Therapeutic Cardiac Catheterization Research Articles

Cardiac Catheterization in Port Harcourt: Initial Two Years’ Experience

Introduction: Cardiac catheterization for diagnostic and therapeutic purposes is now routinely done at the Save a Life Port Harcourt, since last two years. Also included are cardiac devices which include pacemakers, Implantable Cardiac Defibrillators and Cardiac Resynchronization Therapy. In this retrospective study, we review our initial two years’ experience of Cardiac Catheterization at the Save a Life Mission Hospital, Port Harcourt. Methods: This is a retrospective study over a period of two years, form 1st February, 2021 to 31st March, 2023. A total of 216 consecutive diagnostic and therapeutic cardiac catheterization including cardiac devices performed in Save a life Mission Hospital between 1st February 2021 to 31st March 2023 were evaluated. Among them 88; (40.7%) were coronary angiogram, 41 (18.98%) percutaneous transluminal coronary angioplasty (PTCA) and stenting, 59(27.3%) permanent pacemaker insertion, 29 (13.4%) Implantable cardioverter defibrillators, 14 (6.5%) cardiac resynchronization therapy and 26 (12.1%) with peripheral angiography. Six patients were referred for coronary artery bypass surgery. Vascular complications [groin hematoma] occurred in two patients (0.9%). Conclusion: Both diagnostic and therapeutic cardiac catheterization procedures are safe with very low risk of complications even in its initial experience. The optimate goal of these procedures is to ensure the safety of the patients.

Effect of Mothers Instructional Guidelines on Selected Post Therapeutic Cardiac Catheterization Outcomes among Children

Effect of Mothers Instructional Guidelines on Selected Post Therapeutic Cardiac Catheterization Outcomes among Children

PATIENT DOSIMETRY SURVEY OF PEDIATRIC DIAGNOSTIC AND THERAPEUTIC CARDIAC CATHETERISATION IN JAPAN.

To propose reference values for air-kerma at the reference point (Ka,r), air-kerma area product (PKA), fluoroscopy time (FT) and number of cine images (CI) for four age groups in Japan, a nationwide questionnaire was posted to 132 pediatric catheterisation of certified facility in Japan, using the conventional post system, to which 43 facilities responded. For diagnostic cardiac angiography, reference values were as follows: Ka,r: 86, 102, 165 and 264mGy; PKA: 9.3, 9.5, 16 and 34Gy.cm2; FT: 33, 29, 26 and 30min and CI: 1904, 1966, 2405 and 1871 images. For therapeutic cardiac angiography, reference values were as follows: Ka,r: 107, 163, 103 and 202mGy; PKA: 7.5, 18, 7 and 24Gy.cm2; FT: 56, 52, 42 and 30min and CI: 3886, 3232, 2212 and 4316 images for less than 1, 1-5, 6-10 and 11-15y, respectively. To optimal patient exposure from diagnostic and therapeutic cardiac catheterisation, it is therefore necessary to establish reference values for pediatric cardiac catheterisation examinations for four age groups.

Do COVID-19 pandemic-related behavior changes affect perioperative respiratory adverse events in children undergoing cardiac interventional catheterization?

