Seminars in Pediatric Surgery最新文献_第10页

Extracorporeal life support in neonates and children: Innovations, controversies, and promise 新生儿和儿童的体外生命支持：创新、争议和前景。

IF 1.7 3区医学

Seminars in Pediatric Surgery Pub Date : 2023-08-01 DOI: 10.1016/j.sempedsurg.2023.151325

Brian W. Gray , George B. Mychaliska

引用次数: 0

The new frontier in ECLS: Artificial placenta and artificial womb for premature infants ECLS的新前沿：早产儿的人造胎盘和人造子宫。

IF 1.7 3区医学

Seminars in Pediatric Surgery Pub Date : 2023-08-01 DOI: 10.1016/j.sempedsurg.2023.151336

Nikhil R. Shah , George B. Mychaliska

引用次数: 0

Advances in pulmonary management and weaning from ECLS ECLS的肺部管理和断奶进展。

IF 1.7 3区医学

Seminars in Pediatric Surgery Pub Date : 2023-08-01 DOI: 10.1016/j.sempedsurg.2023.151329

Keith A. Thatch , David W. Kays

{"title":"Advances in pulmonary management and weaning from ECLS","authors":"Keith A. Thatch , David W. Kays","doi":"10.1016/j.sempedsurg.2023.151329","DOIUrl":"10.1016/j.sempedsurg.2023.151329","url":null,"abstract":"<div><p>ECMO for neonatal and pediatric respiratory failure provides gas exchange to allow lung recovery from reversible pulmonary ailments. This is a comprehensive discussion on the various strategies and advances utilized by pediatric ECLS specialists today. ECMO patients require continual monitoring, serial gasses and radiographs, near-infrared spectroscopy (NIRS - to monitor oxygen delivery to regional tissue beds), and more quality ECLS directed care. As the foundation to lung recovery, good EMCO closely monitors ECLS flow rates, sweep gasses, and membrane lung function. Mixed venous oxygen saturation (Sv0<sub>2</sub>) greater than 65% indicates good oxygen delivery and sweep gas adjustments maintain PaCO2 of 40–45 mm Hg. Lung recovery ventilatory settings do not fully rest the lungs but maintain normal or nontoxic pressure and oxygen levels. Neonatal recovery settings are PIP (cm H<sub>2</sub>0) of 15–20, PEEP of 5–10, ventilator rate of 12–20 and an inspiratory time of 0.5–1 s, and FiO2 of 0.3–0.5. Pediatric recovery settings are PIP (cm H<sub>2</sub>0) < 25, PEEP of 5–15, ventilator rate of 10–20 and an inspiratory time of 0.8–1 s, and FiO2 of <0.5. Some studies demonstrate a higher recovery PEEP level decreases duration of ECMO, but do not demonstrate a mortality difference. Multiple adjunctive therapies such as surfactant, routine pulmonary clearance and respiratory physiotherapy, iNO, prone positioning, bronchoscopy, POCUS, CT imaging, and extubation or “awake ECLS” can significantly affect pulmonary recovery. Patience is necessary as lung recovery may take weeks or even months on the nontoxic settings. On these settings, dynamic recovery will be revealed by improvement in tidal volume, minute ventilation and radiographic pulmonary aeration, prompting discussion about weaning. When this pulmonary compliance recovery becomes evident, decreasing ECLS flow while also decreasing circuit FiO2 and/or sweep gas are common components to ECMO weaning strategies.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"32 4","pages":"Article 151329"},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Managing the kidney – The role of continuous renal replacement therapy in neonatal and pediatric ECMO 肾脏管理——持续肾脏替代治疗在新生儿和儿童ECMO中的作用。

IF 1.7 3区医学

Seminars in Pediatric Surgery Pub Date : 2023-08-01 DOI: 10.1016/j.sempedsurg.2023.151332

