Abstract P-555: PHOSPHATE IMBALANCE IN INTENSIVE CARE PATIENTS AFTER NORWOOD, BIDIRECTIONAL GLENN, HEMI-FONTAN AND FONTAN PROCEDURES.

Abstract

Aims & Objectives: Hypophosphatemia is commonly seen in critically ill children and has been shown to hamper clinical recovery. Patients after surgical palliation of HLHS are prone to develop this disturbance as they require large doses of medications known to decrease serum phosphorus levels. Moreover, deleterious effects of hypophosphatemia on the cardiopulmonary system can be especially harmful to those patients. Methods We conducted a retrospective review of the medical records of children consecutively admitted to our PICU between October 2015 and November 2017, immediately after Norwood, Glenn or Fontan procedure. The following data were recorded: type of procedure with assigned Aristotle Basic Complexity Score, duration of cardiopulmonary bypass, serum phosphorus levels monitored during the first 3 days of PICU admission, hemodynamic parameters, medications, use of blood products, duration of mechanical ventilation and PICU length of stay. Results 76 children were included in the study, with a median age of 6,2 months (range: 2d - 75.7m).Throughout the study period decreased serum phosphorus levels occurred in 32 patients (42.1%), and the prevalence of hypophosphatemia on D0, D1, and D2 was 2.6%, 23.7%, and 23.7%. No association between factors previously described in the literature and hypophosphatemia was observed, except for the use of furosemide at a mean dose of over 2 mg/kg/day. Conclusions Hypophosphatemia is highly prevalent in children after staged surgical palliation of HLHS, especially in those receiving high doses of furosemide. Given the greater susceptibility and potential complications, serum phosphorus levels should be routinely measured after the surgery, so that appropriate replacement therapy may be started.