BackgroundThe novel coronavirus disease (COVID-19) suddenly broke out in China in December 2019. Pandemic-related behavioral changes can cause perioperative respiratory adverse events in children with congenital heart disease (CHD). Here, we compared the incidence of perioperative respiratory adverse events (PRAEs) in CHD children with and without upper respiratory infection (URI) undergoing the cardiac catheterization before and during the COVID-19 pandemic.MethodsThis prospective observational single-center study was based at a tertiary care center in Shanghai, China. A total of 359 children with CHD with and without recent URI were included between January 2019 and March 2021. The overall incidence of PRAEs (laryngospasm, bronchospasm, coughing, airway secretion, airway obstruction, and oxygen desaturation) in non-URI and URI children undergoing elective cardiac catheterization was compared before and during the COVID-19 pandemic. A logistic regression model was fitted to identify the potential risk factors associated with PRAEs.ResultsOf the 564 children enrolled, 359 completed the study and were finally analyzed. The incidence of URIs decreased substantially during the COVID-19 pandemic (14% vs. 41%, P < 0.001). Meanwhile, the overall PRAEs also significantly declined regardless of whether the child had a recent URI (22.3% vs. 42.3%, P = 0.001 for non-URI and 29.2% vs. 58.7%, P = 0.012 for URI, respectively). Post-operative agitation in children without URI occurred less frequently during the pandemic than before (2.3% vs. 16.2%, P = 0.001). Behaviors before the COVID-19 pandemic (odds ratio = 2.84, 95% confidence interval [CI] 1.76–4.58) and recent URI (odds ratio = 1.79, 95% CI 1.09–2.92) were associated with PRAEs.ConclusionsCOVID-19 pandemic-related behavioral changes were associated with a reduction in PRAEs in non-URI and URI children undergoing elective therapeutic cardiac catheterization.

Implementation of Improvements Based on the Analysis of Severe Adverse Events in Pediatric Patients

Introduction: Health systems currently present a great degree of complexity, which provides risks to patients related to healthcare, and the possibility of incidents with or without harm. Patient safety culture highlights the need to investigate, analyze, and mitigate incidents to reduce risks to the patient. Medication errors have a high potential to do harm in pediatric hospital routines and most of them are preventable. The objective of this study was to describe a severe drug-related adverse event and present the root cause analysis and implemented improvements. Methods: A 3-month-old patient undergoing therapeutic cardiac catheterization at another hospital presented with cardiorespiratory arrest in post-procedure progression after returning to the hospital of origin; this was a case of adverse events with medication use in pediatrics. Root cause analysis was performed using the London Protocol. Brainstorming was conducted to study the main improvements to be proposed to the institution. Results: Improvements were identified and implemented in various processes, such as patient transport, drug dispensing, and administration. Root cause analysis made it possible to select the processes and departments involved and detect possible factors related to the adverse event. These changes were monitored, and after five years the indicators show that they have become consolidated. Conclusions: The explanation of this event shows how a hospital service can review workflows and processes and implement improvements to reduce risks and prevent further damage through the analysis of an adverse event.

Complicaciones relacionadas con el cateterismo cardíaco pediátrico y cardiopatías congénitas.

ResumenIntroducción:Las cardiopatías congénitas son las anomalías congénitas más comunes en recién nacidos con una prevalencia de 1%. El cateterismo cardíaco diagnóstico y terapéutico ha revolucionado el tratamiento de estas enfermedades, aunque puede acompañarse de complicaciones.Objetivo:Describir la incidencia y el tipo de complicaciones vinculadas con el cateterismo cardíaco pediátrico en un centro de referencia para cardiopatías congénitas.Método:Estudio observacional retrospectivo, con intención analítica a partir de registros de cateterismos cardíacos realizados a pacientes con cardiopatías congénitas y adquiridas.Resultados:Se incluyeron 2,688 registros durante nueve años consecutivos. El 53.9% correspondió a hombres, 21.3% con edades de dos a cinco años y 20.3% de seis meses a dos años. El 63.5% de los procedimientos fue electivo. La prevalencia de complicaciones en las primeras 24 horas posteriores al cateterismo fue de 6.7% (4.2% menores y 2.4% mayores). En el 0.8% de los procedimientos sobrevino la muerte temprana. Los factores relacionados con las complicaciones fueron: edad al momento del cateterismo <28 días (OR, 2.18; IC 95%, 1.28-3.70), saturación de oxígeno antes del cateterismo <79% (OR, 2.15; IC 95%, 1.02-4.53), uso de inotrópicos antes del cateterismo (OR, 3.00; IC 95%, 1.68-5.33). Las variables incluidas en el modelo explican el 38% de la varianza de las complicaciones posteriores al cateterismo cardíaco en pacientes menores de 18 años.Conclusiones:En este estudio, el cateterismo cardíaco se vinculó con complicaciones mayores y menores, incluida la muerte. Los factores adjuntos fueron edad menor de 28 días, menor saturación de oxígeno y uso de inotrópicos antes del cateterismo.

