Prolonged Mechanical Ventilation Associated with Hypothyroidism after Paediatric Cardiac Surgery

Year 2017, Issue: 3, 193 - 202, 30.12.2017

Erkut Öztürk İbrahim Cansaran Tanıdır Yakup Ergül Alper Güzeltaş

Abstract

Aim: In this study
we retrospectively evaluated the incidence and the possible effects of
hypothyroidism in patients with Prolonged Mechanical Ventilation (PMV) after
paediatric cardiac surgery.

Method: We evaluated
the patients who underwent cardiac surgery between September 2014 and September
2015, and needed PMV (>7 days) due to hypothyroidism. The demographic data,
cardiac diagnosis and intensive care data of the patients were evaluated.

Findings: During this
period, 430 paediatric open heart surgeries were performed and in 6 patients
(1.4%) hypothyroidism was identified. Four of the patients were female (66%). Mean
age and weight at the time of operation were 4.8±4.1 months (range 1-12) and
5.6±2.4 kg (range 3-9), respectively. Diagnoses were complete atrioventricular
septal defect (n=3), ventricular septal defect (n=1), transposition of great
arteries (n=1), and hypoplastic left heart syndrome (n=1). Three patients had
Down syndrome. TSH levels were higher than 50 µIU/ml in all patients and
>100 µIU/ml in four patients. Free T4 levels are less than 0.3 ng/dl in all
patients. After a 10 mg/kg/day oral L- thyroxine therapy, thyroid hormone levels normalized
within a median of 8 days (4-12 days). Five of the patients (83%) have been
extubated 4 days after L-
thyroxine initiation. Despite oral L-thyroxine therapy, the patient with
hypoplastic left heart syndrome could not be extubated and died due to sepsis.

Conclusion: Hypothyroidism
should be investigated in patients with PMV after paediatric cardiac surgery.

Keywords

Hypothyroidism, prolonged mechanical ventilation, after paediatric cardiac surgery

Konjenital Kalp Cerrahisi Operasyonu Sonrası Uzamış Mekanik Ventilasyona Sebep Olan Hipotiroidizm

Abstract

Amaç: Bu çalışmada pediatrik kardiyak operasyon sonrası uzamış
mekanik ventilasyon desteği gereksinimi olan olgularda hipotiroidizmin
insidansı ve olası etkileri değerlendirilmiştir.
Yöntem: Çalışmaya 1 Eylül 2014 - 1
Eylül 2015 tarihleri arasında pediatrik kardiyak cerrahi yoğun bakım ünitesinde
yatan, potoperatif dönemde uzamış mekanik ventilatör gereksinimi (> 7 gün)
gelişen ve neden olarak hipotiroidi saptanmış olgular alındı. Olguların
demografik verileri, kardiyak tanıları ve ek patolojileri belirlendi.

Bulgular: Bu dönemde 430 pediatrik kalp
cerrahisi operasyonu yapılmış ve 6 olguda (%1,4) hipotiriodizm saptanmıştır.
Dört olgu kız (%66) idi. Olguların ortalama yaş 4,8 ±4,1 (aralık 1-12) ay,
ortalama ağırlık 5,6±2,4(3-9) kg idi. Olguların 3’ü komplet atrioventriküler
septal defekt, 1’i ventriküler septal defekt, 1’i büyük arterlerin
transpozisyonu ve 1’i hipoplastik sol kalp sendromu tanılıydı. Üç olguda ayrıca
genetik olarak Down Sendromu mevcuttu. Tüm olgularda TSH > 50 µIU/ml iken
dört olguda TSH > 100 µIU/ml ve tüm olgularda fT4 < 0,3 ng/dl idi. Oral
L-thyroxine 10 µg/kg/gün tedavisi sonrası ortalama 8 gün (4-12 gün) sonra TSH
ve fT4 normal düzeye gelmişti. Olguların 5’i (%83) L-thyroxine tedavisi sonrası
ortalama 4 gün sonra ekstübe edilip taburcu edildi. Hipoplastik sol kalp
sendromlu olgu tedaviye rağmen ekstübe edilemedi ve sepsis nedeniyle
kaybedildi.

Sonuç: Kardiyak cerrahi sonrası pediatrik
olgulardaki uzamış entübasyon durumunda tedavi edilebilen bir durum olan
hipotiroidizm varlığı araştırılmalıdır. 

Keywords

uzamış mekanik ventilatör süresi, Hipotiroidizm, konjenital kalp cerrahisi

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