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Cardiac performance in pediatric near-drowning
C A Hildebrand1, A G Hartmann, E L Arcinue
1Pediatric Intensive Care Unit, Huntington Memorial Hospital, Pasadena, CA 91105.
Critical Care Medicine
|April 1, 1988
Summary
Cerebral resuscitation in near-drowned children can negatively impact cardiovascular function, potentially worsening outcomes. Monitoring cardiac index and pulmonary capillary wedge pressure is crucial for optimizing cerebral perfusion and neurologic recovery.
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Cardiovascular Physiology
Background:
- Near-drowning incidents in children can lead to severe neurological compromise.
- Cardiopulmonary arrest (CPR) is a critical event in pediatric near-drowning cases.
- Intracranial hypertension is a significant concern following near-drowning events.
Purpose of the Study:
- To investigate the hemodynamic effects of cerebral resuscitative therapy in near-drowned children.
- To assess the impact of interventions like controlled hyperventilation, hypothermia, pentobarbital, and mannitol on cardiovascular function.
- To determine the necessity of cardiovascular support during cerebral resuscitation.
Main Methods:
- Retrospective analysis of 29 near-drowned children admitted to a Pediatric ICU.
- Hemodynamic monitoring (cardiac index, systemic vascular resistance index) in select patients.
- Implementation of cerebral resuscitative therapies for intracranial hypertension.
Main Results:
- Patients experiencing cardiopulmonary arrest often presented with low cardiac index and high systemic vascular resistance index post-CPR.
- Cerebral resuscitative therapy led to a decrease in systemic vascular resistance index, cardiac index, mean arterial pressure, and cerebral perfusion pressure.
- Fluid volume therapy and inotropic support were required to maintain adequate cerebral perfusion pressure.
Conclusions:
- Cerebral resuscitative therapies can induce significant hemodynamic depression in near-drowned children.
- These cardiovascular effects may potentially exacerbate the overall outcome.
- Continuous monitoring of cardiac index and pulmonary capillary wedge pressure is recommended to optimize cerebral perfusion and neurologic outcomes.