Incidence and Management of Vascular Injuries after Invasive Cardiac Catheterization in Children

Background: Vascular injuries after cardiac catheterization are well documented in adult population. The incidence of vascular injuries after pediatric cardiac catheterization is not as well defined. With the advent of therapeutic cardiac catheterization in pediatric patients, the incidence of vascular complications is likely to increase. Purpose: The aim of the study was to determine the incidence and management of vascular injuries associated with pediatric cardiac catheterization as an initial experience of in a newly established pediatric center. Methods: This retrospective and observational study was conducted on 268 children with congenital heart disease who have undergone cardiac catheterization either as diagnostic procedure or a therapeutic intervention between March 2018 and August 2019. Patient records were reviewed to obtain demographic, procedural, and treatment data. Patients were analyzed for the incidence and the type of vascular injury seen and treatment given for the same. The type of vascular injury was divided in to major and minor based on severity of the injury. Results: Diagnostic cardiac catheterization was performed in 77 patients and interventions in 191 patients. A total of 62 (23.1%) patients developed some vascular injury out of which 60 (22.3%) cases had minor complication and 2 (0.7%) had major a complication. The most common type of vascular complication seen in our study was transient loss of femoral pulse. Conclusions: Vascular injury is common in children undergoing cardiac catheterization, majority of which are minor complications and can be managed conservatively. They are seen more commonly during therapeutic cardiac catheterization. Further studies with larger sample size are needed to identify the risk factors for vascular injury.

Periprocedural Management during Therapeutic Cardiac Catheterization in Patients with Sleep Apnea Syndrome: Report of Three Cases and Review of Literature

AbstractMost of the patients with sleep apnea syndrome (SAS) also known as sleep disordered breathing are not diagnosed before undergoing any cardiac interventional procedure. Many of them can safely undergo outpatient procedure under sedation or anesthesia. Few of them with moderate to severe grade of SAS, who are not optimized medically, may create problem and need special consideration. We managed three such cases in cardiac catheterization laboratory; two of them were not diagnosed before. The periprocedural problems we faced in these patients are narrated in this article along with review of literature. Some suggestions for management of such patients undergoing therapeutic cardiac catheterization are also highlighted.

Diagnosis and Therapeutic Cardiac Catheterization of Symptomatic Bicuspid Aortic Stenosis in the Pediatric Population.

ABSTRACTBicuspid aortic valve (BAV) is the most common congenital heart disease with a prevalence of 0.5%–1.3% of the population. Many children with BAV are asymptomatic. Clinically relevant abnormal valve function usually occurs in adulthood. However, in rare cases, children can fail to thrive which requires valvular intervention. In this review, we will explore in more detail the anatomy of the BAV, clinical presentation of BAV, diagnosis of BAV, and its function by echocardiography, and indications for transcatheter intervention in the pediatric population.

Considerations on the invasive management of ischemic and structural heart disease during the COVID-19 coronavirus outbreak.

The current COVID-19 outbreak is forcing healthcare workers to continuously reconsider the proper indications for cardiac catheterization. Human and material resources optimization, infection prevention for patients and healthcare workers, and transfer times force a rethink of the previously established protocols. This article is a consensus statement of the Interventional Cardiology Association and the Ischemic Heart Disease Association of the Spanish Society of Cardiology and aims to provide information to healthcare workers on the indications of diagnostic or therapeutic cardiac catheterization during the current COVID-19 pandemic. © 2019 Permanyer Publications. All rights reserved.

Anesthesia timing for children undergoing therapeutic cardiac catheterization after upper respiratory infection: a prospective observational study.