Abhinav Totapally , Brian C Bridges , David T Selewski , Elizabeth E Zivick

{"title":"Managing the kidney – The role of continuous renal replacement therapy in neonatal and pediatric ECMO","authors":"Abhinav Totapally , Brian C Bridges , David T Selewski , Elizabeth E Zivick","doi":"10.1016/j.sempedsurg.2023.151332","DOIUrl":"10.1016/j.sempedsurg.2023.151332","url":null,"abstract":"<div><p>Extracorporeal membrane oxygenation (ECMO) represents a lifesaving therapy utilized in in the most critically ill neonates and children with reversible cardiopulmonary failure. As a result of the severity of their critical illness these patients are among the highest risk populations for developing acute kidney injury (AKI) and disorders of fluid balance including the pathologic state of fluid overload (FO). In multiple studies AKI has been shown to occur commonly in 60-80% children treated with ECMO and is associated with adverse outcomes. In early studies evaluating ECMO in neonatal respiratory populations, the importance of fluid balance and the development of FO was recognized as an important contributor to adverse outcomes. Multiple single center studies and multicenter work have confirmed that FO occurs commonly across ECMO populations and is consistently associated with adverse outcomes. As a result of the high rates of AKI and the high rates of FO, continuous renal replacement therapy (CRRT) is increasingly utilized in neonatal and pediatric ECMO. In this state-of-the-art review, we cover the definitions, pathophysiology, incidence, and impact of AKI and FO in neonates and children supported with ECMO and summarize and appraise the evidence regarding the use of CRRT concurrently with ECMO. This review will cover the appropriate timing of this initiation, the options for providing CRRT with ECMO, overview of CRRT prescription, and the long-term implications of kidney support therapy in this population.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"32 4","pages":"Article 151332"},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pediatric ECLS Neurologic Management and Outcomes 儿童ECLS神经系统管理和结果。

IF 1.7 3区医学

Seminars in Pediatric Surgery Pub Date : 2023-08-01 DOI: 10.1016/j.sempedsurg.2023.151331

Kylie Callier , Goeto Dantes , Kevin Johnson , Allison F. Linden

{"title":"Pediatric ECLS Neurologic Management and Outcomes","authors":"Kylie Callier , Goeto Dantes , Kevin Johnson , Allison F. Linden","doi":"10.1016/j.sempedsurg.2023.151331","DOIUrl":"10.1016/j.sempedsurg.2023.151331","url":null,"abstract":"<div><p>Neurologic complications associated with extracorporeal life support (ECLS), including seizures, ischemia/infarction, and intracranial hemorrhage significantly increase morbidity and mortality in pediatric and neonatal patients. Prompt recognition of adverse neurologic events may provide a window to intervene with neuroprotective measures. Many neuromonitoring modalities are available with varying benefits and limitations. Several pre-ECLS and ECLS-related factors have been associated with an increased risk for neurologic complications. These may be patient- or circuit-related and include modifiable and non-modifiable factors. ECLS survivors are at risk for long-term neurological sequelae affecting neurodevelopmental outcomes. Possible long-term outcomes range from normal development to severe impairment. Patients should undergo a neurological evaluation prior to discharge, and neurodevelopmental assessments should be included in each patient's structured, multidisciplinary follow-up.</p><p>Safe pediatric and neonatal ECLS management requires a thorough understanding of neurological complications, neuromonitoring techniques and limitations, considerations to minimize risk, and an awareness of possible long-term ramifications. With a focus on ECLS for respiratory failure, this manuscript provides a review of these topics and summarizes best practice guidelines from international organizations and expert consensus.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"32 4","pages":"Article 151331"},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72015859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neonatal venoarterial and venovenous ECMO 新生儿静脉-动脉和静脉-静脉ECMO。

IF 1.7 3区医学

Seminars in Pediatric Surgery Pub Date : 2023-08-01 DOI: 10.1016/j.sempedsurg.2023.151326

Artur Chernoguz, Julie Monteagudo

{"title":"Neonatal venoarterial and venovenous ECMO","authors":"Artur Chernoguz, Julie Monteagudo","doi":"10.1016/j.sempedsurg.2023.151326","DOIUrl":"10.1016/j.sempedsurg.2023.151326","url":null,"abstract":"<div><p>ECMO remains an important support tool in the treatment of neonates with reversible congenital cardiopulmonary diseases. There are specific circumstances that call for either venoarterial (VA) or venovenous (VV) ECMO in neonates. While limited by the infant's the size and gestational age, ECMO can confer exceptional survival rates to a number of neonates who can often develop without devastating complications. However, it remains a labor and time intensive endeavor, which may be impractical or unattainable in resource-limited environments. While adult and pediatric ECMO indications and equipment options have expanded in recent years, neonatal ECMO continues to be a niche subspecialty requiring specific expertise and technical skill, especially considering the ever-changing neonatal physiology in the setting of cardiopulmonary support.</p><p>It is critical to recognize the unique approaches to cannulation options, imaging, vessel management, anticoagulation, and monitoring protocols to achieve optimal outcomes. Thus, it becomes nearly impossible to separate the role of pediatric surgeons from the continuous involvement with and management of neonatal ECMO patients. This necessitates that pediatric surgeons in ECMO centers continue to hone their expertise and remain heavily involved in neonatal ECMO. This section reviews the most critical current approaches and unresolved controversies in neonatal ECMO with special attention to the practical aspects and decisions a surgeon faces in initiation and termination of neonatal ECMO.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"32 4","pages":"Article 151326"},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

ECMO for premature neonates- Are we there yet? 早产儿体外膜肺氧合-我们做到了吗?

