To manage pediatric ventilation in children with congenital heart disease, the knowing of the many differences from adult respiratory system is not enough.
In fact, into the wide contest of pediatric cardiac defect, lung and cardiac systems work affecting continuously their function. Any interventions designed to improve the function of one system may lead to unwanted effects on another. For these reasons, to have an optimal manage on this interaction, a thorough understanding of respiratory mechanics, patient-ventilator interactions, intrapulmonary gas exchange mechanisms, hemodynamics under physiologic and pathophysiologic conditions, and a complete knowledge of the procedures are therefore required and mandatory.
In this chapter are summarized the bases of the respiratory system in pediatric patients, the physiology of cardiopulmonary interaction, the principal respiratory support methods, and finally the specific considerations for each pathological cardiopulmonary interaction.
This is a preview of subscription content, log in to check access.
Venus B, Cohen LE, Smith RA. Hemodynamics and intrathoracic pressure transmission during controlled mechanical ventilation and positive end-expiratory pressure in normal and low compliant lungs. Crit Care Med. 1988;16:686–90.CrossRefPubMedGoogle Scholar
West J, Dollery C, Naimark A. Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures. J Appl Physiol. 1964;19:713–24.CrossRefPubMedGoogle Scholar
Sommer N, Dietrich A, Schermuly RT, Ghofrani HA, Gudermann T, Schulz R, Seeger W, Grimminger F, Weissmann N. Regulation of hypoxic pulmonary vasoconstriction: basic mechanisms. Eur Respir J. 2008;32:1639–51.CrossRefPubMedGoogle Scholar
Thiene G, Frescura C. Anatomical and pathophysiological classification of congenital heart disease. Cardiovasc Pathol. 2010;19:259–74.CrossRefPubMedGoogle Scholar
Mayfield S, Jauncey-Cooke J, Hough JL, Schibler A, Gibbons K, Bogossian F. High-flow nasal cannula therapy for respiratory support in children. Cochrane Database Syst Rev. 2014;(3):CD009850.Google Scholar
Lee JH, Rehder KJ, Williford L, Cheifetz IM, Turner DA. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med. 2013;39:247–57.CrossRefPubMedGoogle Scholar
Caliumi-Pellegrini G, Agostino R, Orzalesi M, Nodari S, Marzetti G, Savignoni PG, Bucci G. Twin nasal cannula for administration of continuous positive airway pressure to newborn infants. Arch Dis Child. 1974;49:228.CrossRefPubMedPubMedCentralGoogle Scholar
Rotta AT, de Carvalho WB. Mechanical ventilation following cardiac surgery in children. Curr Respir Med Rev. 2012;8(1):44–52.CrossRefGoogle Scholar
Bradley SM, Simsic JM, Mulvihill DM. Hyperventilation impairs oxygenation after bidirectional superior cavopulmonary connection. Circulation. 1998;98:II372–6; discussion II6–7PubMedGoogle Scholar
Bradley SM, Simsic JM, Mulvihill DM. Hypoventilation improves oxygenation after bidirectional superior cavopulmonary connection. J Thorac Cardiovasc Surg. 2003;126:1033–9.CrossRefPubMedGoogle Scholar
Gamillscheg A, Zobel G, Urlesberger B, et al. Inhaled nitric oxide in patients with critical pulmonary perfusion after Fontan-type procedures and bidirectional Glenn anastomosis. J Thorac Cardiovasc Surg. 1997;113:435–42.CrossRefPubMedGoogle Scholar