Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 12;14(2):e12360.
doi: 10.1002/pul2.12360. eCollection 2024 Apr.

A single institution anesthetic experience with catheterization of pediatric pulmonary hypertension patients

Emily Morell  1 , Elizabeth Colglazier  1 , Jasmine Becerra  1 , Leah Stevens  1 , Martina A Steurer  1   2 , Anshuman Sharma  3 , Hung Nguyen  3 , Irfan S Kathiriya  3 , Stephen Weston  3 , David Teitel  1 , Roberta Keller  1 , Elena K Amin  1 , Hythem Nawaytou  1 , Jeffrey R Fineman  1   4
Affiliations

A single institution anesthetic experience with catheterization of pediatric pulmonary hypertension patients

Emily Morell et al. Pulm Circ. .

Abstract

Cardiac catheterization remains the gold standard for the diagnosis and management of pediatric pulmonary hypertension (PH). There is lack of consensus regarding optimal anesthetic and airway regimen. This retrospective study describes the anesthetic/airway experience of our single center cohort of pediatric PH patients undergoing catheterization, in which obtaining hemodynamic data during spontaneous breathing is preferential. A total of 448 catheterizations were performed in 232 patients. Of the 379 cases that began with a natural airway, 274 (72%) completed the procedure without an invasive airway, 90 (24%) received a planned invasive airway, and 15 (4%) required an unplanned invasive airway. Median age was 3.4 years (interquartile range [IQR] 0.7-9.7); the majority were either Nice Classification Group 1 (48%) or Group 3 (42%). Vasoactive medications and cardiopulmonary resuscitation were required in 14 (3.7%) and eight (2.1%) cases, respectively; there was one death. Characteristics associated with use of an invasive airway included age <1 year, Group 3, congenital heart disease, trisomy 21, prematurity, bronchopulmonary dysplasia, WHO functional class III/IV, no PH therapy at time of case, preoperative respiratory support, and having had an intervention (p < 0.05). A composite predictor of age <1 year, Group 3, prematurity, and any preoperative respiratory support was significantly associated with unplanned airway escalation (26.7% vs. 6.9%, odds ratio: 4.9, confidence interval: 1.4-17.0). This approach appears safe, with serious adverse event rates similar to previous reports despite the predominant use of natural airways. However, research is needed to further investigate the optimal anesthetic regimen and respiratory support for pediatric PH patients undergoing cardiac catheterization.

Keywords: airway; anesthesia; pediatric pulmonary vascular disease; sedation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Nice classification of pulmonary hypertension in study cohort (n = 232 patients).
Figure 2
Figure 2
Highest level of respiratory support during catheterization of pediatric pulmonary hypertension cohort (n = 379 cases).
Figure 3
Figure 3
Airway type during pediatric pulmonary hypertension catheterization (n = 379 cases). Invasive airway is defined as endotracheal tube, laryngeal mask airway, or tracheostomy with ventilator support. Natural airway is defined as those receiving nasal cannula, high‐flow nasal cannula, bilevel positive airway pressure, continuous positive airway pressure, bag mask, non‐rebreather, or tracheostomy without ventilator support.
See this image and copyright information in PMC

References

    1. Hansmann G, Koestenberger M, Alastalo TP, Apitz C, Austin ED, Bonnet D, Budts W, D'Alto M, Gatzoulis MA, Hasan BS, Kozlik‐Feldmann R, Kumar RK, Lammers AE, Latus H, Michel‐Behnke I, Miera O, Morrell NW, Pieles G, Quandt D, Sallmon H, Schranz D, Tran‐Lundmark K, Tulloh R, Warnecke G, Wåhlander H, Weber SC, Zartner P. 2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: The European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT. J Heart Lung Transpl. 2019;38(9):879–901. - PubMed
    1. Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, Stenmark KR, Steinhorn R, Thébaud B, Fineman JR, Kuehne T, Feinstein JA, Friedberg MK, Earing M, Barst RJ, Keller RL, Kinsella JP, Mullen M, Deterding R, Kulik T, Mallory G, Humpl T, Wessel DL. Pediatric pulmonary hypertension. Circulation. 2015;132(21):2037–2099. - PubMed
    1. Haworth SG, Hislop AA. Treatment and survival in children with pulmonary arterial hypertension: the UK pulmonary hypertension service for children 2001–2006. Heart. 2008;95(4):312–317. - PubMed
    1. Barst RJ, McGoon MD, Elliott CG, Foreman AJ, Miller DP, Ivy DD. Survival in childhood pulmonary arterial hypertension. Circulation. 2012;125(1):113–122. - PubMed
    1. Morell E, Gaies M, Fineman JR, Charpie J, Rao R, Sasaki J, Zhang W, Reichle G, Banerjee M, Tabbutt S. Mortality from pulmonary hypertension in the pediatric cardiac ICU. Am J Rep Crit Care. 2021;204(4):454–461. - PubMed