2011 Montreux

4 - 7 MayMontreux Palace Hotel

www.epncic.com

2nd European Conferenceon Pediatric and NeonatalCardiac Intensive Care

An educational meeting organized by the Working Group on Pediatric Cardiac Intensive Care (WGPCIC)

FINAL PROGRAM

EPNCIC2011

2

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dNotes

3

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Table of content

Conference Organization 4

Welcoming Words by the Organizing Committee 5

Conference Overview 6

Faculty and Workshop Leaders 7

Program 8

Sponsors and Exhibitors 13

Table of Abstracts 16

Oral Presentations 18

Posters 25

Index of Authors 31

About Montreux 32

General Information 33

Social Program 34

Exhibition Plan 35

Map of Montreux 36

EPNCIC2011

4

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Organized by the Working Group of Pediatric Cardiac Intensive Care (WGPCIC) of the Association for Euro-pean Pediatric Cardiology, the 2nd Conference on Pediatric and Neonatal Cardiac Intensive Care (EPNCIC) offers a unique opportunity for delegates to learn about leading edge innovations from all over the world. The format of the program includes keynote speakers, oral and poster presentations from peer reviewed submitted abstracts, and very importantly, interactive sessions and workshops with hands-on practice and troubleshooting of clinical scenarios. The social program offers the opportunity for networking and meet-ing the delegates.

Organizing commitee:•EduardodaCruz(USA)•EvelynLechner(Austria)•PeterRimensberger(Switzerland)

Scientific and educational program committee:•EduardodaCruz(USA)•AlainFraisse(France)•EvelynLechner(Austria)•PhilippePouard(France)•PeterRimensberger(Switzerland)

Endorsed by:•TheAssociationforEuropeanPediatricCardiology(AEPC)•TheEuropeanAssociationforCardio-ThoracicSurgery(EACTS)•TheEuropeanSocietyofPediatricandNeonatalIntensiveCare(ESPNIC)•TheEuropeanAssociationofCardio-ThoracicAnesthesiologists(EACTA)•TheWorldFederationofPediatricIntensiveandCriticalCareSocieties(WFPICCS)

CME credits by EACCME:The 2nd European Conference on Pediatric and Neonatal Cardiac Intensive Care Montreux, Switzerland (4.–7.05.2011) has been accredited by the European Accreditation Council for Continuing Medical Educa-tion (EACCME) to provide the following CME activity for medical specialists. 2nd European Conference on Pediatric and Neonatal Cardiac Intensive Care is designated for a maximum of, or up to 12 European CME credits (ECMEC). Each medical specialist should claim only those credits that he/she actually spent in the educational activity.

TheEACCMEisaninstitutionoftheEuropeanUnionofMedicalSpecialists(UEMS),www.uems.net.ECMEC’sarerecognizedbytheAmericanMedicalAssociationtowardsthePhysician’sRecognitionAward(PRA).

CME credits by EBAC:The event “2nd conference on pediatric and neonatal cardiac intensive care” is accredited by the European Board for Accreditation in Cardiology for: 16 CME credit hour(s)(Day #1: 3 CME credit(s) - Day #2: 6 CME credit(s) - Day #3: 4 CME credit(s) - Day #4: 3 CME credit(s))

EBAC works according to the quality standards of the European Accreditation Council for Continuing Medi-calEducation(EACCME),whichisaninstitutionoftheEuropeanUnionofMedicalSpecialists(UEMS).

Administrative secretariat

Avenue Krieg 7, 1208 Geneva, Switzerland Phone: +41 22 839 84 84 info@epncic.com – www.symporg.com

Conference Organization

5

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Welcome to the 2nd European Conference on Pediatric and Neonatal Cardiac Intensive Care

Dear Colleagues and Friends,

On behalf of the Organizing Committee, we are pleased to welcome you at the 2nd European Conference on Pediatric and Neonatal Cardiac Intensive Care. The First event held in 2009 was very successful and a great opportunity for sharing good practice. It has inspired us to organize the Second Conference, with the main objective of serving the multidisciplinary community involved with critical pediatric cardiac patients in Europe and across the world. This conference is again a result from a joint effort between the Working Group on Pediatric Cardiac Intensive Care (WGPCIC) of the Association for European Pediatric Cardiology (AEPC), the European Society of Pediatric and Neonatal Intensive Care (ESPNIC),the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Cardio-Thoracic Anesthesiologists (EACTA). We are once again endeavoring to bring to reality the crucial principle of inter-disciplinarity that can only result in improving management of pediatric cardiac patients.

Topics will be revisiting the state of the art management practices, new available technologies and drugs, as well as – and very importantly - the current initiatives for quality improvement and safety. The conference will promote interactivity, and offer main conferences, open forums and workshops in different areas.

The purpose of this conference is to offer the opportunity to involve practitioners from different fields in discussions with key experts and internationally known speakers on various topics, in a spontaneous, relaxed atmosphere.

We are inviting you to participate actively in the sessions and to help us make this 2nd European Conference on Pediatric and Neonatal Cardiac Intensive Care another successful, enriching experience.

Eduardo da Cruz, MD Evelyn Lechner, MD Peter Rimensberger, MDCommittee EPNCIC Committee EPNCIC Committee EPNCIC President WGPCIC

Welcoming Words by the Organizing Committee

EPNCIC2011

6

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dConference Overview

Wednesday 4 May 2011

14:00 - 16:00Workshop 1

Basic and advanced mechanical ventilation

Workshop 2Hemodynamic Monitoring

Workshop 3SIM Baby® scenarios

16:00 - 16:15 Coffee break

16:15 - 18:15Workshop 4

Basics of Echocardiography in the ICU for beginners

Workshop 5Postoperative arrhythmia: External

pacing in different types of arrhythmia

Workshop 3SIM Baby® scenarios

Thursday 5 May 2011

08:00 - 10:00Workshop 6

Mechanical ventilation in the CICU: Specific issues

Workshop 7Extracorporeal life support: ECMO

and VAD

Workshop 8SIM Baby® scenarios

10:00 - 10:15 Coffee break

10:15 - 12:15Workshop 9

Echocardiography in the ICU for experts

Workshop 7Extracorporeal life support: ECMO

and VAD

Workshop 8SIM Baby® scenarios

13:30 - 13:45 Welcome Note

13:45 - 14:45 OPENING LECTURE: Simulation

14:45 - 15:45 SESSION 1: Rapid deployment ECMO or E-CPR

15:45 - 16:30 POSTERWALKS 1 (presentation of poster numbers P1-P5) Coffee break in the exhibition area

16:30 - 18:15 SESSION 2: Perioperative care of high risk patients

18:30 - 20:30 Welcome reception - Commercial exhibition

Friday 6 May 201108:00 - 09:45 SESSION 3: Cardiac Transplantation

09:45 - 10:30 POSTERWALKS 2 (presentation of poster numbers P6-P10) Coffee break in the exhibition area

10:30 - 12:15 SESSION 4: Perioperative neuroprotection

12:30 - 13:30 Lunch break / Hotel Eurotel

13:45 - 15:00 SESSION 5: Management of the patient with complex right-sided cardiac dysfunction

15:15 - 16:00 TRAVELLING TO GRUYERE

16:00 - 17:15INDUSTRY SYMPOSIUM sponsored by MAQUET:

New trends and development in mechanical ventilation(session not CME accredited)

17:15 - 23:30 Visit of the the Gruyere Cheese Makery

Saturday 7 May 201108:30 - 10:05 SESSION 6: Cardiovascular Pharmacology

10:05 - 10:20SATELLITE SYMPOSIUM sponsored by Orion Pharma:

Efficacy of Levosimendan: recent studies and own experience(session not CME accredited)

10:20 - 10:45 Coffee break in the exhibition area

10:45 - 12:15 SESSION 7: The Single Ventricle Paradigm

12:15 - 12:30 Closing remarks

7

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Faculty & Workshop Leaders

RaoulArnold Germany

Desmond Bohn Canada

ShannonBuckvold UnitedStates

GrantBurton UnitedStates

Davide Colombo Italy

Juan Comas Spain

EduardoDaCruz UnitedStates

JesseDavidson UnitedStates

ClaytonDobronyi UnitedStates

Christoph Fink Germany

Alain Fraisse France

Friederike Graf Germany

Christoph Haun Germany

Evelyn Lechner Austria

Joris Lemson The Netherlands

DuncanMacrae UnitedKingdom

FionaMcDicken UnitedKingdom

RicardoMunoz UnitedStates

ChoNg UnitedKingdom

MauraO’Callaghan Canada

Philippe Pouard France

PeterRimensberger Switzerland

Julia Stegger Germany

Brigitte Stiller Germany

Cécile Tissot Switzerland

Evi Vonderbank Germany

EPNCIC2011

8

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dProgram

Pre-Conference Workshop Program

Wednesday 4 May 2011

14:00 - 16:00 Workshop 1 Basic and advanced mechanical ventilation Peter Rimensberger (Switzerland) SupportedbyanunrestrictededucationalgrantfromMAQUET

14:00 - 16:00 Workshop 2 Hemodynamic Monitoring Joris Lemson (The Netherlands)

14:00 - 18:15 Workshop 3 SIM Baby® scenarios: - Acute Management of Pediatric Cardiac Emergencies -AcuteManagementofPediatricArrhythmia’s - Adult Congenital Emergencies Shannon Buckvold, Grant Burton, Jesse Davidson & Clayton Dobronyi (USA) SupportedbyanunrestrictededucationalgrantfromTheHeartInstitute,Denver,USA

16:15 - 18:15 Workshop 4 Basics of Echocardiography in the ICU for beginners Cécile Tissot (Switzerland) & Evelyn Lechner (Austria) 16:15 - 18:15 Workshop 5 Postoperative arrhythmia: External pacing in different types of arrhythmia Raoul Arnold (Germany) Supported by an unrestricted educational grant from OSYKPA

Thursday 5 May 2011

08:00 - 10:00 Workshop 6 Mechanical ventilation in the CICU: Specific issues Peter Rimensberger (Switzerland) and TBN SupportedbyanunrestrictededucationalgrantfromMAQUET

