Fluid Overload and Pulmonary Function

Pirogov Russian National Research Medical University40 enrolled

Overview

Esophageal atresia is a rare but severe malformation, and it requires early surgery. Coloesophagoplasty is surgical repair of the esophageal with an isoperistaltic transverse colon graft. In the postoperative period after coloesophagoplasty children require careful monitoring of fluid balance, because clinically significant fluid overload can lead to dysfunction of various organs and systems.

Esophageal atresia (EA) is a defect of the embryogenesis of the laryngotracheal tube. There are isolated forms of EA and combinations with a tracheoesophageal fistula (TPF). Esophageal plastic surgery with an isoperistaltic transplant from the transverse colon was performed in children with EA. After this surgical intervention children require observation in the intensive care unit (ICU). During this period, infusion therapy satisfies physiological needs and compensates for physiological and pathological losses. However, it is not always possible to compensate for the body's fluid needs and maintain a normovolemic state. Thus, fluid overload develops. It is based on a pathophysiological process when severe operational stress leads to the damage of glycocalyx in the vascular wall. As a result, albumin freely passes into the interstitium, and oncotic pressure rises in tissues. Fluid overload in the intra- and postoperative period can be a factor in an unfavorable outcome, leading to organ damage, as well as death.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Water-Electrolyte Imbalance Intensive Care Units Pediatric Critical Illness

Eligibility

Sex: ALLMin age: 1 MonthMax age: 3 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Аge from 1 month to 3 years * EA with / without * Tracheoesophageal fistula (TPF) * Сoloesophagoplasty. Exclusion Criteria: * Аesophageal burn, * Oesophageal peptic stenosis, * Congenital heart disease * Cardiotonic support in the postoperative period * Renal malformations * Bacterial pneumonia in the postoperative period, * Bronchopulmonary malformations.

Outcomes

Primary Outcomes

duration of intensive care unit (ICU) stay

number of days in ICU after surgery before discharge

Time frame: up to 30 days after the surgery

duration of mechanical ventilation (MV)

number of days of MV after surgery before switching to continuous positive airway pressure (CPAP)

Time frame: up to 30 days after the surgery

intraoperative fluid overload (IVF)

((injected fluid (ml) - diuresis (ml) - blood loss (ml))/weight before surgery)\*100%

Time frame: during the surgery

fluid overload (FO) on the first postoperative day in the ICU

((injected fluid (ml)-lost fluid (ml))/weight before admission to ICU)\*100%

Time frame: during the first postoperative day, exclude intraoperative period

total fluid overload on the first postoperative day

((injected fluid (ml) - lost fluid (ml))/weight before surgery)\*100%

Time frame: during the first postoperative day, include intraoperative period

Fraction of Inspired Oxygen (FiO2)

Time frame: in the the first postoperative day

Fraction of Inspired Oxygen (FiO2)

Time frame: in the second postoperative day

Fraction of Inspired Oxygen (FiO2)