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Application of kinetics in intensive care management of children with generalized oedema
1Institute Of Child Health, Hospital For Sick Children, London, UK.
Insights
Pulsating air beds significantly reduced total body water and tissue edema in pediatric cardiac surgery patients. This intervention led to shorter intensive care unit (ICU) stays and improved patient outcomes.
Area of Science:
- Pediatric cardiac surgery
- Critical care medicine
- Biomedical engineering
Background:
- Post-cardiac surgery patients often experience tissue edema due to fluid shifts.
- Managing fluid balance and reducing edema is crucial for recovery in pediatric intensive care units (ICUs).
Purpose of the Study:
- To assess the impact of a pulsating air bed on tissue edema relief.
- To determine the effect of pulsating air beds on the duration of ICU stay in children after cardiac surgery.
Main Methods:
- Randomized controlled trial involving 16 pediatric patients (3-48 months) undergoing atrioventricular septal defect repair.
- Treatment group used a pulsating low air-loss bed; control group used a standard bed.
- Total body water (TBW) measured by bioelectrical impedance until preoperative levels were restored.
Main Results:
- Pulsating air beds significantly reduced the increase in total body water (TBW) post-surgery compared to standard beds.
- TBW returned to normal levels within 24 hours in the treatment group versus 48-72 hours in the control group.
- Patients on pulsating beds had a significantly shorter ICU stay.
Conclusions:
- Continuous air pulsation in specialty ICU beds effectively reduces tissue edema and improves hemodynamics in pediatric cardiac surgery patients.
- This intervention shows potential for cost-effectiveness through decreased ICU stay and resource utilization.
- Further research is recommended to explore the utility of pulsating air bed technology in critically ill pediatric populations.
Objective:
To evaluate the effects of a pulsating air bed on the relief of tissue oedema and duration of intensive care unit (ICU) stay of children post-cardiac surgery.
Design:
Random allocation.
Setting:
Pediatric cardiac ICU.
Patients And Participants:
Sixteen patients, aged 3-48 months, who underwent the surgical repair of atrioventricular septal defect.
Intervention:
The treatment group received continuous postoperative management on a pulsating low air-loss bed. The control group was managed on a standard non-pulsating bed. The end point of the study was that total body water (TBW) returned to preoperative levels.
Measurements:
The TBW was measured by bioelectrical impedance and expressed as a percentage change of body weight as determined prior to treatment. Measurements were made before surgery, upon arrival on the ICU, and serially until TBW returned to preoperative levels. All patients were treated according to the standard ICU protocol, which includes strict fluid and diuretic regimens. Urine output, mean blood pressure and central venous pressure were measured.
Results:
All patients developed a 2-20% increase in TBW above baseline after open heart surgery. Preoperative measurements and ICU admission values were identical. The maximum increase in TBW was reached 3-6 h after return to the ICU. These values were higher in the control group (p < 0.01). The TBW returned to normal in the treatment group at 24 h after surgery, and at 48-72 h after surgery in the control group (p < 0.001). There was a tendency for higher urine output and central venous pressure in the treated group. The duration of stay in the ICU was significantly less for the treated group (p < 0.05).
Conclusions:
Continuous air pulsation by a specialty ICU bed reduced TBW, relieved tissue oedema, and improved hemodynamics in oedematous post-operative paediatric cardiac surgery patients. This reduced morbidity may have cost-effective implications relating to decreased ICU stay and resource consumption. Further studies to evaluate the use of this technology in critically ill children are warranted.