This study aims to describe chest wall mechanics during delayed sternal closure (DSC) in neonates following cardiopulmonary bypass or palliation of congenital heart diseases.
This research study is being done so that investigators can understand the complex interactions between the heart, the lungs and the chest wall after heart surgery. Understanding this may guide future care that can help patients with their recovery from heart surgery. The heart and lungs work together to make sure the body has the oxygen-rich blood it needs to function properly. The chest wall protects the heart, lungs, and other important organs. Investigators would like to learn how a patient's chest wall contributes to the heart and lungs interaction when the chest is left open after heart surgery. Investigators will be using a device called an esophageal pressure catheter to estimate the pressure that is transmitted to the lungs and heart, called pleural pressure. Previous research has shown that this pressure measurement is used to adjust the breathing machine for patients with lung diseases. Measuring the pressure transmitted to the lungs and heart after heart surgery and delayed chest wall closure may help investigators understand how the chest wall contributes to the heart and lung interaction.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
10
Participants will undergo placement of an esophageal manometry catheter before planned sternal closure. This catheter will be used to measure esophageal pressure which is a surrogate for pleural (intrathoracic) pressure. Esophageal pressure will then be used to estimate changes in respiratory system mechanics and hemodynamics following sternal closure and across different levels of positive end-expiratory pressure (PEEP) and tidal volumes.
The Hospital for Sick Children
Toronto, Ontario, Canada
Percentage of patients with successful insertion and measurement of esophageal pressures
Investigators hypothesize that successful esophageal catheter placement and measurement of Pes (full data set) will occur in ≥80% of enrolled subjects.
Time frame: Immediately prior to chest closure and repeated measurements after chest closure
End-inspiratory and end-expiratory transpulmonary pressure
cmH20
Time frame: Prior to and immediately after sternal chest wall closure procedure
Transmural systolic pressures
mmHg
Time frame: Prior to and immediately after sternal chest wall closure procedure
Transmural diastolic pressures
mmHg
Time frame: Prior to and immediately after sternal chest wall closure procedure
Chest wall and lung compliance
mL/cmH20
Time frame: Prior to and immediately after sternal chest wall closure procedure
Changes in transmural pressures
mmHg
Time frame: Prior to and immediately after sternal chest wall closure procedure
Duration of inotropic support
Hours
Time frame: At 30 days post-operation or discharge (whichever comes first)
Duration of support with supplemental oxygen
Days
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Time frame: At 30 days post-operation or discharge (whichever comes first)
Length ICU Stay
Days
Time frame: At 30 days post-operation or discharge (whichever comes first)
Duration of mechanical ventilation
Hours
Time frame: At 30 days post-operation or discharge (whichever comes first)
Length of Hospital Stay
Days
Time frame: At 30 days post-operation or discharge (whichever comes first)
Mortality
Yes/No
Time frame: At 30 days post-operation or discharge (whichever comes first)