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1. Repeated bedside echocardiography in children with respiratory failure

Author

Jehlicka Petr, Sasek Lumir, Pizingerova Katerina, Fremuth Jiri, Kobr Jiri, Fikrlova Sarka, and Slavik Zdenek

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background The aim of this study was to verify the benefits and limitations of repeated bedside echocardiographic examinations in children during mechanical ventilation. For the purposes of this study, we selected the data of over a time period from 2006 to 2010. Methods A total of 235 children, average age 3.21 (SD 1.32) years were included into the study and divided into etiopathogenic groups. High-risk groups comprised: Acute lung injury and acute respiratory distress syndrome (ALI/ARDS), return of spontaneous circulation after cardiopulmonary resuscitation (ROSC), bronchopulmonary dysplasia (BPD), cardiomyopathy (CMP) and cardiopulmonary disease (CPD). Transthoracic echocardiography was carried out during mechanical ventilation. The following data were collated for statistical evaluation: right and left ventricle myocardial performance indices (RV MPI; LV MPI), left ventricle shortening fraction (SF), cardiac output (CO), and the mitral valve ratio of peak velocity of early wave (E) to the peak velocity of active wave (A) as E/A ratio. The data was processed after a period of recovery, i.e. one hour after the introduction of invasive lines (time-1) and after 72 hours of comprehensive treatment (time-2). The overall development of parameters over time was compared within groups and between groups using the distribution-free Wilcoxons and two-way ANOVA tests. Results A total of 870 echocardiographic examinations were performed. At time-1 higher average values of RV MPI (0.34, SD 0.01 vs. 0.21, SD 0.01; p < 0.001) were found in all groups compared with reference values. Left ventricular load in the high-risk groups was expressed by a higher LV MPI (0.39, SD 0.13 vs. 0.29, SD 0.02; p < 0.01) and lower E/A ratio (0.95, SD 0.36 vs. 1.36, SD 0.64; p < 0.001), SF (0.37, SD 0.11 vs. 0.47, SD 0.02; p < 0.01) and CO (1.95, SD 0.37 vs. 2.94, SD 1.03; p < 0.01). At time-2 RV MPI were lower (0.25, SD 0.02 vs. 0.34, SD 0.01; p < 0.001), but remained higher compared with reference values (0.25, SD 0.02 vs. 0.21, SD 0.01; p < 0.05). Other parameters in high-risk groups were improved, but remained insignificantly different compared with reference values. Conclusion Echocardiography complements standard monitoring of valuable information regarding cardiac load in real time. Chest excursion during mechanical ventilation does not reduce the quality of the acquired data.

Published
2011
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2. Control of hyperglycaemia in paediatric intensive care (CHiP): study protocol

Author

Percy Deborah, Snowdon Claire, Allen Elizabeth, Betts Helen, Truesdale Ann, Goldman Allan, Slavik Zdenek, Fortune Peter-Marc, Baines Paul, Schindler Margrid, Nadel Simon, Parslow Roger, Grieve Richard, Pappachan John, Macrae Duncan, Broadhead Michael, Quick Tara, Peters Mark, Morris Kevin, Tasker Robert, and Elbourne Diana

Subjects
Pediatrics, RJ1-570
Abstract

Abstract Background There is increasing evidence that tight blood glucose (BG) control improves outcomes in critically ill adults. Children show similar hyperglycaemic responses to surgery or critical illness. However it is not known whether tight control will benefit children given maturational differences and different disease spectrum. Methods/Design The study is an randomised open trial with two parallel groups to assess whether, for children undergoing intensive care in the UK aged ≤ 16 years who are ventilated, have an arterial line in-situ and are receiving vasoactive support following injury, major surgery or in association with critical illness in whom it is anticipated such treatment will be required to continue for at least 12 hours, tight control will increase the numbers of days alive and free of mechanical ventilation at 30 days, and lead to improvement in a range of complications associated with intensive care treatment and be cost effective. Children in the tight control group will receive insulin by intravenous infusion titrated to maintain BG between 4 and 7.0 mmol/l. Children in the control group will be treated according to a standard current approach to BG management. Children will be followed up to determine vital status and healthcare resources usage between discharge and 12 months post-randomisation. Information regarding overall health status, global neurological outcome, attention and behavioural status will be sought from a subgroup with traumatic brain injury (TBI). A difference of 2 days in the number of ventilator-free days within the first 30 days post-randomisation is considered clinically important. Conservatively assuming a standard deviation of a week across both trial arms, a type I error of 1% (2-sided test), and allowing for non-compliance, a total sample size of 1000 patients would have 90% power to detect this difference. To detect effect differences between cardiac and non-cardiac patients, a target sample size of 1500 is required. An economic evaluation will assess whether the costs of achieving tight BG control are justified by subsequent reductions in hospitalisation costs. Discussion The relevance of tight glycaemic control in this population needs to be assessed formally before being accepted into standard practice. Trial Registration Current Controlled Trials ISRCTN61735247

