Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T07:04:41.696Z Has data issue: false hasContentIssue false

Landmark lecture on cardiac intensive care and anaesthesia: continuum and conundrums*

Published online by Cambridge University Press:  29 December 2017

Peter C. Laussen*
Affiliation:
Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada Department of Anesthesia, University of Toronto, Toronto, ON, Canada
*
Correspondence to: P. C. Laussen, The Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1×8. Tel: +1 416 813 6860; Fax: +1 416 813 5313; E-mail: Peter.laussen@sickkids.ca

Abstract

Cardiac anesthesia and critical care provide an important continuum of care for patients with congenital heart disease. Clinicians in both areas work in complex environments in which the interactions between humans and technology is critical. Understanding our contributions to outcomes (modifiable risk) and our ability to perceive and predict an evolving clinical state (low failure-to-predict rate) are important performance metrics. Improved methods for capturing continuous physiologic signals will allow for new and interactive approaches to data visualization, and for sophisticated and iterative data modeling that will help define a patient’s phenotype and response to treatment (precision physiology).

Type
Original Articles
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Presented at the 2017 Seventh World Congress of Pediatric Cardiology & Cardiac Surgery (WCPCCS 2017), Barcelona, Spain, 16–21 July, 2017. Presented Friday, 21 July, 2017.

References

1. Burkhardt, BEU, Rucker, G, Stiller, B. Prophylactic milrinone for the prevention of low cardiac output syndrome and mortality in children undergoing surgery for congenital heart disease (review). Cochrane Database Syst Rev 2015; 25: 121.Google Scholar
2. Gaies, M, Pasquali, SK, Donohue, JE, et al. Seminal postoperative complications and mode of death after pediatric cardiac procedures. Ann Thorac Surg 2016; 102: 628635.Google Scholar
3. Boyd, AD, Tremblay, RA, Spencer, FC, Bahnson, HT. Estimation of cardiac output soon after intracardiac surgery with cardiopulmonary bypass. Ann Surg 1959; 150: 613626.Google Scholar
4. Grant, VS, Parr, MD, Blackstone, EH, Kirklin, JW. Cardiac performance and mortality early after intracardiac surgery in infants and young children. Circulation 1975; 51: 867874.Google Scholar
5. Wernovsky, G, Wpij, D, Jonas, RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. Circulation 1995; 95: 22262235.Google Scholar
6. Hoffman, GM, Ghanayem, NS, Tweddell, JS. Noninvasive assessment of cardiac output. Semin Thorac Cardiovasc Surg Ann 2005; 8: 1221.Google Scholar
7. Tibby, S, Hatherill, M, Marsh, MJ, Murdoch, IA. Clincians’ abilities to estimate cardiac index in ventilated children and infants. Arch Dis Child 1997; 77: 516518.Google Scholar
8. Munoz, R, Laussen, PC, Palacio, G, Zienko, L, Piercey, G, Wessel, DL. Changes in whole blood lactate levels during cardiopulmonary bypass for surgery for congenital cardiac disease: an early indicator of morbidity and mortality. J Thorac Cardiovasc Surg 2000; 119: 155162.CrossRefGoogle ScholarPubMed
9. Palermo, RA, Palac, HL, Wald, EL, et al. Metabolic uncoupling following cardiopulmonary bypass. Congenit Heart Dis 2015; 10: E250E257.CrossRefGoogle ScholarPubMed
10. Lin, YL, Guerguerian, AM, Tomasi, J, Laussen, P, Trbovich, P. Usability of data integration and visualization software for multidisciplinary pediatric intensive care: a human factors approach to assessing technology. BMC Med Inform Decis Mak 2017; 17: 122.Google Scholar
11. Rusin, CG, Acosta, SI, Shekerdemian, LS, et al. Prediction of imminent, severe deterioration of children with parallel circulations using real-time processing of physiologic data. J Thorac Cardiovasc Surg 2016; 152: 171177.CrossRefGoogle ScholarPubMed
12. Eytan, D, Goodwin, AJ, Greer, R, Guerguerian, AM, Laussen, PC. Heart rate and blood pressure centile curves and distributions by age of hospitalized critically ill children. Front Pediatr 2017; 5: 52.Google Scholar