08:00 - 12:15 Workshop 7 Extracorporeal life support: ECMO and VAD Julia Stegger , Christoph Haun, Friederike Graf , Evi Vonderbank, Brigitte Stiller (Germany), Cho Ng, Maura O’Callaghan, Fiona McDicken (UK) SupportedbyanunrestrictededucationalgrantfromLEVITRONIX

08:00 - 12:15 Workshop 8 SIM Baby® scenarios: - Acute Management of Pediatric Cardiac Emergencies -AcuteManagementofPediatricArrhythmia’s - Adult Congenital Emergencies Shannon Buckvold, Grant Burton, Jesse Davidson & Clayton Dobronyi (USA) SupportedbyanunrestrictededucationalgrantfromTheHeartInstitute,Denver,USA

10:15 - 12:15 Workshop 9 Echocardiography in the ICU for experts Cécile Tissot (Switzerland) & Evelyn Lechner (Austria)

9

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Program

EPNCIC 2011: Scientific and Educational Program

Thursday 5 May 2011

13:30 - 13:45 Welcome Note Eduardo Da Cruz (USA), Evelyn Lechner (Austria), Peter Rimensberger (Switzerland)

13:45 - 14:45 OPENING LECTURE: Simulation Chairs: Eduardo da Cruz (USA), Peter Rimensberger (Switzerland)

13:45 - 14:45 Simulation as a tool for quality improvement in pediatric cardiac intensive care patients: an interactive session Shannon Buckvold (USA), Clayton Dobronyi (USA)

14:45 - 15:45 SESSION 1: Rapid deployment ECMO or E-CPR Chairs: Brigitte Stiller (Germany), Ricardo Munoz (USA)

14:45 - 14:55 General principles, indications and limitations Desmond Bohn (Canada)

14:55 - 15:15 Centrifugal pumps are the future Shannon Buckvold (USA)

15:15 - 15:45 ORAL PRESENTATIONS 1: Incidence and outcome of Extra Corporeal Membrane Oxygenation (ECMO) initiated in operating room after pediatric surgery Ruchik Sharma (USA)

The UK Berlin Heart Journey Jane Cassidy (United Kingdom)

15:45 - 16:30 POSTERWALKS 1 (presentation of poster numbers P1-P5) Coffee break in the exhibition area

16:30 - 18:15 SESSION 2: Perioperative care of high risk patients Chairs: Eduardo Da Cruz (USA), Duncan Macrae (UK)

16:45 - 17:05 Children are not like adults : management of low weight and premature patients with cardiac disease Evelyn Lechner (Austria)

17:05 - 17:25 Management of the multioperated patient Juan Comas (Spain)

17:25 - 17:45 Adults are not like children: management of complex GUCH patients Philippe Pouard (France)

17:45 - 18:30 ORAL PRESENTATIONS 2: Transesophageal echocardiography in critically ill post-operative infants comparison of acunay ice versus mini tee transducers Kanwar Multani (United States)

EPNCIC2011

10

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dProgram

Short term respiratory and circulatory effects of respiratory physiotherapy in infants after heart surgery Oswin Grollmuss (France)

Prediction of pre-operative decompensation in neonatal hypoplastic left heart syndrome Victoria Sheward (United Kingdom)

18:30 - 20:30 Welcome reception - Commercial exhibition

Friday 6 May 2011 (morning sessions)

08:00 - 09:45 SESSION 3: Cardiac Transplantation Chairs: Cécile Tissot (Switzerland), Cho Ng (UK)

08:00 - 08:20 Donation after cardiac death Eduardo da Cruz (USA)

08:20 - 08:40 Postoperative management of the orthotopic heart transplantation Duncan Macrae (UK)

08:40 - 09:00 Preparation and acute management of the re-transplanted patient Ricardo Munoz (USA)

09:00 - 09:15 «Meet the expert» – session, Questions and answers CécileTissot(Switzerland),ChoNg(UK),EduardodaCruz(USA), DuncanMacrae(UK),RicardoMunoz(USA)

09:15 - 09:45 ORAL PRESENTATIONS 3: Mediastinitis in paediatric cardiosurgical patients: comparison of three antibiotic prophylactic regimens Martina Sperkova (Slovakia)

High frequency oscillation and obstructive total anomalous pulmonary venous return outcome Simone Gioanni (France)

09:45 - 10:30 POSTERWALKS 2 (presentation of poster numbers P6-P10) Coffee break in the exhibition area

10:30 - 12:15 SESSION 4: Perioperative neuroprotection Chairs: Alain Fraisse (France), Eduardo Da Cruz (USA)

10:30 - 10:50 Brain monitoring Ricardo Munoz (USA)

10:50 - 11:10 Clinical strategies to protect the brain in the critically-ill pediatric cardiac patient Brigitte Stiller (Germany)

11:10 - 11:30 Hypothermia vs. normothermia after cardiac arrest Desmond Bohn (Canada)

11:30 - 11:45 «Meet the expert» – session, Questions and answers Alain Fraisse (France), Ricardo Munoz (USA), Phillipe Pouard (France), Brigitte Stiller (Germany)

11

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Program

11:45 - 12:15 ORAL PRESENTATIONS 4: Increased plasma N-Terminal pro-BNP in neonates less than 32 weeks gestation with open ductus arteriosus Anna Sellmer (Denmark)

Intravenous sodium bicarbonate verifies intravenous position of catheters in ventilated patients Ilan Keidan (Israel)

12:30 - 13:30 Lunch break / Hotel Eurotel

Friday 6 May 2011 (afternoon sessions)

13:45 - 15:00 SESSION 5: Management of the patient with complex right-sided cardiac dysfunction Chairs: Duncan Macrae (UK), Philippe Pouard (France)

13:45 - 14:05 Surgical management Juan Comas (Spain)

14:05 - 14:25 Interventional catheterization management Alain Fraisse (France)

14:25 - 14:45 Intensive care management Eduardo da Cruz (USA)

14:45 - 15:00 «Meet the expert» – session, Questions and answers Juan Comas (UK), Eduardo da Cruz (USA), Alain Fraisse (France), Duncan Macrae (UK), Philippe Pouard (France)

15:15 - 16:00 TRAVELLING TO GRUYERE

16:00 - 17:15 INDUSTRY SYMPOSIUM sponsored by MAQUET: New trends and development in mechanical ventilation Chairs: Duncan Macrae (UK), Peter Rimensberger (Switzerland)

16:00 - 16:25 Assisting spontaneous ventilation Peter Rimensberger (Switzerland)

16:25 - 16:50 Neurally adjusted ventilatory assist (NAVA): experience from a CICU Philippe Pouard (France)

16:50 - 17:15 Noninvasive Ventilation – Synchronization with NAVA Davide Colombo (Italy)

17:15 - 23:30 Visit of the the Gruyere Cheese Makery Cheese Tasting Evening Party Dinner

EPNCIC2011

12

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dProgram

Saturday 7 May 2011

08:30 - 10:05 SESSION 6: Cardiovascular Pharmacology Chairs: Evelyn Lechner (Austria), Eduardo da Cruz (USA)

08:30 - 08:50 Pro: use of vasopressin after pediatric cardiac surgery Grant Burton (USA)

08:50 - 09:10 Con: use of vasopressin after pediatric cardiac surgery Alain Fraisse (France)

09:10 - 09:50 ORAL PRESENTATION 5: Levosimendan versus milrinone after corrective open-heart surgery in neonates and infants Evelyn Lechner (Austria)

Use of Levosimendan as rescue therapy in children with low cardiac output syndrome Vivianne Amiet (Switzerland)

09:50 - 10:05 Cardiovascular Pharmacology : «Meet the expert» – session, Questions and answers Grant Burton (USA), Eduardo da Cruz (USA), Alain Fraisse (France), Evelyn Lechner (Austria)

10:05 - 10:20 SATELLITE SYMPOSIUM: Efficacy of Levosimendan: recent studies and own experience supported by an unrestricted grant from Orion Pharma Brigitte Stiller (Germany)

10:20 - 10:45 Coffee break in the exhibition area

10:45 - 12:15 SESSION 7: The Single Ventricle Paradigm Chairs: Alain Fraisse (France), Duncan Macrae (UK)

10:45 - 11:05 Pro: Therapeutic Interruption of Pregnancy should be considered for single ventricle fetuses Cécile Tissot (Switzerland)

11:05 - 11:25 Con: Therapeutic Interruption of Pregnancy should not be considered for single ventricle fetuses Brigitte Stiller (Germany)

11:25 - 11:45 Long Term Outcomes of Single ventricle patients in the early 21st century Evelyn Lechner (Austria)

11:45 - 12:15 «Meet the expert» – session, Questions and answers Alain Fraisse (France), Eveyln Lechner (Austria), Duncan Macrae (UK), Brigitte Stiller (Germany), Cécile Tissot (Switzerland)

12:15 - 12:30 Closing remarks Eduardo da Cruz (USA), Peter Rimensberger (Switzerland)

13

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Sponsors and Exhibitors

The Organizing Committee of the 2nd European Conference on Pediatric and Neonatal Critical Care would like to thank the following companies and institutions for their support.

Maquet Critical Carewww.maquet.com

Acutronic Medical Systems AGwww.acutronic-medical.ch

Gambro Hospal AGwww.gambro.com

Gambro is a global medical technology company and a leader in developing, manufacturing and supplying products and therapies for Kidney and Liver dialysis, Myeloma Kidney Therapy, and other extracorporeal therapies for Chronic and Acute patients. For decades, Gambro has been first to market with many ground-breaking innovations.

RadiometerRSCHGmbHwww.radiometer.ch

Linde AG - Linde Healthcarewww.linde-healthcare.com

Linde Healthcare supplies medical professionals with safe, effective solutions to their pharmaceutical and medical gas needs. Our pro-ducts and services play important roles in emergency, anaesthesia and intensive care. The company has a strong track record as innovator and is a ge-nuine global player, represented in more than 70 countries around the world.

Pall Medicalwww.pall.com

EPNCIC2011

14

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dSponsors and Exhibitors

Covidien AGwww.covidien.com

Covidien, a leading global provider of healthcare products, par-tners with medical professionals around the world to develop new technologies, products and solutions. Covidien has been at the fo-refront of innovation, responsible for breakthrough developments such as pulse oximetry or mechanical ventilation. With training & research facilities worldwide, Covidien works closely with medical professionals to improve patient outcomes and remains committed to developing solutions that will propel advances in healthcare.

