Mechanical ventilation, cardiopulmonary interactions, and pulmonary issues in children with critical cardiac disease

Abstract

The respiratory care of the child with critical heart disease has profound effects on overall outcome. While often simplified or ignored, a focus on the intricacies and vagaries of pulmonary issues and their management can help pediatric cardiac surgical patients. The intent of this chapter is to describe specific pulmonary and ventilatory issues that arise most frequently during the care of a child with critical heart disease. First, a thorough description of the relevant cardiopulmonary interactions involved in caring for the ventilated patient with critical heart disease is attempted, including the effects of positive pressure ventilation on both right and left heart performance, as well as detailed information on the effects of blood gas manipulation on cardiac and circulatory function. Second, practical management strategies for patients with specific cardiac conditions are described, including the management of patients with cardiopulmonary bypass-induced lung injury, passive pulmonary circulation, open sternum, pulmonary hypertension and right ventricular dysfunction, tetralogy of Fallot with absent pulmonary valve, diaphragmatic injury, and others. Finally, specific, practical, evidence-based management strategies are provided for ventilator management, ventilator weaning, extubation, the use of adjunct respiratory therapies and modalities, as well as the management of failed extubations. In the end, it is hoped that this chapter provides a solid foundation in the respiratory and pulmonary issues facing the practitioner caring for children with critical heart disease.