Tume Sebastian C, Conway Jennifer, Ryan Kathleen R, Philip Joseph, Fortkiewicz Justine M, Murray Jenna
Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Division of Pediatric Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
World J Pediatr Congenit Heart Surg. 2019 Nov;10(6):759-768. doi: 10.1177/2150135119880890. Epub 2019 Oct 30.
Mechanical support devices have revolutionized the management of circulatory failure. This has been met by a dramatic increase in ventricular assist device (VAD) utilization in children over the last two decades. Previous wide gaps in experience and knowledge have significantly narrowed in the recent years. As we continue to gain experience with this technology, we face new challenges such as complex congenital circulations and small patient size. The emergence of new pharmacologic therapies and device technology offers more opportunities and requires constant adjustment in practice. As we continue to embark on this journey, constant insight is needed to refine patient selection criteria, minimize complications, and continue to push the field for safer smaller devices to accommodate these complex patient populations. In this review focused at inpatient critical care environment, we discuss the recent field developments and focus on challenging patient populations, the emergence of temporary support, management of anticoagulation, and diagnostic approach to stroke in the setting of VAD support.
机械支持设备彻底改变了循环衰竭的治疗方式。在过去二十年里，儿童心室辅助装置（VAD）的使用急剧增加。过去在经验和知识方面存在的巨大差距近年来已显著缩小。随着我们在这项技术上不断积累经验，我们面临着诸如复杂先天性循环和患者体型小等新挑战。新的药物治疗方法和设备技术的出现提供了更多机会，并且需要在实践中不断调整。在我们继续踏上这段征程时，需要持续深入了解，以完善患者选择标准、将并发症降至最低，并继续推动该领域开发更安全的小型设备，以适应这些复杂的患者群体。在这篇聚焦于住院重症监护环境的综述中，我们讨论了该领域的最新进展，并关注具有挑战性的患者群体、临时支持的出现、抗凝管理以及VAD支持情况下中风的诊断方法。