Vygon Schweizwww.vygon.ch

Dräger Medical Schweiz AGwww.draeger.com

Medos AGwww.medos-ag.com

MCM Medsys AGwww.mcm-medsys.ch

Fumedica AGwww.fumedica.ch

Fumedica with its headquarters in Muri (AG) was found in 1985. Fu-medica’smainfieldsofactivityareinAnesthesia&IntensiveCareaswell as Heart- and Vascular Surgery and Interventional Cardiology.

Orion Pharmawww.orion.fi

15

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Sponsors and Exhibitors

Gambro Hospal AGwww.gambro.com

Levitronixwww.levitronix.com

Levitronix magnetically levitated CentriMag and PediVAS pumps are approved to provide up to 30 days circulatory support (VAD or ECMO). They provide flows of up to 1.7 l/min (PediVAS) and up to 9 l/min (CentriMag) and are used to support patients with all types of cardio-respiratory failure.

Osypkawww.osypka.de

Founded in 1977 by Dr. Ing. Peter Osypka the continuous impro-vementoftreatmentoptionsandpeople’slivesisstillthefocusofOsypka AG.

OSYPKA AG is specialized in the areas of permanent and temporary pacing, external pacemakers, including biventricular (CRT) stimu-lation, electrophysiology, interventional and pediatric cardiology (e.g. valvuloplasty balloon catheters), and products for cardiac sur-gery (post-operative cardiac stimulation).

All products are developed and manufactured exclusively at OSYP-KAAGinRheinfelden,Germany.

Turning Technologieswww.turningtechnologies.com

UnrestrictedEducationalGrantby:

EPNCIC2011

16

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dTable of Abstracts

Oral presentations, Session 1: Rapid deployment ECMO or E-CPR 18

OP1: Incidence and Outcome of Extra Corporeal Membrane Oxygenation (ECMO) 18initiated in operating room after pediatric cardiac surgery.

OP2:TheUKBerlinHeartJourney 18

Oral presentations, Session 2: Perioperative care of high risk patients 19

OP3: Transesophageal echocardiography in critically ill post-operative infants: 19comparison of acunay-ice versus mini-tee transducers

OP4: Short term respiratory and circulatory effects of respiratory physiotherapy 19in infants after heart surgery

OP5: Prediction of pre-operative decompensation in neonatal hypoplastic left heart syndrome 20

Oral presentations, Session 3: Cardiac transplantation 20

OP6: Mediastinitis in paediatric cardiosurgical patients: 20comparison of three antibiotic prophylactic regimens

OP7: High frequency oscillation and obstructive total anomalous pulmonary venous 20return outcome

Oral presentations, Session 4: Perioperative neuroprotection 22

OP8: Increased plasma N-terminal Pro-BNP in neonates less than 32 weeks gestation 22with open ductus arteriosus

OP9: Intravenous sodium bicarbonate verifies intravenous position of catheters 22in ventilated patients

Oral presentations, Session 6: Cardiovascular Pharmacology 23

OP10: Levosimendan versus milrinone after corrective open-heart surgery in neonates and infants 23

OP11: Useoflevosimendanasrescuetherapyinchildrenwithlowcardiacoutputsyndrom 23

17

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Posters

P1: Isolated critical coarctation of the aorta - a single centre experience 25

P2: Low cortisol levels in children undergoing heart surgery do not correlate with 25more severe postoperative course

P3: The Berlin Heart excor pediatric device experience at the heart and diabetes center 26North-RhineWestphalia,BadOeynhausen,Germany

P4: Does nurse led parental education of pre-ventricular assist device reduce subsequent 26parental anxiety levels?

P5: Change of paradigm in ventilation. experiences with nava-ventilation in phrenic nerve injury 26

P6: Do serum troponin I concentrations correlate with severity of HIE? 27

P7: Compartment syndrome after pediatric cardiac surgery: a rare but devasting complication 28

P8: Coronary vasospasm (prinzmetal angina) in a 6 years old girl: an unsual diagnosis 28

P9: Succesful lung transplantation after cardiopulmonary resuscitation with extracorporeal membrane 29 oxygenation (ECMO-CPR) in a child with idiopathic severe pulmonary arterial hypertension (PAH)

P10:Approachesdirectedtoavoidtheinfluenceofcompartment-syndromeonlungs’mechanical 29functioning in newborns in early post-operative period

EPNCIC2011

18

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dOral Presentations

Oral presentations, Session 1: RapiddeploymentECMOorE-CPR

OP1: Incidence and Outcome of Extra Corporeal Membrane Oxygenation (ECMO) initiated in operating room after pediatric cardiac surgery.Ruchik Sharma, Ravi Thiagarajan, Francis Fynn-Thompson, Kirsten Odegard.

PurposeThe ELSO registry database shows cardiac ECMO survival is 42% in children. Since January 2000, the cardiovascular program at Children’s Hospital Boston has maintaineda database of all patients undergoing either an open (cardiopulmonary bypass, CPB) or closed (non-CPB) procedure in the cardiac operating rooms. The purpose of this study is to report our incidence and outcomes of ECMO initiated in the OR in patients with congenitalheart surgery undergoing cardiac surgery.

MethodsAll cardiac surgical patients who were unable to be weaned from cardiopulmonary bypass and were transitioned to ECMO in the OR between January 2000 and December2010 were reviewed. Descriptive analysis is presented.

ResultsOf a total of 11,611 open and closed cardiac surgery procedures requiring anesthesia over this 11 year period, 43 were transitioned to ECMO for failure to come off bypass (37 per 10,000 procedures or 0.37%). The median age was 0.04 years (1 day -42 years), and the mean weight was 3.2 kgs(1.49-82.3 kgs). There were no patients in RACHS-1 category, 1 in RACHS-2, 19 in RACHS-3, 7 inRACHS-4, 1 inRACHS-5, 12 inRACHS-6, and3werenotclassifiableinRACHSsystem.TheindicationforECMOwasresidual anatomic lesion in 4 patients (9.3%), myocardial dysfunction in 22 patients (51.2%), hypoxemia in 5 patients (11.6%), and more than one of these above reasons in 12 patients (27.9%). Median duration of ECMO was 7 days (1 day to 24 days). Overall, 28 out of 43 patients were successfully weaned off ECMO, and 17 survived to hospital discharge. ECMO survival (to discharge) in these patients was 39.5%, which is similar to the ELSO registry.

ConclusionNeed for ECMO for patients with congenital heart disease undergoing cardiac surgery was low (0.37%) in this large-volume single centre review. ECMO provided effective support for post-cardiotomy cardiac and pulmonary failure refractory to aggressive medical management. The survival to hospital discharge was 39.5% which is similar to outcomes reported for all children with congenital heart disease supported by ECMO.

OP2: The UK Berlin Heart Journey.Cassidy J, Hoskote A, Haynes S, Fenton M, Smith J, Burch M, Kirk R, Hsia T, Hasan A, Karimova A.

ObjectiveTheBerlinHeart(BH)wasfirstusedintheUKinNovember2004. Outcomes to October 2010 are reviewed.

MethodsReviewof all childrenbridgedwith theBH in the2UKpaediatric heart transplant units

ResultsBetween 2004-10 77 children with end stage cardiac failure received BH support with the intention of bridge to transplant (BTT). There were 3678 support days in total. Median age was 23 months (range 1 week-16.9 years), median weight 11(3-90) kg and median support duration 39 (1-163) days. 64(83%) survived to transplant or explantation. 55 (71%) were transplanted and 53 survived to discharge. These comprise 29% of the UK paediatricheart transplants in this time. 9(12%) of children had sufficient cardiac recovery on support for explantation – 7 surviving to discharge. Overall survival to discharge was 78%. Half of those treated are </= 10 kg in weight. The median support time in this group was 40 days as opposed to 24 days in those children >20 kg. Survival did not differ between age groups. 24(31%) required ECMO pre BH support with 75% surviving. 36(47%) required BIVAD support with 79% survival. 33(43%) required LVAD support with 88% survival. 18 children had ongoing renal dysfunction post BH support of whom 8 subsequently died. 21(27%) had a cerebrovascular event (CVA) on support. This was the direct cause of death in 6 children. The majority of survivors made a good functional recovery. Of the remaining 7 deaths on support 5 were the result of intractable multiple organ failure and 2 sepsis.

ConclusionSurvival across all ages is good. Neurological events remain the leading cause of morbidity and mortality.

19

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Oral Presentations

Oral presentations, Session 2: Perioperative care of high risk patients

OP3: Transesophageal echocardiography in critically ill post-operative infants: comparison of acunav- ice versus mini-tee transducers.Sunita Ferns, Kanwar Multani, Vivian Wei Cui, Rukmini Komarlu, Andrew Van Bergen, David A Roberson.

BackgroundTransthoracic echocardiography in the post operative infant can be challenging. Transesophageal echo (TEE) is sometimes needed to obtain specific important information. In the past we used the Acunav-ICE (iceT) transducer for this purpose. Recentlyweused themini-TEE (miniT) probe in this setting.

ObjectiveTo compare the safety, ease of insertion, capabilities, efficacy and changes in utilization and cost of iceT vs miniT.

MethodsRetrospectivechartreviewofallcaseshavingiceTinthelast5yearsorthenewPhilipsUltrasoundminiTinthelastyear. The complication type and rate, ease of insertion, echo modality capabilities, efficacy to demonstrate the designated clinical question, changes in utilization and cost in the group having iceT vs. miniT were compared.

Results42 infants in the post-operative state were studied: 21 babies had 23 studies with iceT; 21 babies had 22 studies with miniT. Diagnoses were similar in the 2 groups including a total of 15 hypoplastic left heart, 7 double outlet RV, 6 heterotaxy, 5 total anomalous pulmonaryveins,and2Ebstein’sanomaly.Therewasoneofeachofthe following diagnoses: D-transposition, tricuspid atresia, pulmonary atresia, mitral stenosis, truncus arteriosus, interrupted aortic arch and ectopia cordis. Indications for TEE after failed TTE were to analyze: aortopulmonary shunt patency; pulmonary vein obstruction; atrial septal defect patency, flow direction and gradient; distal conduit patency; mechanism and severity of valve regurgitation; presence of thrombus or vegetation; evaluate residual VSD; evaluate residual valve obstruction; ventricular function; and pulmonary hypertension.

