National Variation in the Use of Tracheostomy in Patients With Congenital Heart Disease
Abstract Objectives: The postsurgical care of children with congenital heart disease may be complicated by the need for cardiorespiratory support, including tracheostomy. The variation of the use of tracheostomy across multiple pediatric cardiac surgical centers has not been defined. We describe multicenter variation in the use of tracheostomy in children undergoing congenital heart surgery. Design: We retrospectively […]
Epidemiology and Outcomes of Cardiac Arrest in Pediatric Cardiac ICUs
Abstract Objectives: In-hospital cardiac arrest occurs in 2.6-6% of children with cardiac disease and is associated with significant morbidity and mortality. Much remains unknown about cardiac arrest in pediatric cardiac ICUs; therefore, we aimed to describe cardiac arrest epidemiology in a contemporary multicenter cardiac ICU cohort. Design: Retrospective analysis within the Pediatric Cardiac Critical Care Consortium clinical […]
Cardiopulmonary Bypass Reduces Early Thrombosis of Systemic-to-Pulmonary Artery Shunts
Abstract Background: Shunt thrombosis is a significant cause of morbidity and mortality after systemic-to-pulmonary artery shunt (SPS) placement. Concurrent procedures with placement of SPS may require cardiopulmonary bypass (CPB). Cardiopulmonary bypass is known to cause bleeding and platelet dysfunction in infants, which may protect from early shunt thrombosis. We hypothesized that infants undergoing SPS placement on […]
Characteristics, Risk Factors, and Outcomes of Extracorporeal Membrane Oxygenation Use in Pediatric Cardiac ICUs: A Report From the Pediatric Cardiac Critical Care Consortium Registry
Abstract Objectives: Cardiopulmonary failure in children with cardiac disease differs from the general pediatric critical care population, yet the epidemiology of extracorporeal membrane oxygenation support in cardiac ICUs has not been described. We aimed to characterize extracorporeal membrane oxygenation utilization and outcomes across surgical and medical patients in pediatric cardiac ICUs. Design: Retrospective analysis of the Pediatric […]
Hypoplastic left heart syndrome: from fetus to fontan
Abstract The care of children with hypoplastic left heart syndrome is constantly evolving. Prenatal diagnosis of hypoplastic left heart syndrome will aid in counselling of parents, and selected fetuses may be candidates for in utero intervention. Following birth, palliation can be undertaken through staged operations: Norwood (or hybrid) in the 1st week of life, superior […]
Using a Pediatric Trigger Tool to Estimate Total Harm Burden Hospital-acquired Conditions Represent
Abstract Introduction To improve patient safety, the Centers for Medicare & Medicaid Services (CMS) has promoted systematically measuring and reporting harm due to patient care. The CMS’s Partnership for Patients program identified 9 hospital-acquired conditions (HACs) for reduction, to make care safer, more reliable, and less costly. However, the proportion of inpatient pediatric harm represented […]
Reduction in Unintended Extubations in a Level IV Neonatal Intensive Care Unit
Abstract Objectives: Unintended extubations (UEs) lead to significant morbidity in neonates. A quality improvement project was initiated in response to high rates in our level IV NICU. We targeted creating and sustaining UE rates below the published standard of 1 per 100 ventilator days. Methods: This project spanned 4 time periods: baseline, epoch 1 (December 2010-May 2012), […]
Updates in Congenital Heart Disease: Can Outcomes Improve?
Abstract Despite numerous advances in medical and surgical management, congenital heart disease (CHD) remains the number one cause of death in the first year of life from congenital malformations. The current strategies used to approach improving outcomes in CHD are varied. This article will discuss the recent impact of pulse oximetry screening for critical CHD, […]
George Washington University MD Diploma
Unplanned Extubation During Pediatric Cardiac Intensive Care: U.S. Multicenter Registry Study of Prevalence and Outcomes
Objectives: The epidemiology of unplanned extubations (UEs) and associated adverse outcomes in pediatric cardiac ICUs (CICU). Design: Registry data (August 2014 to October 2020). Setting: Forty-five Pediatric Cardiac Critical Care Consortium hospitals. Patients: Patients receiving mechanical ventilation (MV) via endotracheal tube (ETT). Interventions: None. Measurements and main results: Fifty-six thousand five hundred eight MV courses occurred in 36,696 patients, with a […]