We aimed to analyze anesthesia timing and perioperative respiratory adverse event (PRAE) risk factors in children undergoing therapeutic cardiac catheterization after upper respiratory tract infection (URI). We prospectively included children for elective therapeutic cardiac catheterization. Parents or legal guardians were asked to complete a questionnaire on the child's demographics, tobacco exposure, and URI symptoms. PRAEs (laryngospasm, bronchospasm, coughing, airway secretion, airway obstruction, and oxygen desaturation) as well as details of anesthesia management were recorded. Of 332 children, 201 had a history of URI in the preceding eight weeks. The occurrence rate of PRAEs in children with URI≤two weeks reached the highest proportion, which was higher than that in children without URI (66.3% vs. 46.6%, P=0.007). The overall incidence of PRAEs in children with URI in 3-8 weeks was significantly lower than that in children with URI in the recent ≤two weeks (49.0% vs. 66.3%, P=0.007), and similar to that in the control group (49.0% vs. 46.6%). Multivariate analysis showed association between PRAEs and type of congenital heart disease (CHD) (P<0.001), anesthesia timing (P=0.007), and age (P=0.021). Delayed schedule (two weeks after URI) minimized the risk of PRAEs to the level comparable to that observed in children without URI (OR, 1.11; 95% CI: 0.64-1.91; P=0.707). If treatment is not urgent, a pediatric patient at a high risk of PRAEs will be benefit from the postponement of an interventional operation by at least two weeks after URI.

Growth Parameters in Children with Congenital Acyanotic Heart Disease before and after Cardiac Catheterization at Sohag University Hospital

Background and objectives: Growth failure is common among children with congenital heart disease (CHD). This study aimed at the assessment of the effect of therapeutic cardiac catheterization on the growth status of children with CHD.Patients and Method: This was a prospective observational study conducted at pediatric cardiac catheterization unit-Sohag university hospital, from October-2016 to September-2017, on children with congenital acyanotic heart diseases who were admitted for therapeutic cardiac catheterization. We assessed the growth parameters as a weight for age Z-score (WAZ), height for age Z-score (HAZ), body mass index and upper arm circumference before catheterization, at one month, three months and six months after catheterization. The growth status was considered normal when WAZ and HAZ were from -2 SD, underweight if WAZ was ≤ -2 SD and stunting if HAZ was ≤ -2 SD. Results: One-hundred and two children with congenital acyanotic heart diseases were included. The mean age was 3.95 ±3.11 years. Sixty participants(58.8%) were females. Before catheterization,70 patients (68.6%) had normal growth status, 20 patients (19.6%) had underweight and 19 patients (18.6%) had stunting. The prevalence of underweight significantly diminished to3.92% (p < 0.001) at the 6th month after catheterization. However, no significant differences in the prevalence of stunting were found during the follow-up period.Conclusion: Therapeutic cardiac catheterization had a significantly positive impact on weight gain shortly after catheterization. However, improvement in the height could not be detected in the first 6 months after catheterization and longer follow-up periods are required.

Radiogenic risks to patients and staff from fluoro-assisted therapeutic cardiac catheterizations

Advances in sectional imaging have led to prolonged x-ray fluoro-assisted therapeutic cardiac catheterizations. Given the frequency of such procedures, limited data are available for patient and staff doses. For certain pediatric cardiac catheterization procedures we examine: (i) effective and organ doses, also the radiogenic and tissue reaction risks and; (ii) staff effective dose during cardiac interventions. At four cardiac catheterization centres, patient doses were measured with a calibrated kerma area product (KAP) meter; staff doses were measured using calibrated TLDs. The mean and range of age (years) and weight (kg) for patients were 4.3 (0.04–14.0) and 10.8 (3.0–46.0) respectively; the overall mean and range of fluoroscopic time (min) was 13.0 (1.4–54.8). For coronary angiography and pacemaker procedures the overall mean and range of cumulative kerma area product (CKAP, cGy.cm2) were 350 (12.0–510). The average annual staff dose of 9.0 (7.2–14.4) mSv is relatively low given the current workload. Some patients received high doses approaching the threshold for tissue reactions. Optimisation of radiation dose is required as is follow-up of patients receiving high doses to detect the possibility of tissue reactions.