ConclusionsIceT is safe, easy to insert by transnasal route and does not require paralysis. MiniT has greater capabilities, similar safety profile and lower sterilization cost. MiniT is slightly more difficult to insert and may require paralysis. UtilizationofTEEinthissettinghasincreasedduetothedemonstrated safety and efficacy of miniT.

OP4: Short term respiratory and circulatory effects of respiratory physiotherapy in infants after heart surgery.O Grollmuss, A Serraf.

ObjectivesRespiratoryphysiotherapyiscrucialintheICUtreatmentof infants suffering from heart disease. It mobilizes secretions, may help to recruit alveoli, protect the lungs against atelectasis formation and thus progress to extubation more rapidly. Hitherto, its effects on respiratory and circulatory conditions in children with heart disease have not yet been studied. The aim of this study was to evaluate the cardio-respiratory effects of lung physiotherapy in infants after heart surgery.

MethodsWe integrated 16 randomly chosen infants after heart surgery in this prospective study (median age 40,5 days, median weight 3,95 kg). Observation of the effects of respiratory physiotherapy was made in the clinically stable postoperative period (on mean 5,9 ± 1,9 days) whilst the patients still being under artificial ventilation (volume controlled, median PEEP 3 cm H2O, median FiO2 0,4, mean tidal volume 40,8 ml). Physiotherap consisted in aspiration, balloon ventilation and expiratory flow acceleration. The ventilators used were: Servo i® (Maquet) and Evita XL® (Draeger). Respiratory mechanical parameterswere measured as well as blood gases, non invasively measured stroke volume and myocardial contractility (ICON®, Osypka), clinical circulatory parameters and brain natriuretic peptide (BNP) before and 1 hour after the therapy.

ResultsOf the ventilatory parameters, there was a significant decrease of positive inspiratory pressure (median 23 to 21 cmH2O), mean ventilatory pressure (median 9 to 7 cmH2O) and dynamic compliance (median 2,0 to 2,35 ml/cmH2O, p < 0.001). No difference could be found for resistance whereas breathing work went down from median 1,63 to 1,52 J/l (p = 0,03). pH, SaO2, paO2 and pa CO2 remained unchanged. Stroke volume rose significantly from median 5 to 6 ml (p = 0,04), the index of cardiac contractility (ICON) from 55,1 to 67,2 (p = 0,02), whereas the clinical parameters: heart rate, mean blood pressure, central venous pressure and urine output remained unchanged. Of the functional circulatory parameters, SvO2, base excess and lactates remained unchanged, whereas there was a significant fall of BNP from median 601 to 505 mg/l (p < 0,001).

ConclusionThere are beneficial immediate positive respiratory mechanical effects of respiratory physiotherapy in infants with congenital heart disease after heart surgery. Surprisingly, ventricular afterload, reflected by BNP,

EPNCIC2011

20

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dOral Presentations

is also positively influenced as well as the ventricular ejection function, and thus respiratory physiotherapy had beneficial circulatory effects, too. However, these effects did not result in short term clinical improvements. The study, that certainly suffers from the small cohort of patients integrated, could not create evidence of the cardiopulmonary interaction initiated by the therapeutic act, but makes it likely.

OP5: Prediction of pre-operative decompensation in neonatal hypoplastic left heart syndrome.V Sheward, A Durward, N Puppala, I Murdoch, S Tibby.

ObjectivesIn neonates with hypoplastic left heart syndrome (HLHS), the right ventricle supplies both the pulmonary and systemic circulation in parallel. Prior to surgery, neonates are at risk of decompensation (critical reduction in systemic DO2), due to pulmonary overcirculation. We compared the predictive value for decompensation of arterial oxygen saturation, PaO2 and P50.

MethodsRetrospectivecohortanalysisina20bedPICU,including39 newborns with HLHS. Decompensation (n = 18) was defined as the need for emergency intubation due to uncontrolled hypotension or acidosis. All blood gas variablesweretimeaveraged,yieldingamedian(IQR)of4 (3 to 7) observations per patient. P50 was calculated via the revised Severinghaus equations, corrected to a pH of 7.40.1 Intergroup comparisons utilised unpaired t tests for unequal variance.

ResultsInfants who underwent decompensation manifested higher mean arterial PaO2 values (51.6 vs 45.6 mmHg, p = 0.02), despite similar O2 saturations (92.2% vs 90.1%, p = 0.11) and P50s (17.8 vs 18.7 mmHg, p = 0.48). The groups yielded a similar mild reduction in pH (7.32 vs 7.35, p = 0.39), producing comparable rightward shifts in the O2 dissociation curve (delta P50 of 1.7 and 1.1 mmHg, p = 0.24). Despite group differences in PaO2, the predictive valueofthisvariablewasmodest,withanareaunderROCcurve of 0.71 (95% CI 0.0.55 to 0.86).

ConclusionsArterial PaO2 provides better discrimination than oxygen saturation or P50 for pre-operative decompensation in neonates with HLHS. Analysis of trajectories (rate of change) for this variable may improve the predictive value for PaO2.

References1. Severinghaus J. J. Appl. Physiol 1979(revised 2003); 46(3):599

Oral presentations, Session 3: Cardiac transplantation

OP6: Mediastinitis in paediatric cardiosurgical patients: comparison of three antibiotic prophylactic regimens.M. Sperkova, L. Kovacikova, L. Bordacova, M. Zahorec.

ObjectivesMediastinitis is rare but potentially fatal postoperative complication after cardiac surgery. The study was conducted to evaluate the incidence and the course of mediastinitis in paediatric cardiac patients after three different regimens of perioperative antibiotic prophylaxis.

MethodsRetrospective analysis of the paediatric cardiac patientsrequiring surgical mediastinal debridement and antibiotics for treatment of postoperative mediastinitis. Analysis was performed during the period between January 2000 to December 2010 when cephazolin as a perioperative antibiotic prophylaxis was used as 1) one preoperative and one postoperative dose (Group I), 2) one preoperative dose and during 24 hours postoperatively (Group II), and 3) one preoperative dose and during 48 hours postoperatively (Group III).

ResultsForty- five patients aged between 10 days and 22 years (median, 7 months) were included in the study. Of 45 patients, 25 were in the Group I, 14 in Group II, and 6 in Group III. The number of patients represent incidence of mediastinitis in children undergoing cardiac surgery with three different prophylactic regimens 1.9%, 1.6 %, and 0.6% (p < 0.001). In all groups Bidirectional Glenn was the most common procedure and Staphylococcus aureus was the most frequent causal microorganism. Comparing the groups, time from primary procedure to mediastinitis development was longest in group III, duration of mechanical ventilation after debridement was shortest in Group II. There was no difference in length of stay in cardiac intensive care unit and mortality.

ConclusionMediastinitis is life-threatening complication after cardiac procedures. With adequate duration of perioperative antibiotic prophylaxis very low incidence of this complication can be achieved.

OP7: High frequency oscillation and obstructive total anomalous pulmonary venous return outcome.S Gioanni, M Bojan , P Mauriat, P Pouard.

Objectives The aim of the study was to assess the benefit of high

21

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Oral Presentations

frequency oscillation ventilation (HFO) on obstructive totalpulmonaryvenousreturn(TAPVR)outcome.

MethodsAll infants with total anomalous pulmonary venous connection undergoing repair between 2002 and 2010 were retrospectively analyzed. HFOV was available since January 2007. Criteria to switch from conventional mechanical ventilation (CMV) to HFOV was the impossibility to keep a normal pH (7.35 –7.45) despite a tidal volume of 10 ml/kg . The aim of the switch was to avoid hypercarbia and acidosis known as triggers of pulmonary arterial hypertension.

StatisticsBaseline and outcome characteristics were compared betweengroupsusingMann-Whitney,X2orFisher’sexacttests, as appropriate. The relative probability of successful weaningandICUdeliveryovertimewascalculatedusingamultivariable Cox proportional-hazards model.

ResultsAfter exclusion of cases with pulmonary lymphangienctasia, 29 patients were available for analysis, 16 ventilated conventionally and 13 switched to HFOV on the operative day, their characteristics are shown in table 1.

HFOV was a predictor of successful weaning from mechanicalventilation,HR=25.34[5.9109.2],p<0.001,andICUdelivery,HR=8.6 [2.4, 30.3], p<0.001. Length of CPB

adversely affected weaning from mechanical ventilation, HR=0.98[0.96,0.99],p=0.004,andkidneyinjuryrequiringdialysis adversely affected weaning from mechanical ventilation,HR=0.28[0.09,0.79],p=0.02,andICUdelivery,HR=0.32[0.12,0.88],p=0.03.

Discussion Preoperative ventilation, pulmonary arterial hypertension, pulmonary edema, CPB, prematurity induce major pulmonary dysfunction after neonatal correction of obstructive TAPVR. In order to ovoid aggressiveconventional ventilation and to worsen pulmonary function, HFO has been applied and in this small cohort of patientshasshownitsbenefittoreducetheICUoutcome.

ConclusionAfterneonatalobstructiveTAPVRrepair,HFOventilationallows to reduce the length of mechanical ventilation and ICUstay.

References 1. Alveolar recruitment strategy and PEEP improve oxygenation, dynamic compliance of respiratory system and end-expiratory lung volume in pediatric patients undergoing cardiac surgery for congenital heart disease.Scohy TV, Bikker IG, Hofland J, de Jong PL, Bogers AJ, Gommers DPaediatr Anaesth. 2009 Dec;19(12):1207-12.2. Ventilation strategies and adjunctive therapy in severe lungdisease..KissoonN,RimensbergerPC,BohnD.Pediatr Clin North Am. 2008 Jun;55(3):709-33, xi

Table 1. Data shown as medians and ranges, unless stated otherwise.