Published
2010
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3. Accuracy of computed tomography in detection of great vessel stenosis or hypoplasia before superior bidirectional cavopulmonary connection: Comparison with cardiac catheterization and surgical findings

Author

Krupickova, Sylvia, Vazquez-Garcia, Laura, Obeidat, Monther, Banya, Winston, DiSalvo, Giovanni, Ghez, Olivier, Michielon, Guido, Castellano, Isabel, Rubens, Michael, Semple, Thomas, Nicol, Edward, Slavik, Zdenek, Rigby, Michael L., and Fraisse, Alain

Published
2019
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4. Contributors

Author

Ahmed, Mubbasheer, primary, Alaish, Samuel M., additional, Alanmanou, Euleche, additional, Alexander, Plato, additional, Aljiffry, Alaa, additional, Almodovar, Melvin C., additional, Alsoufi, Bahaaldin, additional, Anders, Marc M., additional, Andersen, Nicholas D., additional, Ascenzi, Judith, additional, Aydin, Scott I., additional, Bacon, Matthew K., additional, Barron, David J., additional, Basken, Amy, additional, Beddows, Kimberly D., additional, Bembea, Melania M., additional, Benscoter, Alexis L., additional, Bergstrom, Charles P., additional, Bernier, Meghan, additional, Bibevski, Steve, additional, Bichell, David, additional, Bird, Geoffrey L., additional, Boukas, Konstantinos, additional, Bove, Edward L., additional, Brady, Ken, additional, Broberg, Craig S., additional, Bronicki, Ronald A., additional, Brothers, Julie A., additional, Brown, Kristen M., additional, Brownlee, John R., additional, Bryant, Roosevelt, additional, Buddhavarapu, Amulya, additional, Cameron, Duke E., additional, Chai, Paul J., additional, Checchia, Paul A., additional, Cheifetz, Ira M., additional, Chin, Clifford, additional, Cholette, Jill Marie, additional, Cole, Charles R., additional, Cooper, David S., additional, Coulson, John D., additional, Damiano, Ralph J., additional, DeLeon, Miguel, additional, DeSena, Holly C., additional, Deutsch, Nina, additional, Eghtesady, Pirooz, additional, Engorn, Branden, additional, Everett, Allen, additional, Felmly, Lloyd, additional, Fiore, Andrew C., additional, Fleming, Gregory A., additional, Flores, Saul, additional, Franklin, Rodney, additional, Fraser, Charles D., additional, Gaies, Michael, additional, Gangemi, James J., additional, Gaur, Lasya, additional, Ghanayem, Nancy S., additional, Ginde, Salil, additional, Gist, Katja M., additional, Goldman, Allan, additional, Goldstein, Stuart L., additional, Goswami, Dheeraj, additional, Graham, Eric M., additional, Grenier, Michelle A., additional, Handler, Stephanie S., additional, Herlong, James R., additional, Hill, Kevin D., additional, Romano, Jennifer C., additional, Ho, Siew Yen, additional, Hoffman, George M., additional, Honjo, Osami, additional, Hornik, Christoph P., additional, Hsu, Daphne T., additional, Huddleston, Charles B., additional, Huff, Christin, additional, Hunt, Elizabeth A., additional, Idriss, Salim F., additional, Iliopoulos, Ilias, additional, Jackson, Kimberly Ward, additional, Jacobs, Jeffrey P., additional, Jacobs, Marshall L., additional, Jaggers, James, additional, Jansen, Laura N., additional, Janson, Christopher M., additional, Jaquiss, Robert, additional, Johnson, Emily, additional, Jones, Melissa B., additional, Justice, Lindsey, additional, Kane, Patricia L., additional, Karamlou, Tara, additional, Kartha, Vyas M., additional, Kavarana, Minoo N., additional, Khan, Abigail May, additional, King, Valerie, additional, Kirsch, Roxanne E., additional, Kirshbom, Paul M., additional, Knott-Craig, Christopher J., additional, Koo, Jeannie, additional, Kramer, Jennifer, additional, Krawczeski, Catherine D., additional, Krishnamurthy, Ganga, additional, Kudchadkar, Sapna