Peri-Operative Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Cardiac and Thoracic Surgery: A RAND/UCLA Appropriateness Method Consensus Study
Abstract
:1. Introduction
2. Methods
2.1. RAND/UCLA Method of Appropriateness
2.2. Recruiting the Expert Panel
2.3. Scenario Formulation
2.4. Two-Round Consensus Process
3. Results
3.1. Cardiac Surgery
3.1.1. SCENARIO #1: Cardiac Surgery for Correction of Congenital Heart Disease and/or Valve Surgery
Type of Molecule
Intra-Operative Re-Dosing
Continuing Post-Operative Prophylaxis
3.1.2. SCENARIO #2: Cardiac Catheterization without Placement of Prosthetic Material
3.1.3. SCENARIO #3: Cardiac Catheterization with Placement of Prosthetic Material
3.1.4. SCENARIO #4: Implantable Cardiac Defibrillator or Epicardial Pacemaker Placement
3.1.5. SCENARIO #5: Patients Undergoing ExtraCorporeal Membrane Oxygenation (ECMO)
3.1.6. SCENARIO #6: Patients Undergoing Other Cardiac Surgery
3.2. Non-Cardiac Thoracic Surgery
3.2.1. SCENARIO #7: Non-Cardiac Thoracic Surgery with Thoracotomy
3.2.2. SCENARIO #8: Non-cardiac Thoracic Surgery Using Video-Assisted Thoracoscopy
3.2.3. SCENARIO #9: Elective Chest Drain Placement in the Pediatric Patient
3.2.4. SCENARIO #10: Elective Chest Drain Placement in the Newborn
3.2.5. SCENARIO #11: Thoracic Drain Placement in the Trauma Setting
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Congenital Heart Diseases |
---|
Patent ductus arteriosus |
Ostium primum type atrial septal defect |
Ostium secundum type atrial septal defect |
Partial anomalous pulmonary venous connection |
Total anomalous pulmonary venous connection |
Ventricular septal defect |
Partial/Complete atrial septal defect |
Atrioventricular septal defect |
Tetralogy of Fallot |
Transposition of great arteries |
Double outlet right ventricle |
Pulmonary stenosis |
Aortic valve stenosis |
Coarctation of the aorta |
Univentricular heart |
Hypoplasia of pulmonary arteries |
Hypoplasia of the aortic arch |
Non-Cardiac Thoracic Surgery |
---|
Primary lung tumors (rare) and metastatic tumors (more common) |
Congenital lung malformations |
Congenital vascular malformation of the chest |
Congenital chest deformities |
Non-Cardiac Thoracic Surgery Using Video-Assisted Thoracoscopy |
---|
Lobectomy and segmentectomy (congenital lung lesions) |
Thoracoscopic biopsies |
Congenital diaphragmatic hernia |
Congenital esophageal atresia |
Congenital esophageal duplications |
Congenital vascular malformation |
Bronchogenic cyst |
Congenital chest deformities (pectus excavatum) |
Pulmonary empyema |
Pulmonary metastasectomy for oligometastatic disease |
Cardiac Surgery | Prophylaxis | Molecule | Dosage and Timing |
---|---|---|---|
Correction of congenital heart disease and/or valve surgery, with sternotomy or thoracotomy | YES | Cefazolin |
|
Diagnostic or interventional cardiac catheterization without prosthetic material placement | NO | - | - |
Interventional cardiac catheterization with prosthetic material placement | Yes | Cefazolin |
|
Placement of implantable cardiac defibrillator or epicardial pacemaker (PM), with thoracotomy or sternotomy or subxiphoid or subcostal incision. | Yes | Cefazolin |
|
Patient undergoing extracorporeal circulation (ECMO), both venous and veno-arterial | Yes | Cefazolin |
|
Other interventions (treatment of cardiac tumors and heart transplantation) | Yes |
|
Non-Cardiac Thoracic Surgery | Prophylaxis | Molecule | Dosage and Method of Administration |
---|---|---|---|
Non-cardiac thoracic surgery with thoracotomy | Yes | Cefazolin | Single dose of 30 mg/Kg (maximum dose 2 g) IV, within 30 min before surgery, repeatable if surgery lasts more than 4 h |
Non-cardiac thoracic surgery using video-assisted thoracoscopy (VATS) | Yes | Cefazolin | Single dose of 30 mg/Kg (maximum dose 2 g) IV, within 30 min before surgery, repeatable if surgery lasts more than 4 h |
Elective placement of chest drainage in pediatric patients | NO | - | - |
Elective chest drain placement in neonatal age patients | NO | - | - |
Placement of chest drainage in the traumatology field | Yes | Cefazolin | Single dose of 30 mg/Kg (maximum dose 2 g) IV, within 30 min before surgery, repeatable if surgery lasts more than 4 h |
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Bianchini, S.; Nicoletti, L.; Monaco, S.; Rigotti, E.; Corbelli, A.; Colombari, A.; Auriti, C.; Caminiti, C.; Conti, G.; De Luca, M.; et al. Peri-Operative Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Cardiac and Thoracic Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics 2022, 11, 554. https://doi.org/10.3390/antibiotics11050554
Bianchini S, Nicoletti L, Monaco S, Rigotti E, Corbelli A, Colombari A, Auriti C, Caminiti C, Conti G, De Luca M, et al. Peri-Operative Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Cardiac and Thoracic Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics. 2022; 11(5):554. https://doi.org/10.3390/antibiotics11050554
Chicago/Turabian StyleBianchini, Sonia, Laura Nicoletti, Sara Monaco, Erika Rigotti, Agnese Corbelli, Annamaria Colombari, Cinzia Auriti, Caterina Caminiti, Giorgio Conti, Maia De Luca, and et al. 2022. "Peri-Operative Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Cardiac and Thoracic Surgery: A RAND/UCLA Appropriateness Method Consensus Study" Antibiotics 11, no. 5: 554. https://doi.org/10.3390/antibiotics11050554