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Outcomes following thoracoabdominal resection of neuroblastoma
Sara L P Ross1, Bruce M Greenwald, Joy D Howell
1Department of Pediatrics, Division of Critical Care Medicine, Cornell University Medical College and New York Presbyterian Hospital-Weill, Cornell Medical Center, NY, USA. saross@montefiore.org
Objective:
To evaluate the intraoperative and postoperative care of children following thoracoabdominal resection of neuroblastoma.
Design:
Retrospective chart review.
Setting:
Pediatric intensive care unit (PICU) of major pediatric cancer center.
Patients:
Eighty-eight patients undergoing thoracoabdominal resection of neuroblastoma over a 6-year period.
Interventions:
None.
Measurements And Main Results:
Demographic and clinical data were collected, including: length of PICU stay (LOS-P), duration of mechanical ventilation (MVD), mean arterial blood pressure, central venous pressure (CVP), fluid management, pressor use, and mortality. Twenty-one patients required inotropic/vasopressors support pressors following surgery. Patients who received pressors had longer operative times (p < .05) and received less intraoperative fluid (p < .05), but had the same estimated blood loss and urine output as nonpressor (NP) patients. Among the patients who received pressors, the MVD was 57 hrs, compared with 24 hrs in the NP group (p < .01). The LOS-P was 118 hours in the pressors group, vs. 69 hrs in the NP group (p < .01). The mean arterial blood pressure was lower and the CVP was higher in the pressors group compared with the NP group, and pressors patients received significantly more fluid postoperatively (p < .01). When pressors were initiated at a low CVP (<8), MVD was 39 hrs compared with 71 hrs when pressors were started at a higher CVP (p = .08). LOS-P was only slightly shorter in the low CVP group, 112 hrs vs. 123 hours (p = NS). The PICU mortality rate was 0%.
Conclusions:
Patients who received pressors had longer operative times and received less intraoperative fluid. Subsequently, they required more postoperative fluid, which is likely the result of hemodynamic instability leading to longer MVD and LOS-P. A prospective study evaluating operative fluid management and optimal time for initiation of pressors, in addition to the role of catecholamines and cytokines in this unique postoperative patient population is indicated.