Variable CMV (n=16) HFOV (n=13) p

Prematurity, n (%) 3 (18.7) 3 (23.1) 0.86

Obstructed TAPVC, n (%) 10 (62.5) 11 (84.6) 0.24

Age 9, 1-150 17, 0-269 0.40

Weight 3.45, 2.59-4.7 3.4, 2.6 -5 0.72

Ventilated preoperatively n (%) 9 (56.2) 9 (69.3) 0.74

Length of CPB, min 78, 52-159 133, 77-215 0.006

Length of aortic cross-clamping, min 34, 17-56 44, 35 -91 0.008

Hypothermic CPB, n (%) 8 (50.0) 7 (53.8) 0.84

Deep hypothermic cardiac arrest, n (%) 5 (31.2) 1 (7.7) 0.18

Delayed sternal closure, n (%) 3 (18.7) 2 (15.4) 0.99

Delay to sternal closure, days 4, 2 -7 3, 1-11 0.25

Kidney injury requiring dialysis, n (%) 1 (6.2) 6 (46.1) 0.03

PA/systemic pressure ratio 0.5, 0-0.8 0.5, 0-0.75 0.98

Documented respiratory infection, n (%) 1 (-.2) 4 (30.8) 0.14

Length of mechanical ventilation, days 9, 5-44 6, 2 -15 0.008

LengthofICUstay,days 13.5, 10-45 10, 4 -21 0.03

In-hospital mortality, n (%) 4 (25.0) 0

EPNCIC2011

22

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dOral Presentations

Oral presentations, Session 4:Perioperative neuroprotection

OP8: Increased plasma N-terminal Pro-BNP in neonates less than 32 weeks gestation with open ductus arteriosusA. Sellmer, J. Bjerre, B.H. Bech, V.E. Hjortdal, T.B. Henriksen.

ObjectivesTo investigate the proportion of very preterm neonates that has an open ductus arteriosus (DA) on day four. To characterize the DA echocardiographically if present. Furthermore, to investigate plasma levels of N-terminal pro-B-type natriuretic peptide (NTpBNP) and high sensitive cardiac troponin T (cTnT) in newborns with and without DA day four.

MethodsAll newborns (n=82) with gestational age (GA) <32 weeks at our Department were recruited (January 2010 - February 2011). Echocardiography was performed on day four of life. Diameter of DA (dDA) and the left pulmonary artery (LPA), peak systolic velocity in the DA (vmax), and left atrial-aorta ratio (LAAo) were evaluated. In 20 newborns NTpBNP and cTnT were measured. Medians are provided with 25 and 75 centiles.

ResultsMedian GA was 28 weeks, median birth weight 1022 g. DA was open on day four in 37 (45%) of all and in 23 (64%) of children with GA < 28 weeks at birth. In neonates with a DA day four median dDA was 1.8 mm (1.2-2.3) and vmax 2.2 m/s (1.3-2.6), and the median LAAo was 1.4 (1.2-1.6) compared to 1.3 (1.1-1.4) in children with a closed DA (p < 0.01). Median DA-LPA diameter ratio was 0.6 (0.5-0.8). Neonates with an open DA day four had a higher median NTpBNP 23,537 ng/l (4,659-42,292) compared to neonates with a closed DA 2,954 ng/l (1,883-3,789) (p = 0.05). Median cTnT did not differ statistically between neonates with open and closed DA (425 ng/l (212-524) vs. 242 ng/l (121- 388), ns).

Conclusion45% of all very preterm neonates had an open DA on day four. The median LAAo was increased in those neonates. This finding was supported by increased plasma level of NTpBNP. Further analyses are carried out in order to investigate whether plasma biomarkers can be used to predict hemodynamically significant DAs.

OP9: Intravenous sodium bicarbonate verifies intravenous position of catheters in ventilated patientsKeidan I.

Extravasation is an unintentional injection or leakage of fluids into the perivascular or subcutaneous space with potential tissue injury. In this 2-part prospective controlled study, the safety of subcutaneously injected sodium bicarbonate was assessed in rats first. In the second part the diagnostic utility of using intravenous diluted sodium bicarbonate to confirm placement of intravenous (IV) catheters in endotracheally intubated and ventilated rats and patients was tested. Diluted sodium bicarbonate was created using undiluted standard 8.4% (1meq/ml) sodium bicarbonate mixed in a 1:1 ratio with sterile water to achieve a final diluted concentration of 4.2% (0.5meq/ml).

Patients and MethodsSodium bicarbonate (8.4% and 4.2%) was subcutaneously injected into 6 rats and skin samples were evaluated. The hemodynamic and ventilatory effects of intravenous bicarbonate (2mls/kg) in ventilated rats were measured. Subsequently, in 20 ASA I-II ventilated patients, the effects of 50mls of diluted 4.2% sodium bicarbonate or normal saline, injected in a randomized order, were analyzed.

ResultsPart 1 – Undiluted subcutaneous sodium bicarbonateresulted in a small area of skin necrosis in 10% (3/30) of samples. Minimal effects were detected when a diluted solution was used. In ventilated rats intravenous injection of diluted bicarbonate caused a significant increase in end-tidal carbon dioxide while subcutaneous injection had no effect. In humans diluted bicarbonate resulted in an end-tidal carbon dioxide increase (mean of 38 + 5 mmHg to 45 + 7 mmHg) within 7 breaths. Injected normal saline did not result in any changes. Sodium bicarbonate was easily differentiated from normal saline injection by anesthesiologists.

ConclusionThe injection of dilute sodium bicarbonate (in ventilated patients) can be used to reliably identify the correct location of an intravascular catheter by an increase in the exhaled carbon dioxide concentration. The same methodology was shown to be useful in small number of children and neonates and should be confirmed in largerscale clinical study.

55

50

45

40

35

30

25

20

0 2 4 6

Breath number after injection

End

-tid

al C

O2

(mm

Hg

)

8 10 12

23

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Oral Presentations

Oral presentations, Session 6: Cardiovascular Pharmacology

OP10: Levosimendan versus milrinone after corrective open-heart surgery in neonates and infantsLechner E, Hofer A, Leitner- Peneder G, Freynschlag R, Mair R, Weinzettel R, Rehak P, Gombotz H.

Levosimendan has been shown to improve cardiac function and hemodynamics in adults. After open-heart surgery in neonates and infants low cardiac output syndrome (LCOS) commonly complicates the postoperative course and is associated with poor outcome. Therefore, milrinone is used prohylactically to prevent LCOS after open-heart surgery. The aim of our study was to evaluate whether levosimendan is superior to milrinone in preserving cardiac output (CO) after open-heart surgery.

MethodsAfter written informed consent forty children <1yr old (71 +/- 80days, 4.2 +/-1.3kg) undergoing corrective open-heart surgery (basic Aristotle score 8.9 +/-1.8) were included in a prospective single-center, double-blind, randomized pilot-study. Exclusion criteria were <36 weeks of gestation, <3kg weight, preoperative LCOS, pre-treatment with the study drugs, renal impairment and thrombocytopenia. At the time of weaning from cardiopulmonary bypass patients received either a 24hours continuous infusion of 0.1 microg/kg/min of levosimendan (n=20) or a 24hours continuous infusion of 0.5 microg/kg/min of milrinone (n=20). The primary study endpoints cardiac output (CO) and index (CI) using transesophageal Doppler technique (Cardio-QP, Deltex Medical), hemodynamic parameters and FS were evaluated at 2, 6, 12,18, 24 and 48 hours post cardiopulmonary bypass. ANOVA was used for statistics.

ResultsThere were no differences in demographic data, complexity of cardiac surgery, bypass time and aortic cross clamp time. Both drugs were well tolerated and no death or serious adverse event occurred throughout the study. The duration of mechanical ventilation, stays inICUandtotalhospitalstaydidnotdifferbetweenthegroups. Heart rate, systemic arterial pressure, pulmonary artery pressure, left atrial pressure, arterial to venous saturationdifference,NIRS,FS,lactatelevels,totalvolumerequirement, urine output and inotrope score were similar in both groups. In the levosimendan group compared to the milrinone group there was a statistically significant increase of cardiac output (p=0.043) over time. However, the increase in cardiac index between the groups only showed a trend (p=0.077).

SummaryLevosimendan was found to be safe when prophylactically given to neonates and infants following open-heart

surgery. The prophylactic use of levosimendan slightly increased CI. However, this marginal hemodynamic benefit did not observably influence patients´outcome.

OP11: Use of levosimendan as rescue therapy in children with low cardiac output syndrom Amiet V., Perez MH.C, Di Bernardo S., Cotting J.

ObjectiveAim of post operative treatments after cardiac surgery is to avoid low cardiac output syndrome (LCOS). Levosimendan, a new inotrope agent, has been demonstrated in adult patient to be an effective treatment for this purpose when classical therapy is not effective. It shows a positive effect on cardiac output, with fewer adverse effects and lower mortality than with dopamine. There is very few data on its benefit in the paediatric population. The aim of this study is to evaluate the effect of levosimendan in cardiac children with LCOS.

MethodsRetrospective analysis of 25 children hospitalised in ourPICU after cardiac surgery that demonstrated LCOS notresponding to classical catecholamine therapy and who received levosimendan as rescue. LCOS parameters like urine output, mixed venous oxygen saturation (SvO2), arterio-venous differences in CO2 (AVCO2) and plasmatic lactate were compared before therapy and at 12, 24, 48 and 72 hours after the beginning of the levosimendan infusion. We also analyzed the effect on the utilisation of amines (amine score), adverse events and mortality.

ResultsAfter the beginning of levosimendan infusion, urine output (3.1 vs 5.3ml/kg/h, p=0.003) and SVO2 (56 vs 64mmHg, p=0.001) increase significantly during first 72 hours and at the same time plasmatic lactate (2.6 vs 1.4 mmole/l, p<0.001), AVCO2 (11 vs 8 mmHg, p=0.002) and amine score (63 vs 39, p=0.007) decrease significantly. No side effects were noted during administration of levosimendan. In this group of patients, mortality was 0%.

ConclusionLevosimendan is an effective treatment in children after congenital heart surgery. Our study, with a greater sample of patient than other studies, confirms the improvement of cardiac output already shown in other paediatric studies.

