Outcomes following thoracoabdominal resection of neuroblastoma

Sara L P Ross, Bruce M. Greenwald, Joy D. Howell, Steven Pon, Daniel N. Rutigliano, Natalie Spicyn, Michael P. Laquaglia

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE:: To evaluate the intraoperative and postoperative care of children following thoracoabdominal resection of neuroblastoma. DESIGN:: Retrospective chart review. SETTING:: Pediatric intensive care unit (PICU) of major pediatric cancer center. PATIENTS:: Eighty-eight patients undergoing thoracoabdominal resection of neuroblastoma over a 6-year period. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Demographic and clinical data were collected, including: length of PICU stay (LOS-P), duration of mechanical ventilation (MVD), mean arterial blood pressure, central venous pressure (CVP), fluid management, pressor use, and mortality. Twenty-one patients required inotropic/vasopressors support pressors following surgery. Patients who received pressors had longer operative times (p < .05) and received less intraoperative fluid (p < .05), but had the same estimated blood loss and urine output as nonpressor (NP) patients. Among the patients who received pressors, the MVD was 57 hrs, compared with 24 hrs in the NP group (p < .01). The LOS-P was 118 hours in the pressors group, vs. 69 hrs in the NP group (p < .01). The mean arterial blood pressure was lower and the CVP was higher in the pressors group compared with the NP group, and pressors patients received significantly more fluid postoperatively (p < .01). When pressors were initiated at a low CVP (<8), MVD was 39 hrs compared with 71 hrs when pressors were started at a higher CVP (p = .08). LOS-P was only slightly shorter in the low CVP group, 112 hrs vs. 123 hours (p = NS). The PICU mortality rate was 0%. CONCLUSIONS:: Patients who received pressors had longer operative times and received less intraoperative fluid. Subsequently, they required more postoperative fluid, which is likely the result of hemodynamic instability leading to longer MVD and LOS-P. A prospective study evaluating operative fluid management and optimal time for initiation of pressors, in addition to the role of catecholamines and cytokines in this unique postoperative patient population is indicated.

Original languageEnglish (US)
Pages (from-to)681-686
Number of pages6
JournalPediatric Critical Care Medicine
Volume10
Issue number6
DOIs
StatePublished - Nov 2009
Externally publishedYes

Fingerprint

Neuroblastoma
Central Venous Pressure
Pediatric Intensive Care Units
Arterial Pressure
Operative Time
Intraoperative Care
Time Management
Mortality
Postoperative Care
Artificial Respiration
Catecholamines
Hemodynamics
Demography
Urine
Prospective Studies
Pediatrics
Cytokines
Population
Neoplasms

Keywords

  • Neuroblastoma
  • Pediatric
  • Postoperative care
  • Thoracoabdominal resection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Ross, S. L. P., Greenwald, B. M., Howell, J. D., Pon, S., Rutigliano, D. N., Spicyn, N., & Laquaglia, M. P. (2009). Outcomes following thoracoabdominal resection of neuroblastoma. Pediatric Critical Care Medicine, 10(6), 681-686. https://doi.org/10.1097/PCC.0b013e3181a708c1

Outcomes following thoracoabdominal resection of neuroblastoma. / Ross, Sara L P; Greenwald, Bruce M.; Howell, Joy D.; Pon, Steven; Rutigliano, Daniel N.; Spicyn, Natalie; Laquaglia, Michael P.

In: Pediatric Critical Care Medicine, Vol. 10, No. 6, 11.2009, p. 681-686.

Research output: Contribution to journalArticle

Ross, SLP, Greenwald, BM, Howell, JD, Pon, S, Rutigliano, DN, Spicyn, N & Laquaglia, MP 2009, 'Outcomes following thoracoabdominal resection of neuroblastoma', Pediatric Critical Care Medicine, vol. 10, no. 6, pp. 681-686. https://doi.org/10.1097/PCC.0b013e3181a708c1
Ross SLP, Greenwald BM, Howell JD, Pon S, Rutigliano DN, Spicyn N et al. Outcomes following thoracoabdominal resection of neuroblastoma. Pediatric Critical Care Medicine. 2009 Nov;10(6):681-686. https://doi.org/10.1097/PCC.0b013e3181a708c1
Ross, Sara L P ; Greenwald, Bruce M. ; Howell, Joy D. ; Pon, Steven ; Rutigliano, Daniel N. ; Spicyn, Natalie ; Laquaglia, Michael P. / Outcomes following thoracoabdominal resection of neuroblastoma. In: Pediatric Critical Care Medicine. 2009 ; Vol. 10, No. 6. pp. 681-686.
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AU - Greenwald, Bruce M.

