Cardiothoracic Wound Management in Pediatrics: A Scoping Review
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Published on: May 26, 2023
Jacqueline Cunninghame1, Mari Takashima2, Jennifer Orchard3
1Jacqueline Cunninghame, MNursSt, School of Nursing, Midwifery and Social Work, Health and Behavioural Sciences, University of Queensland, St Lucia; and Centre for Children's Health Research, University of Queensland, South Brisbane, Australia.
Insights
This review highlights the limited high-level evidence for pediatric cardiothoracic wound care interventions. Further clinical trials are crucial to improve outcomes and prevent complications in young surgical patients.
Area of Science:
- Pediatric Surgery
- Wound Care Management
- Evidence-Based Practice
Background:
- Congenital heart defects are a leading cause of infant mortality.
- Pediatric cardiothoracic wound care is complex due to tissue fragility and different healing patterns.
- Understanding wound management is key to preventing complications.
Purpose of the Study:
- To explore preoperative, intraoperative, and postoperative cardiothoracic wound care in pediatric patients.
- To identify current practices and evidence gaps in pediatric cardiothoracic wound management.
Main Methods:
- A scoping review systematically searched major databases (MEDLINE, EMBASE, CINAHL).
- Included interventional studies on pediatric patients (<21 years) over the last 10 years.
- Focused on studies addressing wound intervention and outcomes.
Main Results:
- 23 studies were included from 2379 retrieved; predominantly observational.
- Interventions focused on procedures, management, and bundles, mainly in the postoperative period.
- Heterogeneous reporting of wound surveillance and dressing changes; limited data on intervention effectiveness.
Conclusions:
- Limited high-level evidence exists for pediatric cardiothoracic wound care interventions.
- There is a critical need for clinical trials to evaluate intervention effectiveness.
- Collaboration through clinical networks is essential to advance research in this area.
Background:
Congenital heart defects represent the most prominent cause of mortality in a child's first year of life. Management of cardiothoracic wounds in pediatric populations is complex, attributed to the fragility of soft tissue, with healing progressing differently in adults. Understanding the breadth of wound care management is essential in establishing its applicability to clinical practice, especially in the prevention of complications.
Objective:
The aim of this study was to expansively explore preoperative, intraoperative, and postoperative cardiothoracic wound care in pediatrics.
Methods:
In this scoping review, a systematic search of MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature was conducted to retrieve interventional studies on pediatric cardiothoracic surgical patients (younger than 21 years) with wounds requiring intervention published in the preceding 10 years.
Results:
A total of 2379 studies were retrieved, with 23 studies included. This review predominantly consisted of observational studies (n = 13, 57%), with 2 randomized clinical trials (8.7%). Most studies focused on procedural interventions (n = 14, 41.2%), with an equal distribution of management-focused (n = 10, 29.4%) and bundle-focused (n = 10, 29.4%) interventions. Interventions were most used in the postoperative period (n = 68, 49.6%). Study authors typically assessed the association of pharmaceutical, dressing, mechanical, and decontamination interventions with the incidence of sternal wound infections, healing, other infections, nutrition, parental outcomes, and postoperative complications. Frequency of wound surveillance and dressing changes were heterogeneous and rarely reported among studies.
Conclusions:
This review demonstrated the limited availability of high-level evidence evaluating the effectiveness of wound care interventions associated with pediatric cardiothoracic surgery. It is paramount that researchers leverage existing clinical networks to establish clinical trials.
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