末盛 智彦

We compared the reintubation rate in children who received high-flow nasal cannula (HFNC) therapy to the rate in children who received noninvasive ventilation (NIV) therapy for acute respiratory failure (ARF) after cardiac surgery. This was a retrospective analysis of 35 children who received HFNC therapy for ARF after cardiac surgery in 2014-2015 (the HFNC group). We selected 35 children who had received NIV therapy for ARF after cardiac surgery in 2009-2012 as a control group. The matching parameters were body weight and risk adjustment for congenital heart surgery category 1. The reintubation rate within 48 h in the HFNC group tended to be lower than that in the NIV group (3% vs. 17%, p=0.06). The reintubation rate within 28 days was significantly lower in the HFNC group compared to the NIV group (3% vs. 26%, p=0.04). The HFNC group's ICU stays were significantly shorter than those of the NIV group: 10 (IQR: 7-17) days vs. 17 (11-32) days, p=0.009. HFNC therapy might be associated with a reduced reintubation rate in children with ARF after cardiac surgery.

OBJECTIVE: There has been controversy regarding the beneficial effects of calcium on myocardial contractility and the harmful effects on myocardial cells, especially in children. The aim of this study was to investigate an association between ionized calcium concentration (iCa) and outcomes for pediatric patients after cardiac surgery. DESIGN: A retrospective, single-center study from May 2013 to December 2014. SETTING: Referral high-volume pediatric cardiac center in a tertiary teaching hospital. PATIENTS: Patients <72 months old with congenital heart disease who underwent palliative or definitive surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The association between pH-corrected iCa within 24 hours after surgery and intensive care unit (ICU) length of stay (ILOS) was defined as the primary outcome. The highest iCa (iCamax), lowest iCa (iCamin), and time-weighted average iCa (iCaave) were stratified and compared with the outcomes. The authors reviewed 5,468 ionized calcium measurements from 357 consecutive pediatric patients during the study period. One patient died at postoperative day 34 in the ICU. Significant differences in ILOS were observed among patients after cardiopulmonary bypass (CPB) according to iCaave, iCamax, and iCamin but not among patients without CPB. Patients with CPB and an iCaave value of 1.31-to-1.40 mmol/L, 1.41-to-1.50 mmol/L, 1.51-to-1.60 mmol/L, and >1.60 mmol/L stayed in the ICU for 7 (interquartile range [IQR] 4-10) days, 8 (IQR 6-16) days, 10 (IQR 8-14) days, and 19 (IQR 12-38) days, respectively, which was significantly longer than the ILOS of 5 (4-8) days for patients with an iCaave of 1.21-to-1.30 mmol/L. Even after adjustment for other predictors of ILOS using multivariable analyses, there were significant relationships of ILOS with iCaave and iCamin values of >1.50 mmol/L among patients with CPB. CONCLUSIONS: Higher iCa within 24 hours after congenital cardiac surgery using CPB was independently associated with longer LOS in the ICU.