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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Treatment of non-oliguric hyperkalaemia with inhaled salbutamol in premature infants with severe respiratory distress syndrome

Abstract

Non-oliguric hyperkalaemia (NOHK) in neonates is defined as a plasma potassium level > 6.5 mmol/L in the presence of urine output ≥ 1 mL/kg/h during the first 72 hours of life. It is characterized by a rapid rise of serum potassium to excessively high values, a high risk of cardiac arrhythmias and no occurrence after 72 hours of birth. NOHK commonly occurs in premature neonates, especially in those with a gestational age <28 weeks, with only a few reports of this entity in moderate or late preterm neonates. The effectiveness and safety of different treatments for NOHK is uncertain and currently there is no firm treatment recommendation. We describe the case of a moderately premature neonate (32+ 2 weeks gestation), with severe neonatal respiratory distress syndrome, who developed NOHK that was treated with inhaled salbutamol. When salbutamol is used for the treatment of NOHK, an initial paradoxical rise in potassium levels should always be taken into account to avoid cardiac arrhythmias.

Key words: non-oliguric hyperkalaemia, premature, infants, salbutamol, hyperkalaemia

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Veno-venous two-site cannulation versus veno-venous double lumen ECMO: complications and survival in infants with respiratory failure

Abstract

Objective. To compare complications and survival between the two-site veno-venous versus the veno-venous double lumen extracorporeal membrane oxygenation (ECMO) in infants with respiratory failure.
Methods. The Extracorporeal Life Support Organization (ELSO, Ann Arbor, Michigan) provided the registry database, collected between 1999-2009 for this research project. During this period, 9086 infants ≤ 7 kg birth weight (BW) were treated with ECMO. From these children, those who were older than 32 days and received veno-venous extracorporeal membrane oxygenation (VV ECMO), were extracted for analysis. From a total of 270 infants who met the inclusion criteria, 236 infants were treated with veno-venous double lumen (VVDL) ECMO and 34 infants received VV two-site ECMO. ELSO records were reviewed for the following information: demographic data, type of ventilation, ventilator days and settings during ECMO, complications during ECMO and survival.
Results. Eighty-seven percent (n=236) of infants were cannulated with VVDL and 13% (n=34) with VV two-site cannulation. Twenty-four hours after ECMO onset, ventilator settings were significantly higher in the VV two-site group. Median ECMO duration was significantly shorter in the VV two-site group (137(90/208) vs. 203(128/336) hours, p=0.01). Total complication rate and survival rates (71% in the VVDL group and 56% in the VV two-site group) were not significantly different.
Conclusion. Both cannulation modes for ECMO are safe for use in infants with respiratory failure. The decision regarding which technique should be used for this group of patients depends mainly on best practice experience of the individual ECMO center and on the technical equipment routinely used by the center.

 

Key words: ECMO, infants, respiratory failure, complications, survival

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Pediatric surgical extracorporeal membrane oxygenation – a case series

Abstract

Objective. To review demographic and procedural factors and their association with weaning rate and survival from extracorporeal membrane oxygenation (ECMO) in pediatric patients undergoing repair of cardiac malformations.
Methods. The hospital records of children requiring ECMO during cardiac operation due to failure to wean from cardio-pulmonary by pass (CPB) were retrospectively reviewed, and an analysis of variables affecting survival was performed.
Results. Thirty-five pediatric patients between January 1, 2000 and December 31, 2006 required ECMO for cardiopulmonary support during cardiac operations. ECMO survival was 54.3% and was comparable across all age groups. The lowest pH during ECMO treatment was the only predictor of mortality (P = 0.006). No other patient, surgical or anesthetic, factor was associated with either weaning from ECMO or hospital survival.
Conclusions. No clear risk factor could be identified for survival from ECMO in our pediatric patients who underwent cardiac surgery and failed weaning from cardiopulmonary bypass.

Keywords: congenital, cardiopulmonary bypass, infants, neonates, failure to wean for cardiopulmonary bypass, survival

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