Multi Facetted Circulation Monitoring During The First 72 Hours after Switch Operation

  • Dr Oswin Grollmuss, Department of Pediatric Intensive Care, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France, France
  • Dr Soly Fattal, Laboratory Department, Centre Chirurgical Marie Lannelongue, France
  • Dr Mohamedou Ly, Department of Paediatric Cardiac Surgery, Centre Chirurgical Marie Lannelongue, France
  • Dr Valerie Amann, Department of Pediatric Cardiology, Heart Center Leipzig, Germany, France
  • Prof Emre Belli, Department of Paediatric Cardiac Surgery, Centre Chirurgical Marie Lannelongue, France
  • Prof Alain Serraf, Department of Paediatric Cardiac Surgery, Centre Chirurgical Marie Lannelongue, France

    • Background: Monitoring of circulation and cardiac output is a priority in the paediatric cardiac ICU, especially in cases of post surgical heart failure. For this purpose, clinical, biological and technical alternatives are available. But which of them is the most reliable?

    Methods: We examined 20 consecutive newborns undergoing switch operation by clinical, biological and technical means for cardiac and circulatory functions. The clinical parameters were measured every 6 hours: heart rate, mean blood pressure and diuresis. As biological parameters served (every 6 hours): Troponine Ic, BNP, Renine, Lactate. Technical means for the evaluation of cardiac function and output were transthoracic echocardiography (GE, Vivid 7) every 12 hours and continuous bioimpedance measurement (Osypka, Aesculon).

    Results: During the first 24 hours after switch operation for simple TGA, blood pressure fell, heart rate raised and diuresis slowed down significantly (p<0.01). BNP first rose (H6) then fell slowly (p<0.01), renine reacted inversely during the first 36 hours, and then behaved parallel to BNP. Troponine and lactates showed linear kinetics. Cardiac output fell to 50%. Bioimpedance and measurement of cardiac output by transthoracic echocardiography correlated well (r=0,84). Recovery set on at H24-36 and ameliorated significantly in all parameters (p<0.01)

    Conclusions: diagnosis of the circulatory status of a newborn in the first 72 hours after switch operation can be refined by adding BNP and renine measurement in addition to the “classical parameters”. Bioimpedance shows the same reliability as echocardiographical exams with the advantage of a continuous monitoring, thus assuring more security for the patient.