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[How urgent is an operation in enterothorax?]
J Jakschik1, G Brünagel, U Fahnenstich
1Chirurgische Klinik und Poliklinik, Rheinische Freidrich-Wilhelms-Universität Bonn.
Insights
Delayed surgery improves survival for pediatric enterothorax patients. Stabilizing critical cases with intensive care before operation enhances outcomes and vital signs.
Area of Science:
- Pediatric surgery
- Critical care medicine
- Neonatal respiratory distress
Context:
- Enterothorax presents significant challenges in emergency treatment due to compromised lung function and hemodynamic instability.
- The maturity of fetal lungs is not a factor that can be influenced by immediate surgical intervention.
Purpose:
- To evaluate the efficacy of a delayed surgical approach combined with intensive care stabilization for pediatric enterothorax patients.
- To determine if pre-operative stabilization improves patient outcomes in critical enterothorax cases.
Summary:
- A delayed surgical strategy was employed for 10 pediatric enterothorax patients with critical conditions.
- Intensive care stabilization for 12-24 hours successfully improved oxygen saturation (72% to 89%), decreased FiO2 requirements (<50%), normalized pCO2 levels (43 +/- 13 mm Hg), and corrected pH (7.238 to 7.394).
- Immediate surgery is indicated if patient condition deteriorates during the stabilization period. ECMO (extracorporeal membrane oxygenation) was not utilized.
Impact:
- Delayed surgical intervention and intensive care stabilization can significantly improve survival rates in critically ill pediatric enterothorax patients.
- This approach allows for physiological optimization, reducing surgical risks and improving post-operative recovery.
- Further research into advanced supportive measures like ECMO in these complex cases may be warranted.
Abstract:
The emergency treatment of the enterothorax is problematic due to weak lung functions and unstable hemodynamics, and because it does not influence the stage of maturity of the lungs. By delayed operation children with a critical starting position have a greater chance to survive, after their condition has been stabilised by intensive care treatment. During the stabilising period we managed to decrease the FiO2 level below 50% and to decrease the pCO2 level to 43 +/- 13 mm Hg in our patients (n = 10). Furthermore we succeeded to raise the O2 degree of saturation from 72 +/- 13 to 89 +/- 9%. The pH level went up from 7,238 +/- 0,181 to 7,394 +/- 0,060. If the condition of the patients worsens during the stabilising period--in our patients the stabilising period was between 12 and 24 hours--immediate operation is indicated. We have no experience so far in using ECMO in such situations.