R., additional, Kumar, Karan R., additional, Kumar, T.K. Susheel, additional, Kwiatkowski, David M., additional, Lamour, Jacqueline M., additional, Lancaster, Timothy S., additional, Landis, Benjamin J., additional, Lasa, Javier J., additional, Liava'a, Matthew H.L., additional, Licht, Daniel J., additional, Lisi, Matthew T., additional, Loftin, Ryan, additional, Loomba, Rohit S., additional, Marino, Bradley S., additional, Maxey, Thomas S., additional, McCarthy, Karen, additional, McCrory, Michael C., additional, Mehta, Inder D., additional, Mehta, Christopher, additional, Meliones, Jon N., additional, Meliones, Christine, additional, Miles, Alison, additional, Mitchell, Michael E., additional, Molitor-Kirsch, Erica, additional, Montgomery, Jenny A., additional, Moore, Lisa, additional, Morales, David L.S., additional, Morin, Cara, additional, Morin, Nicholas, additional, Mou, Steven S., additional, Muralidaran, Ashok, additional, Murthy, Raghav, additional, Nellis, Joseph R., additional, Nelson, Jennifer S., additional, Nelson McMillan, Kristen, additional, Nies, Melanie, additional, Nigro, John, additional, Noje, Corina, additional, Norris, Sarah E., additional, O'Brien, James, additional, Ofori-Amanfo, George, additional, Ohye, Richard G., additional, Ootaki, Yoshio, additional, Ozment, Caroline P., additional, Peek, Giles J., additional, Peterson, Autumn K., additional, Peterson, Renuka E., additional, Petty, John K., additional, Porayette, Prashob, additional, Procaccini, David E., additional, Quintessenza, James, additional, Ragalie, William S., additional, Ravekes, William, additional, Raymond, Tia T., additional, Redington, Andrew, additional, Rehder, Kyle J., additional, Riggs, Becky, additional, Rivera, Ramon Julio, additional, Roark, Jennifer, additional, Romer, Lewis H., additional, Ryan, Amy, additional, Ryan, Thomas D., additional, Rymeski, Beth A., additional, Sassalos, Peter, additional, Sawyer, Jaclyn E., additional, Scholl, Frank, additional, Schooler, Kevin Patrick, additional, Schuette, Jennifer, additional, McElrath, Jamie, additional, Sedehi, Daniel R., additional, Sekar, Priya, additional, Shaffner, Donald H., additional, Shah, Sanket, additional, Shen, Irving, additional, Shetty, Avinash K., additional, Shope, Edd, additional, Shores, Darla, additional, Si, Ming-Sing, additional, Siddiqi, Nida, additional, Simpson, Leah, additional, Slavik, Zdenek, additional, Smith, Heidi A.B., additional, Spector, Zebulon Z., additional, Speer, Allison L., additional, Spevak, Philip, additional, Stewart, Dylan, additional, Stewart, Robert D., additional, St. Louis, James, additional, Stone, Matthew L., additional, Su, Erik, additional, Swain, Kelly A., additional, Takemoto, Cliff M., additional, Tallent, Sarah, additional, Thiagarajan, Ravi R., additional, Traube, Chani, additional, Tropp, Ephraim, additional, Tsang, Rocky, additional, Tume, Sebastian C., additional, Turek, Joseph W., additional, Turi, Jennifer L., additional, Turner, Immanuel I., additional, Tweddell, James S., additional, Unegbu, Chinwe, additional, Ungerleider, Ross M., additional, Ungerleider, Jamie Dickey, additional, Ungerleider, Graham D., additional, Vricella, Luca A., additional, Vu, Eric L., additional, Wadia, Rajeev S., additional, Walsh, Michael J., additional, Watt, Kevin M., additional, Welke, Karl, additional, Willett, Renée, additional, Williams, Derek A., additional, Woods, Ronald K., additional, Woods-Hill, Charlotte, additional, and Yarrabolu, Tharakanatha R., additional

Published
2019
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6. The role of bidirectional superior cavopulmonary anastomosis in the treatment of complex congenital heart defects

