Dorothy Beke's guest appearances

Dorothy Beke

OPENPediatrics

Michael Fishman

Johns Hopkins

Michelle Lee

George Taylor

Robert Graham

Paul Offit

Tom Kulik

Emma Jones

John Arnold

John Knight

Jamie Harris

David Mooney

Brian Walsh

Michael O'Brien

Mark Rogers

OwlTail

This video discusses optimizing cardiac output in the post-operative management of the pediatric cardiac patient.Initial publication: January 29, 2014.Last reviewed: May 23, 2019.Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user.For further information on how to enroll, please email: openpediatrics@childrens.harvard.eduPlease note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause.Optimizing Cardiac Output After Surgery, by Dorothy Beke.Hello. My name is Dorothy Beke. I'm a clinical nurse specialist in the Cardiac Intensive Care Unit at the Children's Hospital Boston. In this video on post-operative considerations after pediatric cardiac surgery, I will discuss issues related to optimizing cardiac output in the post-operative pediatric cardiac patient.Maintaining Cardiac Output.Preserve myocardial function and minimize oxygen consumption by decreasing stress to the heart. Too much inotropic support, such as with dopamine or epinephrine, causes the heart to work harder, produces cardiac arrhythmias, and increases both systemic and pulmonary vascular resistance. Low intracardiac or central venous pressures will cause tachycardia and decreased peripheral profusion. Fluid boluses of 5 to 10 milliliters per kilogram may be indicated to ensure adequate cardiacpreload.Monitor for Increased Systemic and Pulmonary Vascular Resistance.Increased pulmonary vascular resistance may be due to excessive pulmonary blood flow, inflammatory and ischemic responses related to cardiopulmonary bypass, edema, or prolonged mechanical ventilation. Increased systemic vascular resistance may be related to left ventricular failure, cardiopulmonary bypass, hypoxia, acidosis, or low body temperature, or pain. Measures to decrease pulmonary and systemic vascular resistance include adequate mechanical ventilation and oxygenation, analgesia and sedation as well as afterload reducing agents such as nitroprusside. Milrinone has both inotropic and afterload reducing effects. Maintain cardiac output for improving cardiac contractility with inotropic medications such as dopamine, and by maintaining normal acid-base balance and adequate tissue oxygenation. Normal sinus rhythm will optimize cardiac output.Milrinone. The PRIMACORP trial was one of the few multi-centered, randomized, double blinded, placebo-controlled trials of a pediatric cardiovascular drug. Milrinone is a non-catecholamine inotropic agent with vasodilatory and lusitropic or cardiac relaxation effects. It has been shown to improve cardiac output while lowering filling pressures and systemic and pulmonary vascular resistance with minimal cardiac oxygen consumption. In the PRIMACORP trial, patients were randomized to high-dose Milrinone of 0.75 micrograms per kilogram per minute, 1/3 were randomized to low-dose Milrinone of 0.25 micrograms per kilogram per minute, and 1/3 were randomized to placebo. The prophylactic use of Milrinone in a 64% relative risk reduction in developing low cardiac output syndrome and the first 36 hours after cardiopulmonary bypass with high-dose Milrinone of 0.75 micrograms per kilogram per minute.

This video discusses optimizing cardiac output in the post-operative management of the pediatric cardiac patient. Initial publication: January 29, 2014. Last reviewed: May 23, 2019. Please visit: <a href="http://www.openpediatrics.org" rel="nofollow" target="_blank">www.openpediatrics.org</a> OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access-and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support nor control any related videos in the sidebar, these are placed by Youtube. We apologize for any inconvenience this may cause. Optimizing Cardiac Output After Surgery, by Dorothy Beke. Hello. My name is Dorothy Beke. I'm a clinical nurse specialist in the Cardiac Intensive Care Unit at the Children's Hospital Boston. In this video on post-operative considerations after pediatric cardiac surgery, I will discuss issues related to optimizing cardiac output in the post-operative pediatric cardiac patient. Maintaining Cardiac Output. Preserve myocardial function and minimize oxygen consumption by decreasing stress to the heart. Too much inotropic support, such as with dopamine or epinephrine, causes the heart to work harder, produces cardiac arrhythmias, and increases both systemic and pulmonary vascular resistance. Low intracardiac or central venous pressures will cause tachycardia and decreased peripheral profusion. Fluid boluses of 5 to 10 milliliters per kilogram may be indicated to ensure adequate cardiac preload. Monitor for Increased Systemic and Pulmonary Vascular Resistance. Increased pulmonary vascular resistance may be due to excessive pulmonary blood flow, inflammatory and ischemic responses related to cardiopulmonary bypass, edema, or prolonged mechanical ventilation. Increased systemic vascular resistance may be related to left ventricular failure, cardiopulmonary bypass, hypoxia, acidosis, or low body temperature, or pain. Measures to decrease pulmonary and systemic vascular resistance include adequate mechanical ventilation and oxygenation, analgesia and sedation as well as afterload reducing agents such as nitroprusside. Milrinone has both inotropic and afterload reducing effects. Maintain cardiac output for improving cardiac contractility with inotropic medications such as dopamine, and by maintaining normal acid-base balance and adequate tissue oxygenation. Normal sinus rhythm will optimize cardiac output. Milrinone. The PRIMACORP trial was one of the few multi-centered, randomized, double blinded, placebo-controlled trials of a pediatric cardiovascular drug. Milrinone is a non-catecholamine inotropic agent with vasodilatory and lusitropic or cardiac relaxation effects. It has been shown to improve cardiac output while lowering filling pressures and systemic and pulmonary vascular resistance with minimal cardiac oxygen consumption. In the PRIMACORP trial, patients were randomized to high-dose Milrinone of 0.75 micrograms per kilogram per minute, 1/3 were randomized to low-dose Milrinone of 0.25 micrograms per kilogram per minute, and 1/3 were randomized to placebo. The prophylactic use of Milrinone in a 64% relative risk reduction in developing low cardiac output syndrome and the first 36 hours after cardiopulmonary bypass with high-dose Milrinone of 0.75 micrograms per kilogram per minute.

"Optimizing Cardiac Output After Surgery" by Dorothy Beke for OPENPediatrics