Serum Highly Sensitive Cardiac Troponin I (hs-cTnI) as a Diagnostic Biomarker of Myocardial Injury after Pediatric Cardiac Catheterization

Background: new Highly Sensitive Cardiac Troponin I assay (as hs-cTnI) represents an important advance with added sensitivity for cardiac myocyte necrosis and could have several distinct roles in clinical practice. Aim of the present study: it was to determine the serum level of highly sensitive cardiac troponin I (hs-cTnI) before and after pediatric cardiac catheterization (diagnostic or interventional), as a diagnostic biomarker of myocardial injury in these patients. Patients and Methods: a Prospective Cohort study was carried out during the period from January 2017 to June 2018 at Pediatric Cardiology Unit and Cardiology Department, Tanta University Hospital. It included 30 patients who were admitted and required pediatric cardiac catheterization. Doppler echo- cardiography and Estimation of serum highly sensitive cardiac troponin I (hs-cTnI): using the ELFA technique (Enzyme Linked Fluorescent Assay) was done. Results: there was highly significant increase of serum hs-cTnI levels immediately after and 12 hours after therapeutic pediatric cardiac catheterization (p 0.05). There was significant negative correlation between serum hscTnI levels and Fractional shortening (FS) %, and also there was significant negative correlation between serum hs-cTnI levels and ejection fraction (EF) % (measured by echocardiography). Conclusion: serum highly sensitive cardiac troponin I (hs-cTnI) was significantly increased immediately after pediatric cardiac catheterization, with more significant increase after 12 hours, suggesting myocardial injury in these patients. Also, elevation of this diagnostic biomarker of myocardial injury was more after therapeutic than diagnostic pediatric cardiac catheterization.

Abstract P066: A Meta-Analysis of Protective Effect of Allopurinol in Preventing Contrast Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

Background: Contrast- induced nephropathy (CIN) is an a major adverse outcome of both diagnostic and therapeutic cardiac catheterization procedures. It has been assoicated with prolonged hospitalization, morbidity and mortality. Aim of this study was to understand the protective effect on Allopurinol on CIN. Methods: Search for the literature was done of Science Direct, Pubmed/Medline, and Cochrane library. A total of 385 papers were reviewed according to the PRISMA protocol by two investigators, out of which 5 manuscripts were inculded in this study. Manuscripts which studied effect of allopurinol on CIN in patient undergoing PCI were included in the meta-analysis. In all studies CIN was diagnosed if there was &gt;25% elevation in serum creatinine. Results: A total of 5 studies met the inclusion criteria. Risk difference was calculated for each study and was tabulated in a forest plot. Heterogeneity was 83.81% with P &lt; 0.001 hence a random effect model was used. Overall Risk difference was -0.140 (CI 95% -0.257, -0.022). Conclusion: Our study demonstrates that Allopurinol potentially has a protective in preventing contrast induced nephropathy in patients undergoing percutaneous coronary intervention. Further large clinical trails are warranted to better understand this effect.

Mortality in Patients With Out-of-Hospital Cardiac Arrest Undergoing a Standardized Protocol Including Therapeutic Hypothermia and Routine Coronary Angiography: Experience From the HACORE Registry

