SCCM Resource Library-Postoperative Management of Children Recovering From Surgery for Congenital Heart Disease

Pdf Summary

The postoperative management of children recovering from congenital heart disease (CHD) surgeries is crucial for improving outcomes and reducing complications. Over several decades, advancements in surgical strategies and management protocols have significantly decreased morbidity and mortality rates. According to data from the Society of Thoracic Surgeons Congenital Heart Surgery Database, the operative mortality in 2018 was 2.5%. Despite this improvement, 1 in 40 children may not survive the postoperative period, and many experience complications like cardiac arrhythmias, paralysis, and stroke.<br /><br />The document discusses selected principles for a contemporary approach to managing children with CHD post-surgery. Key objectives include reviewing pathophysiological, pharmacological, and diagnostic approaches and providing evidence-based management algorithms for common scenarios.<br /><br />A case scenario of a 5-month-old male with a ventricular septal defect (VSD) outlines typical postoperative challenges and management strategies. Postoperative critical care must focus on preventing and managing complications such as complete heart block, junctional ectopic tachycardia, and restrictive right ventricular physiology. Temporary epicardial pacing wires are essential for managing conduction disturbances like complete heart block. <br /><br />Medications such as amiodarone, dexmedetomidine, and milrinone are discussed for managing arrhythmias and low cardiac output. The importance of individualized care, based on specific risks and symptoms, is emphasized, while routine prophylactic use of vasoactive medications is discouraged without clinical indication. The document also discusses the management of pulmonary hypertensive crises and the use of inhaled nitric oxide.<br /><br />In summarizing key points, the importance of preparing for potential complications, using tailored pharmacological strategies, and timely interventions are highlighted as essential for improving outcomes in children recovering from CHD surgery. The need for a continuous learning approach to manage this complex patient population is also emphasized.

Asset Subtitle

Pediatrics, Procedures, 2020, 8:00:00

Asset Caption

This is a complimentary chapter from the textbook, Current Concepts in Pediatric Critical Care 2020), titled "Postoperative Management of Children Recovering From Surgery for Congenital Heart Disease."

Learning Objectives:

Review principles of pathophysiology, pharmacology, and diagnostic approaches necessary to care for neonates, infants, and children recovering from congenital heart disease.
Provide contemporary, evidenced-based algorithms for the management of common clinical scenarios involving neonates, infants, and children recovering from congenital heart disease.

Meta Tag

Content Type Book Chapter

Knowledge Area Pediatrics

Knowledge Area Procedures

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Congenital Heart Disease

Tag Surgery

Tag Cardiothoracic Critical Care

Year 2020

Keywords

congenital heart disease

postoperative management

pediatric cardiac surgery

complications

ventricular septal defect

arrhythmias

pharmacological strategies

pulmonary hypertensive crises

inhaled nitric oxide

individualized care

	Society of Critical Care Medicine 500 Midway Drive Mount Prospect, IL 60056 USA Phone: +1 847 827-6888 Fax: +1 847 439-7226 Email: support@sccm.org	Contact Us About SCCM Newsroom Advertising & Sponsorship DONATE	MySCCM LearnICU Patients & Families Surviving Sepsis Campaign Critical Care Societies Collaborative	GET OUR NEWSLETTER
© Society of Critical Care Medicine. All rights reserved. \| Privacy Statement \| Terms & Conditions The Society of Critical Care Medicine, SCCM, and Critical Care Congress are registered trademarks of the Society of Critical Care Medicine.