EPNCIC2011

24

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dOral Presentations

Table 1. Comparasion of ICE T and mini T

iceT miniT

# Patients 21 21

# Studies 23 22

Age in days (range;median) range 1-362; median 18 range 1 - 63; median 12

Body weight in kg (range;median) range 2 -11; median 3 range 1.8 - 9; median 2.9

Increased ventilator & oxygen 0 2

Hemodynamic changes 0 0

Major complication 0 0

Transnasal route 20 0

Difficult insertion 0 3

Sedation: fentanyl/versed 23 22

Paralysis: vecuronium 0 22

ECMO 16 7

Heparinized 16 9

Open sternum 13 11

Capabilities single plane, pulse Doppler multiplane, CW Doppler

Efficacy 20/23 22/22

Changes in utilization (studies per year) 4.6 22

Additional sterilization cost per case $400 0

25

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Posters

P1: Isolated critical coarctation of the aorta - a single centre experienceRamush Bejiqi, R. Retkoceri, M. Kelmendi, H. Bejiqi, N. Zeka, L. Kryeziu, M. Azemi, A. Gerguri.

IntroductionAortic coarctation (CoA) accounts for 6 to 8% of live births with congenital heart disease and used in the context of congenital heart disease refers to on area of narrowing of the thoracic aorta in the region of the insertion of the aortic duct, with or without additional abnormalities of the aortic arch. It represents a spectrum of lesions, generally encompassing variable degrees of tubular hypoplasia along with additionally stenotic areas within the aortic arch. ObjectiveAim of this presentation is to describe pathoanatomical presentation, echocardiographic diagnosis, treatment and outcome of children with isolated CoA, in a single centre.

MethodsRetrospectively we analyzed medical records andechocardiograms of 62 children with CoA during the past 11 years.

ResultsPatients (n = 61, 38 male or 62 %) diagnosed with a median age of 14 months, aged from 4 days to 14 years. Clinical presentation depends from age of diagnosis, where children diagnosed less than 3 months of age (18 of them or 29 %) manifested signs of heart failure; children diagnosed under from 3 to 12 month (32 or 51.6%) manifested signs of cardiac failure, often respiratory infection, children were hypotrophic and had syderopenic anemia while children upper one year (22 or 35.4%) being asymptomatic and with evidence of arterial hypertension. In all children diagnosis were decided by echocardiography, where peak velocity was estimated by continuous Doppler. In absent of cardiac surgery and interventional cardiology in Kosova, children has treated at beginning with symptomatic therapy and continually evacuated in different Europeans and North America cardiac centers where, intervention has been done. All children age under one year, disregard of type of coarctation, therapy was surgical, end-to-end anastomosis. In 4 children age 10 to 13 years, percutaneous balloon angioplasty were performed, in different centers, and in all of them after 6 month of intervention, re-coarctation was noted. Re-coarctationwas noted also in 6 childrenwhere surgery was done. In all of them (10 patients), aged above10 years stent implantation was successfully performed. In 1999 the first mission of cardiac surgery inKosova fromHumanitarianorganization“Samaritan’sPurse” was organized, and 5 patients aged from 9 month to 5 years, with CoA were successfully treated. There was no immediate or late mortality.

ConclusionIsolated CoA is a CHD with excellent prognosis, especially in children under one year of age. The ultimate choice of the treatment technique depends on the age of the patients, associated findings and on the experience of medico-surgical team. The delay on diagnosis and treatment has significant impact in late cardiovascular morbidity and mortality. Percutaneous balloon angioplasty is performed in adult patients but short term results are delicate and stent implantation were performed. Special relevance must be given to hypertension in the follow-up of these patients, its risk factors and complications.

P2: Low Cortisol levels in children undergoing heart surgery do not correlate with more severe postoperative courseOvdi Dagan.

PurposeAlthough some evidence suggests that there is a beneficial effect of steroid supplementation in the postoperative course of children undergoing cardiac surgery, there is scarce data correlating adrenal function and postoperative course. This study aimed to find whether low postoperative cortisol levels are associated with more complicated postoperative course.

Materials and methodsA prospective study conducted in a pediatric and cardiac intensive care units. The cohort included children undergoing heart surgery over a two-year period. Cortisol levels were measured preoperatively and the morning after the surgery. The children were grouped by the complexity of the procedure and divided into low or normal/high cortisol subgroups. Clinical and laboratory parameters were compared between the low and the normal/high cortisol subgroup in each of the complexity groups.

ResultsThe study group consisted of 147 patients. There was no difference in urinary output or inotropic support between the low and normal/high Cortisol subgroups in both complexity categories. Children with normal/high cortisol levels had higher mean lactate level at 12 and 24 hours postoperatively.

Conclusionchildren with low postoperative cortisol levels did not have a more complicated postoperative course. It seems thattheadrenalresponsewasappropriatetothechild’scardiovascular status in our cohort

EPNCIC2011

26

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dPosters

P3: The Berlin Heart ExCOR® pediatric device experience at the heart and diabetes center North-Rhine Westphalia, Bad Oeynhausen, GermanyFrank D, Haas NA, Blanz U, Lauenroth V, Crespo E, Kirchner G, Kececioglu D, Sandica E.

BackgroundThe ventricular assist device (VAD) BerlinHeart EXCOR® Pediatric (BH) has been successfully used in infants and children with myocardial failure refractory to maximal medical treatment providing a “bridge to recovery” or a “bridge to transplantation”. We describe our single center experience since 2008.

MethodsRetrospectivestudyofpatientsundergoingimplantationof a BH. Analyzed were age, weight, gender, type of VAD, length of VAD support, diagnosis, complications and outcome.

ResultsA total of 12 children (6 boys, 6 girls) were treated with the BH from 01/2008 to 12/2010. The median age was 4.6 years (range 0.2-11.8) and the median weight 16.5 kg (range 4.2-50.9). The underlying disease was idiopathic or familial dilated cardiomyopathy (DCM), hypertrophic non obstructive cardiomyopathy, acute or chronic myocarditis. Four patients required a biventricular VAD (BiVAD). Three of them have been successfully transplanted and are alive and well. Patient #10 developed multiorgan failure after initial resuscitation due to progressive catecholamine-refractory vasoplegia and BiVAD was discontinued. Six patients were supported with a left VAD (LVAD) alone, but received catecholamine therapy to support the right ventricle(RV)adequatelyafterLVADimplantation.Fiveofthem have been successfully bridged to transplantation. They are alive and well. The reminder could be weaned off support after developing an intracranial haemorrhage. He recovered with minor neurological impairment. Other major complications were: intraabdominal, intrathoracic hemorrhage, abscess formation, sepsis, ascites, device fibrin deposition and thrombus formation. The duration of VAD support (excluding two patients currently on support) ranged from 3 to 489 days (median 203 days).

ConclusionIn our experience the beneficial effects of mechanical support with the BH outweigh morbidity and mortality. Single LVAD is suitable for many patients when adequate pharmacologicalRVsupport isused intheperioperativeperiod.

P4: Does nurse led parental education of pre-ventricular assist device reduce subsequent parental anxiety levels?Elaine Norris.

ObjectiveTo establish if parental education pre-ventricular assist device (VAD) implantation is effective in reducing parental anxiety and if current nursing practice and knowledge at Paediatric Intensive CareUnit (PICU) Freeman facilitatesthis process.

MethodA qualitative questionnaire was given to parents and nursing staff. It was hoped that this would establish the educational resources nurses were currently aware of for parental education. And if utilised effectively, would it subsequently reduce anxiety levels for parents?

ResultsEducation both before and after implantation was found to be equally beneficial. Seventy-five percent of parents stated anxiety levels could be further decreased ifmore informationof theVADand it’s associated riskswere available. One hundred percent of nursing staff were unaware of the current parent education booklet. Moreover, the vast majority were unaware of any current teaching resources, regularly referring to more experienced colleagues for the relevant information. Twenty-five percent of parents answering the questionnaire were awaiting VAD implantation. They rated their anxiety at optimum levels. Thus re-enforcing the need for better education and support.

ConclusionTeaching aids are widely available to parents regarding VAD insertion and aftercare. However, many nursing staff were unaware of the resources. To improve family centred care we must increase awareness of this information to allow a cascade of knowledge to all nurses caring for children pre or post VAD. Cultural values, beliefs, backgrounds and previous parental experiences, as well as the clinical condition of the child also impacted on the parents’experience.To improve levelsof family centredcare through investigation of current practice, is to ascertain if parental education reduces overall parental anxiety.

P5: Change of Paradigm in Ventilation. Experiences with NAVA-Ventilation in Phrenic Nerve InjuryVeronika Szabó, Gertraud Geiselseder, Franz Hornath, Irmgard Pomberger.

BackgroundPhrenic nerve injury has a high incidence in pediatric cardiac surgery, some centers report even a 20% occurrence.

27

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Posters

Younger age, cold cardioplegic infusions predispose to this complication.Theparesisof thediaphragm lengthens ICUstay, results in prolonged weaning. The recovery of the phrenic nerve might take several weeks. In Neurally Adjusted VentilatoryAssist(NAVA)thepatient’selectricdiaphragmalimpulse (the EDI-signal) triggers the ventilator, which is a very early signal in the breathing cycle. We hypothetized that patients with phrenic nerve injury could be weaned off easier with NAVA as with conventional ventilatory modes.

Materials and methodsYearly cca 300 children receive heart surgery in the Linz Heart Center. In 2008 4 children (1,3%) showed after heart surgery signs of phrenic nerve injury (decreased movement of the diaphgragm detected by ultrasound). Two of these children could be ventilated with NAVA in September and October 2008, in a period where we had the opportunity to try out the NAVA modus of the Maquet Servo-i Ventilator.

Results and discussionIn both of our patients NAVA was started after previous failed extubation attempts. Our first patient, a newborn boy with TGA after arterial switch operation could be successfully extubated after 6 days of NAVA ventilation on the 66.postoperative day. Our second NAVA ventilated patient was a baby girl with totally anomalous pulmonary venousreturn(TAPVR)ofthesupracardiactype.Followingcorrection surgery at age 9 days she developed bilateral phrenic nerve paresis and became ventilator dependent. NAVA was started on postoperative day 18. After a course of NAVA for 13 days she could be finally extubated. The detection of the Edi signal in both patients was possible which spoke for a partial recovery of the phrenic nerve. While conventional mechanical ventilation modes use pneumatic triggers (pressure, volume, or flow changes) to achieve patient-ventilator synchrony NAVA detects the electric impulses of the phrenic nerve. This Edi signal takes place at the very beginning of the breathing cycle while the triggers of all conventional ventilator modes derive from a later phase of the breathing cycle. Therefore, one expects to achieve a much better patient-ventilator synchronization with NAVA. We can not prove to what extent did NAVA contribute to the successful weaning of our patients, however, we were satisfied with the results and impressed by the clinically obvious better patient-ventilator synchronization in both cases.

