Recovery from Fontan circulation failure by application of continuous negative extrathoracic pressure
A 2-year-old girl developed lethal circulatory failure, general edema, and hepatic dysfunction in an acute phase after total cavopulmonary connection, a Fontan-type operation. Application of continuous negative extrathoracic pressure (CNEP) with a cuirass ventilator at -4 cmH2O under spontaneous res...
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| Veröffentlicht in: | Journal of anesthesia 2007-05, Vol.21 (2), p.282-284 |
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| creator | Toida, Chiaki Shime, Nobuaki Itoi, Toshiyuki Yamagishi, Masaaki |
| description | A 2-year-old girl developed lethal circulatory failure, general edema, and hepatic dysfunction in an acute phase after total cavopulmonary connection, a Fontan-type operation. Application of continuous negative extrathoracic pressure (CNEP) with a cuirass ventilator at -4 cmH2O under spontaneous respiration dramatically improved hemodynamics, with systolic arterial pressure increasing from 82 mmHg to 90 mmHg, and central venous pressure decreasing from 15 mmHg to 13 mmHg; also, urine output increased, from 1.6 ml.kg(-1).h(-1) to 6.4 ml.kg(-1).h(-1). Improvements in hepatic function and fluid retention (reduction of pleural fluid and ascites) were also observed. The patient was successfully weaned from CNEP after 5 days. CNEP is an easily applicable, noninvasive tool to reduce pulmonary impedance, and is specifically useful to improve hemodynamics in patients after a Fontan-type operation. Our result suggests that CNEP may represent a first-line option to save patients from critical circulatory failure after a Fontan-type operation. |
| doi_str_mv | 10.1007/s00540-007-0497-y |
| format | Article |
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Application of continuous negative extrathoracic pressure (CNEP) with a cuirass ventilator at -4 cmH2O under spontaneous respiration dramatically improved hemodynamics, with systolic arterial pressure increasing from 82 mmHg to 90 mmHg, and central venous pressure decreasing from 15 mmHg to 13 mmHg; also, urine output increased, from 1.6 ml.kg(-1).h(-1) to 6.4 ml.kg(-1).h(-1). Improvements in hepatic function and fluid retention (reduction of pleural fluid and ascites) were also observed. The patient was successfully weaned from CNEP after 5 days. CNEP is an easily applicable, noninvasive tool to reduce pulmonary impedance, and is specifically useful to improve hemodynamics in patients after a Fontan-type operation. 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Our result suggests that CNEP may represent a first-line option to save patients from critical circulatory failure after a Fontan-type operation.</description><subject>Care and treatment</subject><subject>Case studies</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Decompression - methods</subject><subject>Female</subject><subject>Fontan Procedure - adverse effects</subject><subject>Humans</subject><subject>Methods</subject><subject>Shock - etiology</subject><subject>Shock - therapy</subject><subject>Surgery</subject><subject>Thoracic arteries</subject><subject>Treatment Outcome</subject><issn>0913-8668</issn><issn>1438-8359</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkUFr3DAQhUVoSLZJfkAvRVDIzc1oJVvWMYSkLQQKJTmL2bGUqHgtV7JD_O-jxQs9zfD43vCYx9gXAd8FgL7JALWCqqwVKKOr5YRthJJt1crafGIbMEJWbdO05-xzzn8BoBFCnrFzoVVd9O2GuT-O4ptLC_cp7vlDHCYcOIVEc49TiAP3GPo5Ob5bOI5jH2iVo-dU4DDMcc58cC9FfnPcvU8Jp9eYkALxMbmci_mSnXrss7s6zgv2_HD_dPezevz949fd7WNFqjVTpX3J1ygv0HSq7hSi6LSGBqBTDXmk2pMhklCDk6KlXeNRGilQ7WRnAOUFu17vjin-m12e7D5kcn2PgysxrQYlt7VsCvhtBV-wdzYMPpbYdIDtrdBCm63aQqHESlGKOSfn7ZjCHtNiBdhDA3ZtwB7WQwN2KZ6vxwjzbu-6_47jy-UHMJCDTg</recordid><startdate>200705</startdate><enddate>200705</enddate><creator>Toida, Chiaki</creator><creator>Shime, Nobuaki</creator><creator>Itoi, Toshiyuki</creator><creator>Yamagishi, Masaaki</creator><general>Springer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200705</creationdate><title>Recovery from Fontan circulation failure by application of continuous negative extrathoracic pressure</title><author>Toida, Chiaki ; Shime, Nobuaki ; Itoi, Toshiyuki ; Yamagishi, Masaaki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-7f61164f1a9d45d4aa1d770600d46cfac5fc9cc3050e318cb6fa3931a4b3d90a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Care and treatment</topic><topic>Case studies</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Decompression - methods</topic><topic>Female</topic><topic>Fontan Procedure - adverse effects</topic><topic>Humans</topic><topic>Methods</topic><topic>Shock - etiology</topic><topic>Shock - therapy</topic><topic>Surgery</topic><topic>Thoracic arteries</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Toida, Chiaki</creatorcontrib><creatorcontrib>Shime, Nobuaki</creatorcontrib><creatorcontrib>Itoi, Toshiyuki</creatorcontrib><creatorcontrib>Yamagishi, Masaaki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Toida, Chiaki</au><au>Shime, Nobuaki</au><au>Itoi, Toshiyuki</au><au>Yamagishi, Masaaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Recovery from Fontan circulation failure by application of continuous negative extrathoracic pressure</atitle><jtitle>Journal of anesthesia</jtitle><addtitle>J Anesth</addtitle><date>2007-05</date><risdate>2007</risdate><volume>21</volume><issue>2</issue><spage>282</spage><epage>284</epage><pages>282-284</pages><issn>0913-8668</issn><eissn>1438-8359</eissn><abstract>A 2-year-old girl developed lethal circulatory failure, general edema, and hepatic dysfunction in an acute phase after total cavopulmonary connection, a Fontan-type operation. Application of continuous negative extrathoracic pressure (CNEP) with a cuirass ventilator at -4 cmH2O under spontaneous respiration dramatically improved hemodynamics, with systolic arterial pressure increasing from 82 mmHg to 90 mmHg, and central venous pressure decreasing from 15 mmHg to 13 mmHg; also, urine output increased, from 1.6 ml.kg(-1).h(-1) to 6.4 ml.kg(-1).h(-1). Improvements in hepatic function and fluid retention (reduction of pleural fluid and ascites) were also observed. The patient was successfully weaned from CNEP after 5 days. CNEP is an easily applicable, noninvasive tool to reduce pulmonary impedance, and is specifically useful to improve hemodynamics in patients after a Fontan-type operation. 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| language | eng |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Care and treatment Case studies Child, Preschool Children Decompression - methods Female Fontan Procedure - adverse effects Humans Methods Shock - etiology Shock - therapy Surgery Thoracic arteries Treatment Outcome |
| title | Recovery from Fontan circulation failure by application of continuous negative extrathoracic pressure |
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