/10.21037/atm.2018.04.29
