Omar Hijazi

Effects of protocol-based management on the post-operative outcome after systemic to pulmonary shunt

Objectives Systemic to pulmonary shunt (commonly known as Modified Blalock-Taussig shunt) is a palliative procedure in cyanotic heart diseases to overcome inadequate blood flow to the lungs. Based on the most recent risk stratification score, the mortality and morbidity of this procedure is still high especially in neonates and over-shunting patients. We developed and implemented protocol-based management in March 2013 to better standardize the management of these patients. The aim of this study is to evaluate the effects of applying this protocol-based management in our center. Methods We conducted a retrospective cohort study through chart review analysis.We included all children who underwent MBTS from January 2000 till December 2015. We compared the early postoperative outcome of patients operated after the protocol-based management implementation (March 2013 till December 2015) (protocol group) with patients operated before implementing the MBTS protocoled management (control group). Results 197 patients underwent MBTS from January 2000 till December 2015. Of the 197 patients, 25 patients were in the protocol group and 172 patients were in the control group. There was a significant improvement in the postoperative course and less morbidity after protocoled management implementation as reflected in ventilation time, reintubation rate, inotropic support duration, intensive care unit ICU stay and significantly lower postoperative complications in the protocol group. Mortality of the control group versus protocol group (19.3% VS 8%) with Standardized Mortality Ratio (SMR) dropped from 2.27 before protocoled management to 0.94 after protocoled management (protocol group). Conclusion The study suggests that protocoled management of patients with MBTS can improve the postoperative course and early outcome.

253: EFFECT OF NUTRITIONAL STATUS OF CHILDREN WITH CONGENITAL HEART DISEASE ON POST-OPERATIVE OUTCOME

Learning Objectives: Children with congenital heart disease (CHD) frequently get malnourished due to many factors including hypermetabolic state, inadequate caloric intake, malabsorption, genetic factors and fluid restriction as part of hemodynamic intervention. This nutritional status may affect the early postoperative outcome after pediatric cardiac surgery Methods: Prospective observational cohort study included all pediatric cardiac surgery patients over 2 yr. nutritional status assessed preoperatively according to Waterlow classification and calculated prognostic nutritional index (PNI). The following end points were recorded: patients NPO days, number of days to achieve Recommended Daily Allowance (RDA), weight gain /loss during ICU stay, ICU mortality, PCICU length of stay, hospital length of stay, ventilation hr and rate of infection. Results: 85 children were evaluated. At admission 36.4% (31/85) of the patients were severely malnourished. The usual intake was < 50 % of RDA at admission in 37.6% and was associated with severely malnutrition (P = 0.0001). Mean of the PNI was worse in the infected patients compared to the non-infected (P = 0.017). Comparing severely malnourished (n=31) to rest of our study population (n=54), the mean length of hospital stay was 22.84 ± 25.95vs20.67 ± 14.71 days; (95% CI -6.84–17.37P 0.038). Length of ICU stay was 13.27 ± 37.26 vs 7 ± 6.75 days, (95% CI -4.36–16.89P = 0.014). Patients with severe malnutrition were kept NPO longer postoperatively with mean 3.40 ± 5.56 vs 1.82 ± 1.45 days,(95% CI -0.05–3.21-P= 0.003). Delay in feeding postoperatively were associated with higher risk of infection (P =0.03). No statistically significant relation between mortality or ventilation hr in ICU and the malnutrition category of the patients Conclusions: Children with CHD were significantly malnourished preoperatively and had further loss in weight postoperatively. Delayed postop feeding was associated with higher rate of infection. Management by “specialized pediatric nutritionist” during outpatient visits and during hospital stay may optimize the nutritional status perioperatively.

PO-0032 Urinary Tract Infection In Children After Cardiac Surgery: Incidence, Risk Factors And Outcome

Introduction Urinary tract infection (UTI) can prolong hospitalisation, and increase morbidity. Catheter associated UTI (CAUTI) is a major cause of UTI. Objective To determine the incidence, risk factors, aetiology and outcome of UTI in postoperative cardiac children. Patients and methods This is retrospective cohort study. All post-operative patients admitted to PCICU during 2012 were included. Patients were divided into: group (1) Patients who developed and group (2) patients who did not develop UTI. The two groups were compared for demographic and other variable predictors for UTI. Results 413 post-cardiac surgical children were included. Group (1) had 29 patients (7%) all had CAUTI. Foley catheter utilisation ratio was 44%. CAUTI density rate was 18 per 1000 catheter days. Logistic regression analysis demonstrated that risk factors for developing UTI were: duration of Foley (p < 0.002), associated syndrome (p = 0.01) and prolonged PCICU and hospital stay (p < 0.05). Gram-negative were responsible for 63% and Candida for (24%) of the CAUTI. ESBL caused 30% and MDRO caused 10% of our patients CAUTI. Conclusion Foley catheter duration, presence of syndrome and prolonged PCICU and hospital stay were the main risk factors for CAUTI in postoperative paediatric cardiac patients. Resistant Gram-negative were the main cause for CAUTI with one third of CAUTI cases caused by MDRO or ESBL organisms. The cases with CAUTI were generally sicker and with more morbidity. The study will establish a baseline clinical indicator for monitoring quality improvement and the future measures to minimise CAUTI incidence, and its co-morbidity.