ObjectivesThis study sought to analyze the impact of mandatory therapeutic hypothermia and cardiac catheterization in the absence of overt noncardiac cause of arrest as part of the Hannover Cardiac Resuscitation Algorithm before intensive care admission. BackgroundDespite advanced therapies, out-of-hospital cardiac arrest (OHCA) is still associated with high mortality rates. Recently, the TTM (Target Temperature Management 33°C Versus 36°C After Out-of-Hospital Cardiac Arrest)-trial caused severe uncertainty about the efficacy of and need for therapeutic hypothermia. Furthermore, the role of early coronary angiography in OHCA survivors without ST-segment elevation remains undetermined. MethodsIn the HACORE (HAnnover Cooling REgistry) we investigated 233 consecutive patients (median age 64 [interquartile range: 53 to 74] years) with OHCA admitted to our institution between January 2011 and December 2015 who were treated according to the algorithm. ResultsA total of 73% had ventricular fibrillation as primary rhythm. Return of spontaneous circulation was achieved after 20 (interquartile range: 10 to 30) min. Immediate percutaneous coronary angiography was performed in 96% and coronary angioplasty in 59% of all cases. ST-segment elevation was present in 47%. Critical coronary stenosis requiring percutaneous coronary intervention was present in 67% of patients with and 52% of patients without ST-segment elevation. Overall 30-day intrahospital mortality in this real-world registry was 37%. Patients in our local registry who matched the inclusion/exclusion criteria of the TTM-trial (n = 145) had a markedly lower 30-day mortality (27%) compared with the published trial (44%). ConclusionsStandardized treatment of patients with OHCA following a strict protocol incorporating computed tomography, cardiac catheterization and revascularization, liberal use of active hemodynamic support in presence of shock, and mandatory therapeutic hypothermia results in mortality rates lower than previously reported.

Safety of Diagnostic and Therapeutic Cardiac Catheterization in Cancer Patients With Acute Coronary Syndrome and Chronic Thrombocytopenia

Little data is available on the bleeding risk and outcomes of cancer patients with chronic thrombocytopenia who underwent cardiac catheterization. We sought to assess the safety of coronary angiography, percutaneous coronary intervention, and antiplatelet therapy in cancer patients with acute coronary syndrome (ACS) and chronic thrombocytopenia. We performed a retrospective study of patients with chronic thrombocytopenia who underwent cardiac catheterization for ACS between November 2009 and November 2015. Preprocedural platelet counts were classified into 3 groups: mild thrombocytopenia (50,000 to 100,000/µL), moderate thrombocytopenia (30,000 to 50,000/µL), and severe thrombocytopenia (<30,000/µL). Postprocedural bleeding complications and overall survival (OS) were recorded. A total of 98 patients were included. Mean platelet count on admission was 47.63 ± 29.85 K/µL. Severe thrombocytopenia was identified in 36 patients (36.7%), moderate thrombocytopenia in 20 patients (20.4%), and mild thrombocytopenia in 42 patients (42.9%). Aspirin therapy (alone or in combination with clopidogrel) was used in 66 patients (67.3%), whereas 27 patients (27.6%) were on dual antiplatelet therapy. One procedure-related retroperitoneal hematoma and 3 procedure-related small hematomas were identified. No cerebrovascular events related to the procedure or the antiplatelet therapy were noted. Moderate thrombocytopenia was associated with decreased OS, whereas aspirin, dual antiplatelet therapy, and statin use showed a trend of improved OS. In conclusion, we suggest that coronary angiography and percutaneous coronary intervention can be performed safely in cancer patients with chronic thrombocytopenia. Aspirin therapy and dual antiplatelet therapy should be considered in cancer patients with chronic thrombocytopenia and ACS.

Effect of Nursing Guidelines for Nurses on Occurrence of Selected Post Therapeutic Cardiac Catheterization Complications Among Children

Abstract Background: Pediatric cardiac catheterization has shifted from a diagnostic tool to a therapeutic one and now more applicable for therapeutic reasons.Aim of Study: The aim of the current study was to evaluate the effect of guidelines for nurses on occurrence of selected post therapeutic cardiac catheterization complications among children.Subjects and Methods: Quasi-experimental design (Pre-Posttest) was used to achieve the aim of the current study. A convenient sample of 30 nurses and 60 children having cardiac defects undergoing cardiac catheterization were participated in the current study; children were divided into two equal groups: 30 as a control group and 30 as a study group and nurses were the same for the study and control group of children. The current study was conducted at post cardiac catheterization Intensive Care Unit at Cairo University Spe-cialized Pediatric Hospital (CUSPH). The required data was collected through: 1- Structured interview (questionnaire); 2- Nurses's knowledge and observed practice assessment sheet (pre-posttest) and 3- Post cardiac catheterization assessment sheet. Results: The study's results revealed that, children in the study group exposed to less post cardiac catheterization complications such as weak or absent pulse, hypotension and hypothermia; than children in the control group. There was statistically significance difference between the total mean score of nurses' knowledge before and after implementation of the nursing guidelines.Conclusion: The study concluded that nurses who received nursing guidelines sessions had improved outcomes in relation to less complications on children they were caring. Recom-mendation: It was recommended that provision of nursing guidelines of children undergoing cardiac catheterization is mandatory for fewer occurrences of complications. Simple Arabic illustrated booklet about cardiac catheterization care for children undergoing CC should be available in every post CC unit.

