Our Summary

This research is a study that was carried out in a children’s hospital to test the safety of not giving certain medicines (diuretics) to children who had recently had heart surgery. They compared a group of kids who had surgery between 2020 and 2021, and divided them into two groups: regular risk and high risk. The regular risk kids didn’t get any diuretics, while the high risk kids got a specific diuretic (furosemide) twice a day for 5 days after they left the hospital.

The researchers were mainly interested in whether this would increase the rates of kids getting fluid in their lungs or around their heart and having to be readmitted to the hospital. They compared the results with previous data from kids who had the same surgery in the past 5 years.

They found that none of the kids were readmitted for fluid in their lungs. However, more kids in the current study were readmitted for fluid around their heart compared to the historical data.

The researchers concluded that not giving diuretics didn’t seem to increase the risk of kids getting fluid in their lungs. However, they noticed a concerning increase in kids being readmitted due to fluid around their heart. They suggest that more research is needed to understand what the best diuretic treatment plan is for kids after heart surgery.

FAQs

  1. What was the intervention used in the study on pediatric cardiac surgery?
  2. What were the results of the study regarding the use of diuretics in post-discharge pediatric cardiac surgery patients?
  3. Was there any increase in readmissions for pericardial effusions after implementing the study protocol?

Doctor’s Tip

One helpful tip a doctor might tell a patient about pediatric cardiac surgery is to follow the prescribed diuretic regimen carefully and report any symptoms of fluid buildup, such as difficulty breathing or swelling, to their healthcare provider immediately. It’s important to stay in close communication with the medical team post-surgery to monitor for any potential complications and adjust treatment as needed.

Suitable For

Patients who are typically recommended for pediatric cardiac surgery include children aged 3 months to 18 years who have undergone a two-ventricle repair. In this study, “regular risk” patients received no diuretics at discharge, while pre-specified “high risk” patients received 5 days of twice per day furosemide. It is important to note that further research is needed to determine the optimal diuretic regimen for these patients, as there was a statistically significant increase in readmissions for pericardial effusions after implementation of the study protocol.

Timeline

Before pediatric cardiac surgery:

  • Patient is diagnosed with a cardiac condition that requires surgical intervention
  • Patient undergoes pre-operative evaluation and testing to assess overall health and readiness for surgery
  • Patient and family meet with the surgical team to discuss the procedure, risks, and potential outcomes
  • Patient is admitted to the hospital for surgery and stays in the hospital post-operatively for monitoring and recovery

After pediatric cardiac surgery:

  • Patient is closely monitored in the intensive care unit (ICU) immediately following surgery
  • Patient may require mechanical ventilation, medications to support heart function, and close monitoring of vital signs
  • Patient is gradually weaned off of mechanical support and medications as their condition stabilizes
  • Patient is transferred to a regular hospital room for further recovery and monitoring
  • Patient receives physical therapy, occupational therapy, and other rehabilitative services as needed to regain strength and function
  • Patient is discharged from the hospital with follow-up appointments scheduled to monitor progress and address any concerns or complications
  • Patient may require ongoing medication, lifestyle modifications, and follow-up care to manage their cardiac condition and promote long-term health and well-being.

What to Ask Your Doctor

  1. What is the purpose of diuretics in pediatric cardiac surgery and why are they commonly prescribed post-operatively?

  2. What are the potential risks and side effects of using diuretics in children after cardiac surgery?

  3. How will the decision be made to classify a patient as “high risk” and in need of diuretics at discharge?

  4. What are the specific criteria for determining if a patient needs diuretics at discharge and for how long they should be administered?

  5. What are the potential complications or risks associated with not using diuretics in pediatric patients after cardiac surgery?

  6. How will the effectiveness of the diuretic regimen be monitored and evaluated in the post-operative period?

  7. What is the rationale for comparing the outcomes of this study to historical controls and how reliable are these comparisons?

  8. How will any potential complications, such as pericardial effusions, be managed if they arise in patients who do not receive diuretics at discharge?

  9. Are there any alternative strategies or medications that could be considered instead of diuretics for managing fluid balance in pediatric patients after cardiac surgery?

  10. What are the potential implications of the study findings for future clinical practice and how might they impact the care of pediatric patients undergoing cardiac surgery in the future?

Reference

Authors: Penk JS, de Faria GB, Collins CA, Jackson LM, Porlier AL, Petito LC, Marino BS. Journal: Pediatr Cardiol. 2023 Apr;44(4):915-921. doi: 10.1007/s00246-022-03078-6. Epub 2022 Dec 23. PMID: 36562779