《Journal of Pediatric Surgery: Official Journal of the Surgical Section of the American Academy of Pediatric, the British Association of Paediatric Surgeons, the American Pediatric Surgical Association, and the Canadian Association of Paediatric Surgeons》 2022年57卷9期
摘要
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Objective: To analyze preoperative cardiopulmonary support and define preoperative stability relative to timing of surgical repair for CDH neonates not on ECMO. Study design: We retrospectively analyzed repeated measures of oxygen...
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Objective: To analyze preoperative cardiopulmonary support and define preoperative stability relative to timing of surgical repair for CDH neonates not on ECMO. Study design: We retrospectively analyzed repeated measures of oxygenation index (OI; Paw*FiO(2)x100/PaO2) among 158 neonates for temporal preoperative trends. We defined physiologic stability using OI and characterized ventilator days and discharge age relative to delay in repair beyond physiologic stability. Results: The OI in the first 24 h of life was temporally reliable and representative of the preoperative mean (ICC 0.70, 95% CI 0.61-0.77). A pre-operative OI of <= 9.4 (AUC 0.95) was predictive of survival. Surgical delay after an OI <= 9.4 resulted in increased ventilator days (1.4, 95% CI 1.1-1.9) and discharge age (1.5, 95% CI 1.2-2.0). When prospectively applied to a subsequent cohort, an OI <= 9.4 was again reflective of physiologic stability prior to repair. Conclusion: OI values are temporally reliable and change minimally after 24 h age. Delay in surgical repair of CDH beyond initial stability increases ventilator days and discharge age without a survival benefit. Published by Elsevier Inc.
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