References1. Sinderby C.,Spahia J., Beck J.: 2003 Neurally Adjusted Ventilatory Assist.Yearbok of Intensive Care and Emergency Medicine,pp: 125-1342. Brander L., Leong-Poi H., Hansen MS et al.:2006 Neurally Adjusted Ventilatory Assist (NAVA) in Patients withHypoxicRespiratoryFailureIntensiveCareMed32:5093. Sinderby C. and Beck J: Neurally Adjusted Ventilatory Assist(NAVA):anU(pdateandSumaryofExperiences.Neth.J. Crit.Care Vol.11 No.5 243-251

P6: Do serum troponin I concentrations correlate with severity of HIE?Aravind T Shastri, Sujeevan Samarasekara, Hemananda Muniraman, Paul Clarke.

BackgroundMyocardial dysfunction occurs frequently in babies with perinatal asphyxia. Cardiac troponin I (cTnI) is a surrogate marker of myocardial dysfunction in adults but there are few data in neonates.

ObjectiveTo compare serum cTnI concentrations with clinical severity of encephalopathy in asphyxiated neonates.

Design/MethodsRetrospective reviewof cTnI concentrations in neonatesadmitted to our neonatal unit with hypoxic ischemic encephalopathy (HIE) in the 58-month period from January 2006 to October 2010. We compared serum cTnI concentrations measured in the first 24 hours postnatal with clinical grade of HIE (Sarnat-Sarnat classification), and also with duration of inotropic support.

Results54 neonates were admitted with HIE in the study period. Median (range) gestational age and birth weight were 39.5weeks (27.0 - 42.5 weeks) and 3090 g (1200 - 4620 g). Median time of blood sampling for cTnI concentrations was 13 hours. The table shows cTnI concentrations and duration of inotropic support according to HIE grade.

Table: Cardiac troponin I concentrations and duration of inotropic support

HIE gradeCardiac troponin I

concentration, µg/LDuration of inotropic

support, hrs

1 (n=11) 0.04 (0.02 - 0.11) 0 (0 - 24)

2 (n=26) 0.12 (0.03 - 1.61) 28 (0 - 118)

3 (n=17) 0.67 (0.03 - 16.7) 48 (0 - 140)

Data are median (range)

EPNCIC2011

28

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dPosters

Serum cTnI concentrations and duration of inotropic support were significantly greater with increasing severity of HIE (p<0.0001 and p <0.001 respectively, Kruskal-Wallis test). ConclusionCardiac troponin I concentrations correlate strongly with clinical grade of HIE and with duration of inotropic support in asphyxiated neonates. These data suggest that early cTnI concentrations provide a useful marker of the severity of myocardial dysfunction in asphyxiated neonates.

P7: Compartment syndrome after pediatric cardiac surgery: a rare but devastating complicationVaujois Laurence, Martin Anne-Laure, De Coulon Geraldo, Fluss Joel, Aggoun Yacine, Saudan Sonja, Beghetti Maurice, Tissot Cécile.

IntroductionCompartment syndrome (CS) results when high pressure within a closed fascial space reduces capillarity perfusion below the necessary level for tissue viability. If the pressure remains high for hours, normal function of muscle and nerve is jeopardised and necrosis may result.

Case ReportWe report a 14-year-old overweight child with pulmonary atresia intact ventricular septum following a 3rd cardiac surgery for pulmonary homograft replacement. Cardiopulmonary bypass (CPB) was started from the right groin after a difficult bilateral femoro-femoral cannulation. Because of mediastinal adherences, a long CPB time of 265 minutes was necessary. The post-operative course was remarkable for persistent hemodynamic instability, capillary leak syndrome and renal failure necessitating increasing inotropic support and hemodialysis. Cardiac catheterization was performed on post-operative day (POD) 4 by a left femoral cannulation to exclude aorto-pulmonay collaterals. After 8 days of heavy sedation, the child presented predominantly right leg induration and symptoms of nervous injury with bilateral paresia. Doppler echocardiography ruled out thrombosis and an electromyogram confirmed bilateral sciatic nerve compression. Because of persistent foot drop and inability to walk, physiotherapeutic support was initiated and the patient was discharged home on POD 19. He was readmitted 4 weeks after his surgery in the setting of painful hyperesthesia predominant on the right leg. TheMagnetic Resonance Imaging showed bilateralsciatic nerve fibrosis with extended muscular fibrosis and retractions secondary to an undiagnosed bilateral CS. Pain control with gabapentine and clonazepam, intensive physiotherapy and contention were initiated with slow improvement.

ConclusionCS secondary to femoral cannulation for CPB is rare, all the more in children. The diagnosis in critical care sedated patients is difficult and consequences of a missed CS are serious. Awareness and early diagnosis is essential: a compartment pressure >40mmHg for >6 hours is an indication to prompt fascitomy and can avoid devastating complications.

P8: Coronary vasospasm (Prinzmetal angina) in a 6 years old girl: an unusual diagnosisJulie Wacker, Yacine Aggoun, Emmanuelle Golay, Maurice Beghetti, Cécile Tissot.

IntroductionSyncope is a common complaint in the pediatric population, particularly in teenagers. Among cardiac causes of syncope, the diagnosis of coronary artery anomalies remains rare but can lead to serious complications.

Case ReportA 6 years old girl presented with a one year history of syncope occurring during exercise and emotion, with the frequency increasing during the past 2 weeks to about twice a day. Associated symptoms were palor, dyspnea and leg pain. Her past medical history was significant for spontaneous closure of a perimembranous ventricular septal defect and her familial history is negative. The EKG was normal but cardiac enzymes showed an elevated CK-MB (263 U/l), elevated NT pro-BNP (721 ng/l) but normaltroponin level. Echocardiography showed normal heart anatomy and function with normal-appearing coronary anatomy. The 24h-EKG monitoring showed significant ST segment depression followed by non sustained ventricular tachycardia occurring during exercise. Coronary CT-scan and coronary angiography showed no structural anomaly of the coronaryarteriesandthecardiacMRIwasnormal.Asecond24h-EKG monitoring showed torsade de pointe triggered by an emotional stress with a prolonged QT interval (507 ms), and she was started on beta blocker therapy. However, because of recurrent syncope on beta-blocker, a myocardial stress test scintigraphy showed abnormal captation in the anterior and apical regions, resolving with rest, compatible with myocardial ischemia, allowing us to evoke the diagnosis of coronary vasospasm. Calcium-antagonist therapy was initiated with aggravation of the symptoms, reason why her treatment was changed for a beta-blocker (nebivolol), dinitrate vasodilator and acetylsalicylic acid. Her evolution has been uneventful with no syncope for the last 6 months.

ConclusionPrinzmetal angina is seldom reported in the pediatric population. Calcium antagonists represent the gold standard in adults but had a controversial effect in our patient, with beta-blocker being the most efficacious treatment.

29

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Posters

P9: Successful lung transplantation after cardiopulmonary resuscitation with extracorporeal membrane oxygenation (ECMO-CPR) in a child with idiopathic severe pulmonary arterial hypertension (PAH)Tissot Cécile, Habre Walid, Jaecklin Thomas, Aggoun Yacine, Gasche Paola, Bettex Dominique, Hug Maja, Pellegrini Michel, Barazzone Constance, Rimensberger Peter, Beghetti Maurice.

IntroductionCardiopulmonaryresuscitation(CPR)usingextracorporealmembrane oxygenation (ECMO) is widely used following pediatric cardiac surgery, but is seldom reported in patient with severe pulmonary arterial hypertension (PAH) suffering cardiac arrest.

Case ReportA 9 years old boy was diagnosed at age 4 with idiopathic PAH and failed to respond to sildenafil and bosentan therapy. Cardiac catheterization revealed suprasystemic non-reactive PAH (PAP: systolic 170, diastolic 126 and mean 140mmHg versus SAP: systolic 98, diastolic 62 and mean 74mmHg) with increased right (RAP 25mmHg)and left (PCWP 20mmHg) heart filling pressures. A central venous catheter was inserted under general anesthesia for intravenous prostacyclin therapy. Following extubation, the patient presented a laryngospasm and a pulmonary hypertensive crisis, followed by a cardiac arrest unresponsive to conventional cardiopulmonary resuscitation (CPR).The arterial bloodgas (ABG) showedsevere acidosis with pH 6.9, BE -24.6 and lactate 15mmol/l. After femoral veno-arterial cannulation, extracorporeal membrane oxygenation (ECMO) was started 60 minutes after CPR was initiated. An atrioseptostomy wasperformed to unload the RV and allow for recovery.The child presented several complications related to prolonged CPR which included transient acute renalfailure, left anterior leg compartment syndrome needing emergent fasciotomy and an unresolving anterior medullary syndrome at the level of L4-L5 consecutive to medullary ischemia, without brain damage. After two weeks of support, the child was transferred on ECMO by air ambulance to our transplant center. There, ECMO was weaned after 5 weeks and the child underwent lung transplantation 12 weeks after his cardiac arrest. The child is now 7 months post-transplantation, on tacrolimus and low-dose methylpredinisolone immunosuppressive therapy and shows constant regression of his medullary syndrome but persistent urinary incontinence.

ConclusionECMO-CPR is life saving in children with severe PAHwho suffer cardiac arrest and can be used as a bridge to recovery or lung transplantation.

P10: Approaches Directed to Avoid the Influence of Compartment-syndrome on Lungs’ Mechanical Functioning in Newborns in Early Post-operative PeriodOleksandr Nazarchuk, Dmytro Dmytriiev.

IntroductionPain influence on lungs functioning, happening in peri-operative period in neonates. This problem, changing lungs’mechanicalcharacteristics,havenotbeensolvedyet.We aimed to decrease the influence of intra-abdominal pressure on lungs’ mechanics in neonates, being theresult of early postoperative pain, by means of prolonged administration of fentanyl.

