Application of kinetics in intensive care management of children with generalized oedema.

Abstract

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. Random allocation. Pediatric cardiac ICU. Sixteen patients, aged 3-48 months, who underwent the surgical repair of atrioventricular septal defect. 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. 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. 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). 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.