Author

Slavik, Zdenek

Subjects
610, Medicine
Abstract

Our study was based on a group of 108 patients with complex cyanotic congenital heart defects and BCPA coming from 3 institutions. The study in unique in the number of patients with BCPA included and its results. We have shown that the competitive sources of pulmonary blood flow following BCPA are well tolerated and they will facilitate early postoperative recovery. The BCPA can be performed safely as a primary palliation even in infants as young as 1 month of age but the postoperative course is likely to be more complicated. The postoperative growth of both pulmonary arteries will be slower in the patients undergoing the BCPA under 1 year of age when compared with the older patients. Nevertheless, the patients undergoing BCPA fall broadly into 2 subgroups. Patients with restricted pulmonary blood flow prior to BCPA will have smaller pulmonary arteries and BCPA is likely to promote their growth. In the patients with large pulmonary arteries before BCPA, lack of growth in the early follow-up may be appropriate. The competitive source of pulmonary blood flow after BCPA will mainly supply the pulmonary artery contralateral to the BCPA which may enhance its growth. The high incidence of venovenous collaterals (44%) in a smaller subgroup of patients with BCPA and competitive source of pulmonary blood flow is somewhat worrying. On the other hand, the blood provided by the competitive source will limit the extent of intrapulmonary right to left shunting following BCPA. Our study supports the view that the BCPA is a safe primary palliative surgical procedure in selected patients with complex cyanotic congenital heart defects from early infancy (overall mortality 7.4%). The presence of a concomitant competitive source of pulmonary blood flow will provide at least medium term satisfactory palliation.

Published
1998

8. Outcome after transcatheter occlusion of patent ductus arteriosus in infants less than 6 kg: A national study from United Kingdom and Ireland

Author

Kang, Sok‐Leng, Jivanji, Salim, Mehta, Chetan, Tometzki, Andrew J., Derrick, Graham, Yates, Robert, Khambadkone, Sachin, de Giovanni, Joseph, Stumper, Oliver, Dhillon, Rami, Bhole, Vinay, Slavik, Zdenek, Rigby, Michael, Noonan, Patrick, Smith, Ben, Knight, Brodie, Richens, Trevor, Wilson, Neil, Walsh, Kevin, James, Adam, Thomson, John, Bentham, Jamie, Hayes, Nicholas, Nazir, Sajid, Adwani, Satish, Shauq, Arjamand, Ramaraj, Ram, Duke, Christopher, Taliotis, Demetris, Kudumula, Vikram, Yong, San‐Fui, Morgan, Gareth, Rosenthal, Eric, Krasemann, Thomas, Qureshi, Shakeel, Crossland, David, Hermuzi, Tony, and Martin, Robin P.

Published
2017
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24. A clinical and economic evaluation of Control of Hyperglycaemia in Paediatric intensive care (CHiP): a randomised controlled trial

Author

Macrae, Duncan, primary, Grieve, Richard, additional, Allen, Elizabeth, additional, Sadique, Zia, additional, Betts, Helen, additional, Morris, Kevin, additional, Pappachan, Vithayathil John, additional, Parslow, Roger, additional, Tasker, Robert C, additional, Baines, Paul, additional, Broadhead, Michael, additional, Duthie, Mark L, additional, Fortune, Peter-Marc, additional, Inwald, David, additional, McMaster, Paddy, additional, Peters, Mark J, additional, Schindler, Margrid, additional, Guerriero, Carla, additional, Piercy, Deborah, additional, Slavik, Zdenek, additional, Snowdon, Claire, additional, Van Dyck, Laura, additional, and Elbourne, Diana, additional

Published
2014
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28. Control of hyperglycaemia in paediatric intensive care (CHiP): study protocol

Author

Macrae, Duncan, primary, Pappachan, John, additional, Grieve, Richard, additional, Parslow, Roger, additional, Nadel, Simon, additional, Schindler, Margrid, additional, Baines, Paul, additional, Fortune, Peter-Marc, additional, Slavik, Zdenek, additional, Goldman, Allan, additional, Truesdale, Ann, additional, Betts, Helen, additional, Allen, Elizabeth, additional, Snowdon, Claire, additional, Percy, Deborah, additional, Broadhead, Michael, additional, Quick, Tara, additional, Peters, Mark, additional, Morris, Kevin, additional, Tasker, Robert, additional, and Elbourne, Diana, additional

Published
2010
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37. Influence of bidirectional superior cavopulmonary anastomosis on pulmonary arterial growth

Author

Slavik, Zdenek, primary, Webber, Steven A., additional, Lamb, Robert K., additional, Horvath, Pavel, additional, LeBlanc, Jacques G., additional, Keeton, Barry R., additional, Monro, James L., additional, Tax, Petr, additional, Tuma, Stanislav, additional, Reich, Oleg, additional, Sandor, George G.S., additional, Daubeney, Piers E.F., additional, and Salmon, Anthony P., additional

Published
1995
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45. TREATMENT OF HODGKIN'S DISEASE IN CHILDREN WITH VAMP (VINBLASTINE, ADRIAMYCIN, METHOTREXATE, PREDNISONE) AND VEPA (VINBLASTINE, ETOPOSIDE, PREDNISONE, ADRIAMYCIN).