MethodsThe research included 30 newborns with gastroschisis. They were divided into two groups accordingly to the type of analgesia. In 14 patients we used for analgesia morphine hydrochloride (0,1 – 0,3 mg/kg), in the other group (16 neonates) – prolonged infusion of fentanyl (3-5 mkg/kg/h). The narcosis was: Sodium oxybutyrate 20 % in dose 100-150 mg/kg with fentanyl 0,005 % in dose 20 mkg/kg. For ventilation we used ”Bear Cub“ ventilator (A/C, SIMV/PSV). Lungs’ mechanics characteristics’ interdependencywith effectiveness of post-operative analgesia and abdominal wall relaxation was studied by means of continuous monitoring of dynamic compliance (Cdyn), pressure-volume and flow-volume loops, capnography. Apprising analgesia status, we measured hemodynamic, SaO2, blood level of cortizol, C-reactive protein (CRP),glucose. Postoperative pain syndrome we analyzed using visual analogue scales (VAS) Wang/Baker. Intra-abdominal pressure (IAP) was controlled by Cron [3]. For statisticanalysisweusedStudent’st-test.

ResultsOur study showed IAP increasing at first steps of the study. In the group with morphine there was the increase of IAP by 11-12 cm H2O, being stable during some period of time and also variable levels of pain according to VAS, the increasingofCRPfrom0,8±0,25mg/dlby5mg/dl,cortisolby 674,4 nmol/l and blood glucosae rate – 7,4 mmol/l. High traumatic effect periods and poor analgesia (morphine group) reasoned the increasing IAP, step by step dynamic compliance decreasing in 3,4 times, resistance increasing in 2,42 times and PIP rising till 22 cm H2O and maximum changes in grafical monitor. Prolonged administration of fentanyl prevented high increase of IAP, CRP, levelsofglucoseandcortizolandchangesofVASdata, lungs’mechanical characteristics.

DiscussionWe found direct correlation between IAP increase and lungs’mechanical changes.Compartment syndromeandreceptors’irritationintissuesofabdominalwallsthatwerebeing extended decrease pain reception barrier of А-β

EPNCIC2011

30

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dPosters

myelin nervous filaments and centrifugal reflex arc of IAP increase is formed. High IAP also leads to diaphragmatic displacement resulting in increase of thorax pressure, lungs’volumedecreaseduringexpirationphase,decreaseof lungs’ functional residual capacity, low inspirationlung volume, compression of lungs parenchyma that leads to alveolar collaboration in the base part of lungs, alveolar atelectasis and their damage. Such influence of compartment syndrome, generated by pain perception, is provedbyworldscientificdata[1,2].

ConclusionsAdequate analgesia in peri-operative period can be achieved by giving prolongation fentanyl infusion. Which provides stability of IAP, prevents impulsation of pain, decreases intra-abdominal hypertensive mechanisms, optimizeslungs’functioninginphysiologicalconditions.

References1. Malbrain M. L. The role of abdominal distension in the search for optimal PEEP in acute lung injury (ALI): PEEP-adjustment for raised intra-abdominal pressure (IAP) or calculation of Pflex. Critical Care Medicine 1999; 27: 157.2.ReeseH.Clark,ArthurS.Slutsky,DaleR.Gerstmann.Lung Protective Strategies of Ventilation in the Neonate: What Are They? Pediatrics 2000; 105: 112–114.3.OverholtR.H.Intraperitonealpressure.Arch.Surg1931; 22:1–703.

31

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Index of Authors

First Name Name Number Date Hours

Vivianne Amiet OP11 May 7, 2011 09:10 - 09:50

Ramush Bejiqi P1 May 5, 2011 15:45 - 16:30

Jane Cassidy OP2 May 5, 2011 15:15 - 15:45

Daniela Frank P3 May 5, 2011 15:45 - 16:30

Simone Gioanni OP7 May 6, 2011 09:15 - 09:45

Oswin Grollmuss OP4 May 5, 2011 17:45 - 18:30

Illan Keidan OP9 May 6, 2011 11:45 - 12:15

Evelyn Lechner OP10 May 7, 2011 09:10 - 09:50

Kanwar Multani OP3 May 5, 2011 17:45 - 18:30

Hemananda Muniraman P6 May 6, 2011 09:45 - 10:30

Oleksandr Nazarchuk P10 May 6, 2011 09:45 - 10:30

Ellaine Norris P4 May 5, 2011 15:45 - 16:30

Dagan Ovdi P2 May 5, 2011 15:45 - 16:30

Sharma Ruchik OP1 May 5, 2011 15:15 - 15:45

Anna Sellmer OP8 May 6, 2011 11:45 - 12:15

Victoria Sheward OP5 May 5, 2011 17:45 - 18:30

Martina Sperkova OP6 May 6, 2011 09:15 - 09:45

Veronika Szabó P5 May 5, 2011 15:45 - 16:30

Cécile Tissot P7 May 6, 2011 09:45 - 10:30

P8 May 6, 2011 09:45 - 10:30

P9 May 6, 2011 09:45 - 10:30

EPNCIC2011

32

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dAbout Montreux

The beauty of its site on the Lake Geneva shore and the mildness of its climate have made Montreux “ThePearloftheSwissRiviera”.AtownofeventsandentertainmentwithoutstandingfestivalsliketheMontreuxJazzFestival,GoldenRose,ComedyandChoralFestivals.

Climate and ClothingThe climate is usually mild in May with temperature of around 15 to 20° Celsius. However, in addition to lightclothing,don’tforgetwarmerclothesandaraincoatforrainydaysandgoodwalkingshoesaswellasproper clothing if you plan excursions to the mountains.

Passport and visa requirementsForcitizensofmostcountries,onlyavalidpassportisrequired.EUcitizensneedonlyvalidIdentityCard;forother countries, visitors may need a visa. Please consult your travel agency or the nearest Swiss Consulate. On request, Symporg SA will be pleased to send you an Official Invitation letter.

MoneyThe local currency is the Swiss Franc (CHF). One Swiss Franc equals approximately 0.75 Euro. Banking hours are from Monday to Friday, 8:30 am to 4:30 pm.

ShoppingShops in Montreux are open Monday to Friday from 8:30 am to 6:30 pm and Saturday from 8:30 to 5:00 pm.

Tourist BoardMontreuxTourisme,Pavillond’information,1820Montreux,Phone:+41(0)21962.84.36,Fax:+41(0)2196381 13, www.montreux-vevey.com, e-mail: info@montreuxriviera.com

33

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

General Information

Fairmont Le Montreux PalaceLe Montreux Palace hotel is the epitome of Victorian architecture. This first class hotel is situated in a uniquelocationontheSwissRivieraandhaswelcomedanarrayofinternationalclients.

With its magnificent view on the lake and the Alps, away from the hustle bustle, yet only a few minutes from the town centre, this residence is situated on this idyllic spot on the shores of Geneva Lake.

Address :Fairmont Le Montreux PalaceGrandRue1001820 MontreuxSwitzerlandhttp://www.montreux-palace.ch/

Secretariat opening hoursWednesday, May 4th 2011: 09:00-19:00Thursday, May 5th 2011: 07:00-20:30Friday, May 6th 2011: 07:00-15:00Saturday, May 7th 2011: 07:30-13:00

Official languageEnglish is the official language of the congress. No simultaneous interpretation will be provided.

Access

By airGeneva has an international airport offering direct flights to nearly 100 international destinations. The terminals have all the facilities a traveller could wish for. It is designed for speedy and simple check-in, and has essential services such as change, information and restaurants at strategic points.

Distance Geneva - Montreux : by train 70 min, by car 45 min.Taxi Service: CHF 360.- (1-3 pers)

By railRailwww.sbb.chandroadfacilitiesproviderapidaccesstotherestofSwitzerlandandEurope.TheSwissNationalRailroad systemoffers several linksperhour toLausanne,Geneva,Bern,Basel,Zurichandtheregions of Vaud, Valais and others.

By carWhen travelling:•from the northern part of Europe take the highway Bern - Fribourg - Lausanne (DirectionGd-Saint-Bernard, Vevey - Montreux )•fromthesouthernpartthehighwayGeneva-Lausanne-Vevey,(DirectionGd-Saint-Bernard-Montreux)Exit: Montreux

EPNCIC2011

34

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dSocial Program

WelcomeReception–5th May 2011

The welcome reception will start at 18:30 for a cocktail in the Montreux Palace. You will enjoy the scenic surroundings, gardens, and waterfront a few steps from the hotel. You will be delighted by a buffet of local wines, cold and warm appetizers. You will enjoy the cocktail with a little welcome speech from Swiss authorities and Local Organizing Committee.

Gala dinner – 6th May 2011

At the foot of the Pre-Alps, you will be enchanted by the charm and picturesque architecture of the medieval town of Gruyères. The town has given its name to the area and to its delicious cheese. Come and explore a littletownthat’sbeenunaffectedbythepassageoftime,builtinasuperbsetting.

35

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Exhibition Plan

WC

Registration Desk

Conference Room

PosterArea

Exhibition

WC

Co

ffee

bre

ak

12

3

4

5

6

7 8

9

10

11

12

EPNCIC2011Exhibitors’List

01 - Acutronic Medical System AG

02 - Vygon Schweiz

03 - Covidien AG

04 - Maquet Critical Care

05 - Dräger Medical Schweiz AG

06 - Fumedica AG

07 - Medos AG / MCM Medsys AG

08 - Levitronix GmbH

09 - Pall Medical

10 - Linde AG - Linde Healthcare

11 - Gambro Hospal AG

12-RadiometerGmbH

EPNCIC2011

36

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dMap of Montreux

Hotel Fairmont Le Montreux Palace

GrandRue100,1820Montreux021 962 12 12

Hotel Eden Palace au Lac

RueduThéâtre11,1820Montreux021 966 08 00

BestWestern,EurotelRivieraLunch on Friday May 6th, 2011 at 12h30

GrandRue81,1820Montreux021 966 22 22

37

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Notes

EPNCIC2011

38

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

dNotes

39

EPNCIC2011

4 -

7 M

ay,

Mo

ntr

eux,

Sw

itze

rlan

d

Notes

www.epncic.com