AU - Howell, Joy D.

AU - Pon, Steven

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AU - Spicyn, Natalie

AU - Laquaglia, Michael P.

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N2 - OBJECTIVE:: To evaluate the intraoperative and postoperative care of children following thoracoabdominal resection of neuroblastoma. DESIGN:: Retrospective chart review. SETTING:: Pediatric intensive care unit (PICU) of major pediatric cancer center. PATIENTS:: Eighty-eight patients undergoing thoracoabdominal resection of neuroblastoma over a 6-year period. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Demographic and clinical data were collected, including: length of PICU stay (LOS-P), duration of mechanical ventilation (MVD), mean arterial blood pressure, central venous pressure (CVP), fluid management, pressor use, and mortality. Twenty-one patients required inotropic/vasopressors support pressors following surgery. Patients who received pressors had longer operative times (p < .05) and received less intraoperative fluid (p < .05), but had the same estimated blood loss and urine output as nonpressor (NP) patients. Among the patients who received pressors, the MVD was 57 hrs, compared with 24 hrs in the NP group (p < .01). The LOS-P was 118 hours in the pressors group, vs. 69 hrs in the NP group (p < .01). The mean arterial blood pressure was lower and the CVP was higher in the pressors group compared with the NP group, and pressors patients received significantly more fluid postoperatively (p < .01). When pressors were initiated at a low CVP (<8), MVD was 39 hrs compared with 71 hrs when pressors were started at a higher CVP (p = .08). LOS-P was only slightly shorter in the low CVP group, 112 hrs vs. 123 hours (p = NS). The PICU mortality rate was 0%. CONCLUSIONS:: Patients who received pressors had longer operative times and received less intraoperative fluid. Subsequently, they required more postoperative fluid, which is likely the result of hemodynamic instability leading to longer MVD and LOS-P. A prospective study evaluating operative fluid management and optimal time for initiation of pressors, in addition to the role of catecholamines and cytokines in this unique postoperative patient population is indicated.

AB - OBJECTIVE:: To evaluate the intraoperative and postoperative care of children following thoracoabdominal resection of neuroblastoma. DESIGN:: Retrospective chart review. SETTING:: Pediatric intensive care unit (PICU) of major pediatric cancer center. PATIENTS:: Eighty-eight patients undergoing thoracoabdominal resection of neuroblastoma over a 6-year period. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Demographic and clinical data were collected, including: length of PICU stay (LOS-P), duration of mechanical ventilation (MVD), mean arterial blood pressure, central venous pressure (CVP), fluid management, pressor use, and mortality. Twenty-one patients required inotropic/vasopressors support pressors following surgery. Patients who received pressors had longer operative times (p < .05) and received less intraoperative fluid (p < .05), but had the same estimated blood loss and urine output as nonpressor (NP) patients. Among the patients who received pressors, the MVD was 57 hrs, compared with 24 hrs in the NP group (p < .01). The LOS-P was 118 hours in the pressors group, vs. 69 hrs in the NP group (p < .01). The mean arterial blood pressure was lower and the CVP was higher in the pressors group compared with the NP group, and pressors patients received significantly more fluid postoperatively (p < .01). When pressors were initiated at a low CVP (<8), MVD was 39 hrs compared with 71 hrs when pressors were started at a higher CVP (p = .08). LOS-P was only slightly shorter in the low CVP group, 112 hrs vs. 123 hours (p = NS). The PICU mortality rate was 0%. CONCLUSIONS:: Patients who received pressors had longer operative times and received less intraoperative fluid. Subsequently, they required more postoperative fluid, which is likely the result of hemodynamic instability leading to longer MVD and LOS-P. A prospective study evaluating operative fluid management and optimal time for initiation of pressors, in addition to the role of catecholamines and cytokines in this unique postoperative patient population is indicated.

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