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Evaluation of hemodynamics in infants and small babies after open heart surgery
Insights
Postoperative hemodynamic monitoring in infants after open heart surgery is crucial. Big toe skin temperature serves as a reliable indicator of cardiac output and overall hemodynamic status in these patients.
Area of Science:
- Pediatric Cardiac Surgery
- Hemodynamic Monitoring
- Critical Care Medicine
Background:
- Assessing hemodynamic status in infants post-open heart surgery is challenging.
- Establishing typical hemodynamic changes and reliable clinical indicators is essential for early detection of complications.
- Low cardiac output syndrome (LCOS) is a significant concern in this patient population.
Purpose of the Study:
- To define normal hemodynamic parameters in infants during the first 24 hours after open heart surgery.
- To identify reliable clinical tests for evaluating hemodynamic status.
- To correlate specific clinical measurements with cardiac index and other hemodynamic variables.
Main Methods:
- Cardiac index (CI) was measured using thermodilution in 56 infants (6-28 months, 4-15 kg).
- Clinical parameters including toe temperature and rectal-skin temperature gradient were recorded.
- Data were collected within 24 hours post-operation.
Main Results:
- A hemodynamically stable course was associated with CI > 2.7 L/min/m², normal toe temperature (32-34°C), and rectal-skin gradient (2-3°C) within 6-9 hours.
- LCOS was characterized by CI < 2.5 L/min/m², lower toe temperature (26-28°C), and elevated gradient (8-10°C).
- Big toe skin temperature strongly correlated with CI (r=0.80), stroke index (r=0.70), systemic vascular resistance (r=0.64), and urine output (r=0.74).
Conclusions:
- Big toe skin temperature is a sensitive and reliable non-invasive indicator for assessing hemodynamic status in infants post-open heart surgery.
- Monitoring toe temperature and rectal-skin temperature gradient can aid in the early diagnosis of low cardiac output syndrome.
- These clinical parameters provide valuable insights into postoperative recovery and guide therapeutic interventions.
Abstract:
The study was undertaken to establish typical hemodynamic changes and reliable clinical tests for the evaluation of these in infants after open heart surgery. The cardiac index was measured using the thermodilution technique in 56 infants. The age of the patients varied from 6 to 28 months and body weight from 4 to 15 kg. All studies were done during the first 24 hours after operation. It was shown that in a hemodynamically smooth postoperative course cardiac index exceeds 2.7 l X min-1 X m-2, toe temperature (normal 32 degrees to 34 degrees C) and rectal-skin temperature gradient (normal 2 degrees to 3 degrees C) are normalized within 6 to 9 hours postoperatively. In case of low cardiac output syndrome, the cardiac index was below 2.5 l X min-1 X m-2, toe temperature was lowered to 26 degrees to 28 degrees C and the rectal-skin temperature gradient was 8 degrees to 10 degrees C. Big toe skin temperature correlated well with the magnitude of the cardiac index (r = 0.80; n = 247; p less than 0.001); stroke index (r = 0.70; n = 247; p less than 0.001); systemic vascular resistance (r = 0.64; n = 247; p less than 0.001) and urine output (r = 0.74; n = 247; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)