Impact of upper respiratory tract infections on perioperative outcomes of children undergoing therapeutic cardiac catheterisation.

Recent upper respiratory tract infection (URI) is associated with increased incidence of perioperative complications in children undergoing open heart surgery. As a result, surgery is often postponed. However, the effect of recent URI on the incidence of perioperative complications in children undergoing therapeutic cardiac catheterisation is unknown. We investigated the perioperative outcomes of congenital heart disease (CHD) children with recent URI who underwent elective therapeutic catheterisation. We prospectively included children treated for CHD. Before surgery, parents or legal guardians were interviewed to complete a questionnaire on the child's demographics, history of asthma and passive smoking, and URI symptoms. Recorded perioperative respiratory adverse events (PRAEs) included laryngospasm, bronchospasm, breath holding, oxygen desaturation, and severe cough. Information on postoperative dysphoria, fever, copious sputum, and vomiting was obtained by telephone 24 h after surgery. Of 363 included children, 169 had recently (within 2 weeks) had a URI. The URI did not affect the incidence of laryngospasm, bronchospasm, breath holding, fever, or vomiting. The incidence of desaturation, severe cough, dysphoria, and copious sputum were significantly increased. Independent risk factors for PRAEs in children with a recent URI included age, passive smoking, and presence of rhinorrhoea or moist cough. The lengths of stay in the hospital and intensive care unit were not significantly different between groups. Although recent URI increased the incidence of PRAEs in children undergoing therapeutic cardiac catheterisation, most CHD patients with recent URI can undergo elective therapeutic cardiac catheterisation without serious adverse events or prolonged hospitalisation.

Identification of a “VTE-rich” population in pediatrics – Critically ill children with central venous catheters

BackgroundThe incidence of venous thromboembolism (VTE) is rising among inpatients in US hospitals, especially among kids with central venous catheters (CVCs) in the pediatric intensive care unit (PICU). ObjectivesTo identify a sub-group of “VTE-rich” population among PICU children, and to assess the effect of VTE on morbidity and mortality. MethodsData was extracted from a multicenter Virtual PICU Database, or VPS, for children with a CVC and presence of a VTE. The primary outcome variable was all cause mortality and secondary outcome measure was prolonged mechanical ventilation. Primary diagnoses and Pediatric risk of mortality 2 (PIM 2) score were also recorded. ResultsThe database identified 158,299 PICU patients who had a CVC. A total of 1602 patients had VTE (103 per 10,000 PICU patients). Multivariate analysis showed increased risk of VTE in patients who were <1year old (OR 1.48; 1.30–1.68), mechanically ventilated (OR 2.48; 2.07–2.98), had either a diagnostic (OR 2.32; 1.94–2.78) or therapeutic cardiac catheterization (OR 2.06; 1.66–2.55), PICC (OR 3.91; 3.50–4.37), and percutaneous CVC (OR 3.99; 3.48–4.61). Primary diagnoses associated with VTE were endocrinologic, immunologic, and gastrointestinal disorders. PICU patients with CVC and VTE had increased odds of mortality (OR 1.71; 1.47–2.00) after adjusting for factors associated with mortality, and fewer Ventilator Free Days (VFD) than patients without VTE. ConclusionsCritically ill children with CVC have a significant risk of developing VTE. Identification of the above “VTE-rich” population may aid in design of clinical trials aimed at prevention of VTE among hospitalized PICU children.