Author

Kavan, Petr, Kabickova, E., Koutecky, Josef, Mcclain, Kenneth, Gajdos, Petr, Kodet, Roman, Slavik, Zdenek, and Tousovska, Katerina

Subjects
HODGKIN'S disease in children, VINBLASTINE, DOXORUBICIN, METHOTREXATE, PREDNISONE, THERAPEUTICS
Abstract

Treatment of Hodgkin's disease in children should be directed at maximizing cures and minimizing the long-term effects of alkylating agents, anthracyclines, and bleomycin. In this study methotrexate and etoposide were used in the VAMP/VEPA regimens to treat 60 clinically staged pediatric patients with Hodgkin's disease. Twenty-nine patients with stages I-IIA received four courses of VAMP plus low-dose radiotherapy. Thirty-one IIA bulky disease and IIB-IVB patients received four or six courses of VEPA plus low-dose radiotherapy. There were 6 partial remissions after the completion of chemotherapy and all of these patients relapsed, but 4 were successfuly salvaged with ABMT. Two patients have died. The 3.1-year overall survival rate is 97% (100% VAMP, 94% VEPA) and the event-free survival rate is 88% (97% VAMP, 77% VEPA). These results suggest that VAMP is a reasonable treatment for low stages of Hodgkin's disease, but more advanced disease is not adequately treated by VEPA and low-dose radiotherapy. [ABSTRACT FROM AUTHOR]

Published
1999
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46. Pulmonary atresia with intact ventricular septum Range of morphology in a population-based study

Author

Daubeney, Piers E.F, Delany, David J, Anderson, Robert H, Sandor, George G.S, Slavik, Zdenek, Keeton, Barry R, and Webber, Steven A

Abstract

ObjectivesWe describe the morphologic variability in pulmonary atresia with intact ventricular septum (PAIVS) within a population-based study.BackgroundAn uncommon disease, PAIVS shows considerable morphologic heterogeneity. Clinical reports, based mostly on small samples of patients, may not reflect the true spectrum of pathology of this condition. We have studied the entire range of morphology in a prospective population-based study of patients over a five-year period (1991 to 1995).MethodsAs part of the United Kingdom and Ireland Collaborative Study of PAIVS, all 18 pediatric cardiac centers were visited by a single investigator. Morphologic features of each case were determined by direct review of the echocardiograms and angiocardiograms, from surgical and autopsy reports, and by review of pathology specimens where available.ResultsAmong 183 live-born infants, atresia was valvar (membranous) in 74.7% and muscular in 25.3%. Muscular obliteration of the apical trabecular cavity, and in some cases its infundibulum, resulted in “bipartite” right ventricle (RV) in 33.6%, and a “unipartite” chamber in 7.7%. The remaining 58.7% had “tripartite” morphology. Coronary arterial abnormalities were identified in 45.8%, including arterial stenoses, interruptions and ectasia in 7.6%. Ebstein’s malformation coexisted in 18 patients. Median tricuspid valvar size and RV inlet Z-scores were −5.2 and −5.1, respectively.ConclusionsThis study provides unique data on the diverse pathology of PAIVS in an unselected population. This will help determine if published reports reflect the true spectrum of pathology of the condition.

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47. Aortic Valve Repair of Congenital Stenosis With Bovine Pericardium

Author

Tolan, Michael J, FRCS(I), Daubeney, Piers E, MB, BS, Slavik, Zdenek, Keeton, Barry R, FRCP, Salmon, Anthony P, FRCP, Monro, James L, and FRCS

Abstract

Background. Conservative surgical options in the treatment of congenital aortic stenosis are limited. To relieve the obstruction necessitates full incision of the raphe of the larger valve leaflet, but this inevitably causes prolapse.

Published
1997
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48. THE ASYMPTOMATIC CHILD WITH A HEART MURMUR.

Author

Franklin, Rodney and Slavik, Zdenek

Subjects
*HEART murmurs in children, *HEART valve diseases in children, *HEART valve diseases, *PEDIATRIC cardiology, *JUVENILE diseases
Abstract

The article presents a case of the asymptomatic child with a heart murmur which is the most frequent paediatric cardiology problem. According to a report, up to 90% of children if carefully screened will be found to have a murmur at some point during their development. The author also presented the five main types of innocent murmur that can usually be diagnosed with confidence rather than by exclusion.

Published
2008

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