IF 1.7 3区医学

Seminars in Pediatric Surgery Pub Date : 2023-08-01 DOI: 10.1016/j.sempedsurg.2023.151335

Carmen Mesas Burgos , Natalie Rintoul , Lars Mikael Broman

{"title":"ECMO for premature neonates- Are we there yet?","authors":"Carmen Mesas Burgos , Natalie Rintoul , Lars Mikael Broman","doi":"10.1016/j.sempedsurg.2023.151335","DOIUrl":"https://doi.org/10.1016/j.sempedsurg.2023.151335","url":null,"abstract":"<div><p>Despite ECMO being a well-accepted and established life-saving support for newborns, prematurity (<34 weeks of gestation) and low birth weight <2.0 kg are still considered relative contraindications due to the fear of intracranial bleeding complications.</p><p>In the last decades, outcome in extracorporeal life support for pre-term babies has improved, and morbidity dominated by intracranial bleedings has decreased.</p><p>With the introduction of new methodologies and technological development, the current ELSO guideline for ECMO (GA >34 w, BW > 2.0 kg) deserves to be challenge.</p><p>The authors suggest that <em>Prem-ECMO (GA 32-33) could be considered when r</em>estricted to experienced high-volume neonatal ECMO centers<em>,</em> with closed monitoring and rigorous reporting to the ELSO registry<em>,</em> providing close targeting of oxygen delivery for prevention of retinopathy <em>and</em> being active participants in continuous development of technology and devices for improved biocompatibility for use in the neonate.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"32 4","pages":"Article 151335"},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1055858623000823/pdfft?md5=3ce81e0f07521f879b1c644b6734a914&pid=1-s2.0-S1055858623000823-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91594144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Extracorporeal life support in congenital diaphragmatic hernia 先天性膈疝的体外生命支持。

IF 1.7 3区医学

Seminars in Pediatric Surgery Pub Date : 2023-08-01 DOI: 10.1016/j.sempedsurg.2023.151328

Kylie I. Holden , Alice M. Martino , Yigit S. Guner , Matthew T. Harting

{"title":"Extracorporeal life support in congenital diaphragmatic hernia","authors":"Kylie I. Holden , Alice M. Martino , Yigit S. Guner , Matthew T. Harting","doi":"10.1016/j.sempedsurg.2023.151328","DOIUrl":"10.1016/j.sempedsurg.2023.151328","url":null,"abstract":"<div><p>Congenital diaphragmatic hernia (CDH) is the most common indication for ECLS in neonatal respiratory failure. The ultimate purpose of ECLS is to grant cardiopulmonary support, allowing time for operative intervention and optimization of cardiopulmonary function as the pathophysiologic processes of pulmonary hypertension, pulmonary hypoplasia, and ventricular dysfunction either improve or resolve. In CDH, ECLS plays a crucial role in the management of the most challenging patients, facilitating postnatal stabilization, allowing a ventilation strategy which minimizes barotrauma and volutrauma, and permitting treatment of and recovery from pulmonary hypertension and/or cardiac dysfunction. Understanding the nuances of CDH patients, which differ from other forms of neonatal respiratory failure, and the benefits of ECLS for these infants, is crucial for effective management. CDH patients present distinct challenges. Every aspect of ECLS, from mode of support and anticoagulation medication to pump selection, ventilation strategy, pulmonary hypertension management, and the weaning process, requires meticulous consideration. ECLS for CDH serves as a bridge to making informed decisions, granting clinicians stability and time to manage / recover from specific pathophysiologic consequences, and it offers the potential for survival among even the most challenging and complex patients. As overall care and management for infants with CDH receiving ECLS continue to improve, the focus has shifted toward managing survivor morbidity. Given the multisystem nature of the disease, this requires significant experience, expertise, and multidisciplinary teamwork to optimize long-term outcomes for these patients.</p></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"32 4","pages":"Article 151328"},"PeriodicalIF":1.7,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Quality improvement strategies in pediatric ECMO 儿科ECMO的质量改进策略。

IF 1.7 3区医学

Seminars in Pediatric Surgery Pub Date : 2023-08-01 DOI: 10.1016/j.sempedsurg.2023.151337

Makenzie Hamilton , Steven W. Thornton , Elisabeth T. Tracy , Caroline Ozment

引用次数: 0

Device updates in pediatric and neonatal ECMO 儿科和新生儿ECMO的设备更新。

IF 1.7 3区医学

Seminars in Pediatric Surgery Pub Date : 2023-08-01 DOI: 10.1016/j.sempedsurg.2023.151334

Yujin Park , Natalie A. Drucker , Brian W. Gray

引用次数: 0