Browsing by Author "Duncan, Jay"
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Item Risk Factors Associated with Stroke in Pediatric Patients Undergoing Fontan Palliation(2019-03-05) Duncan, Jay; Hamby, Tyler; Javed, MahnoorRisk Factors Associated with Stroke in Pediatric Patients Undergoing Fontan Palliation Puprose: Congenital heart disease is the leading known cause for stroke in childhood. The Fontan operation is performed as the third palliative procedure in patients who have complex single ventricle physiology. Patients undergoing Fontan Palliation are at risk for 3 types of strokes: watershed, embolic, or hemorrhagic. Stroke following Fontan Palliation can result in significant deterioration of functional ability. The incidence of this complication seemed higher at Cook Children’s Medical Center (CCMC) as compared to a previous study done at Children’s Hospital in Boston (2.6%). Therefore, the aim of our study is to identify variables contributing to the development of stroke and the risk factors associated with it. The hypothesis is that there are identifiable and potentially modifiable intra-operative and post-operative risk factors that are present in Fontan patients who have radiographic and clinical evidence of stroke. Methods: This was a retrospective chart review of 149 pediatric patients who underwent Fontan Palliation at CCMC between 2007 and 2017. Exclusion factors were any patient undergoing revision of prior Fontan or death within 72 hours of the operation. Covariates included AV valve regurgitation, ventricular function, SVC pressure (pre and post op), and intraoperative change in hematocrit. A Fisher’s exact test was used and p Results: Overall 11% post-Fontan patients had a stroke, all of which were watershed infarcts. Stroke was statistically significantly associated with pre- and post-operative AV valve regurgitation, and depressed ventricular function. Cardiac bypass time, mean arterial pressure, SVC pressure (pre- and post-operative) and intraoperative changes in hematocrit were not significantly associated with stroke. Though the relationship wasn’t significant, all stroke patients had a vasoactive infusion score greater than 5. Conclusion: Pre-Fontan physiology is the single most important factor when determining the risk of developing a watershed infarct with Fontan procedure. AV valve regurgitation and depressed pre-operative single ventricular function are potentially the most significant risk factors for perioperative stroke. This information may be helpful in counseling families about potential post-operative complications.Item SecurAcath Device Safety and Efficacy in Pleural Tube Placement in Children(2024-03-21) Patrick, Kara; Lanier, Lane; Debs, Fouad; Ogunyankin, Fadeke; Duncan, JayBackground: Patients in the cardiac intensive care unit (CICU) may develop complications such as pneumothorax (PTX) or pleural effusion (PE), which may be bloody, chylous, or serous in composition. PTX or PE may require placement of a percutaneous chest tube (CT) to evacuate air or fluid in the pleural space. Historically, CTs are sutured to the skin, but migration and removal of CTs can occur inadvertently due to external factors. The securAcath device is a single-use securement device indicated for securement of percutaneous indwelling catheters/tubes and is in use at the Cook Children’s Medical Center (CCMC) CICU. In this study, we introduce a novel use for this securAcath device in CT securement and aim to determine the effectiveness of the securAcath device in CT securement by assessing the incidence in catheter/tube dislodgement and migration. We compared the efficacy of securAcath device to the typical suturing practice for patients admitted to the CICU at CCMC. Case Information: This is a retrospective cohort of patients undergoing CT placement while admitted to the CCMC CICU from March 1, 2018 to March 31, 2023. Patients under 18 years of age using the securAcath device or suture in CT placement while on admission were included. Initial screening for patient encounters yielded 176 subjects. 140 patients met inclusion/exclusion criteria with 204 CT insertions. The data collected included diagnosis prior to chest tube insertion, chromosome abnormalities, type of congenital heart disease, surgical history, chest tube insertions, date of insertion and removal, SecurAcath or suture usage, complications, inadvertent removal, infection, and bleeding. Differences in duration of CT insertion between the securAcath device group and suture group were analyzed by independent sample t-test for continuous data. Chi square test of independence was used to evaluate the association between dependent and independent variables. All statistical tests were two-sided. P-value of less than 0.05 was utilized as a cutoff for statistical significance. Information: Two hundred and four 8.5 French chest tubes were inserted by intensivists in the CICU on 140 patients. There was no statistical difference in gender, diagnosis or type of congenital heart disease between the securAcath device group and suture group. There was no significance in the number of CTs inserted or the duration of the CTs between groups. No significance was found between groups with infection at the CT site or bleeding complications. The securAcath device group was noted to have a lower incidence of inadvertent removal of the CT compared to the suture group. Conclusions: The securAcath device is as safe as suture securement in children in the CICU who require CT insertion. The securAcath device demonstrates a lower incidence of inadvertent removal compared to suture securement of CTs in children in the CICU.