Critical Illness, Esophageal Atresia, Intensive Care Units, Length of Stay, Pediatric, Respiratory Failure, Water-Electrolyte Imbalance
Conditions
Keywords
Liquid, Liquid overload, Mechanical ventilation, Infant, Preschool Child, Respiratory failure, Coloesophagoplasty, Esophageal atresia
Brief summary
Esophageal atresia is a rare but severe malformation, and it requires early surgery. Coloesophagoplasty is surgical repair of the esophageal with an isoperistaltic transverse colon graft. In the postoperative period after coloesophagoplasty children require careful monitoring of fluid balance, because clinically significant fluid overload can lead to dysfunction of various organs and systems.
Detailed description
Esophageal atresia (EA) is a defect of the embryogenesis of the laryngotracheal tube. There are isolated forms of EA and combinations with a tracheoesophageal fistula (TPF). Esophageal plastic surgery with an isoperistaltic transplant from the transverse colon was performed in children with EA. After this surgical intervention children require observation in the intensive care unit (ICU). During this period, infusion therapy satisfies physiological needs and compensates for physiological and pathological losses. However, it is not always possible to compensate for the body's fluid needs and maintain a normovolemic state. Thus, fluid overload develops. It is based on a pathophysiological process when severe operational stress leads to the damage of glycocalyx in the vascular wall. As a result, albumin freely passes into the interstitium, and oncotic pressure rises in tissues. Fluid overload in the intra- and postoperative period can be a factor in an unfavorable outcome, leading to organ damage, as well as death.
Interventions
None listed
Sponsors
Pirogov Russian National Research Medical University
Study design
Observational model
CASE_ONLY
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
1 Months to 3 Years
Healthy volunteers
No
Inclusion criteria
* Аge from 1 month to 3 years * EA with / without * Tracheoesophageal fistula (TPF) * Сoloesophagoplasty.
Exclusion criteria
* Аesophageal burn, * Oesophageal peptic stenosis, * Congenital heart disease * Cardiotonic support in the postoperative period * Renal malformations * Bacterial pneumonia in the postoperative period, * Bronchopulmonary malformations.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| partial pressure of carbon dioxide (pC02) | in the first postoperative day | partial pressure of carbon dioxide (pC02) |
| total fluid overload on the first postoperative day | during the first postoperative day, include intraoperative period | ((injected fluid (ml) - lost fluid (ml))/weight before surgery)\*100% |
| Fraction of Inspired Oxygen (FiO2) | in the the first postoperative day | Fraction of Inspired Oxygen (FiO2) |
| Oxygen saturation (Sp02) | in the first postoperative day | Oxygen saturation (Sp02) |
| Venous oxygen saturation (Svo2) | in the first postoperative day | Venous oxygen saturation (Svo2) |
| duration of intensive care unit (ICU) stay | up to 30 days after the surgery | number of days in ICU after surgery before discharge |
| duration of mechanical ventilation (MV) | up to 30 days after the surgery | number of days of MV after surgery before switching to continuous positive airway pressure (CPAP) |
| intraoperative fluid overload (IVF) | during the surgery | ((injected fluid (ml) - diuresis (ml) - blood loss (ml))/weight before surgery)\*100% |
| fluid overload (FO) on the first postoperative day in the ICU | during the first postoperative day, exclude intraoperative period | ((injected fluid (ml)-lost fluid (ml))/weight before admission to ICU)\*100% |
| inspiratory pressure (Pin) | in the first postoperative day | inspiratory pressure (Pin) |
| Positive end-expiratory pressure (PEEP) | in the first postoperative day | Positive end-expiratory pressure (PEEP) |
| duration of ICU stay corrected to sedation | up to 30 days after the surgery | duration of ICU stay corrected for the duration of sedation |
| duration of MV corrected to sedation | up to 30 days after the surgery | duration of MV corrected for the duration of sedation |
Countries
Russia
Outcome results
None listed