Papers by William Stigall
Mechanical Ventilation, Cardiopulmonary Interactions, and Pulmonary Issues in Children with Critical Cardiac Disease 167
The respiratory care of the child with critical heart disease has profound effects on overall out... more The respiratory care of the child with critical heart disease has profound effects on overall outcome. While often simplified or ignored, a focus on the intricacies and vagaries of pulmonary issues and their management can help pediatric cardiac surgical patients. The intent of this chapter is to describe specific pulmonary and ventilatory issues that arise most frequently during the care of a child with critical heart disease. First, a thorough description of the relevant cardiopulmonary interactions involved in caring for the ventilated patient with critical heart disease is attempted, including the effects of positive pressure ventilation on both right and left heart performance, as well as detailed information on the effects of blood gas manipulation on cardiac and circulatory function. Second, practical management strategies for patients with specific cardiac conditions are described, including the management of patients with cardiopulmonary bypass-induced lung injury, passive pulmonary circulation, open sternum,pulmonary hypertension and right ventricular dysfunction, tetralogy of Fallot with absent pulmonary valve, diaphragmatic injury, and others. Finally, specific, practical, evidence-based management strategies are provided for ventilator management, ventilator
The Linacre Quarterly, Mar 2, 2022
The Hippocratic Oath is the oldest and wisest description of our profession. It contains profound... more The Hippocratic Oath is the oldest and wisest description of our profession. It contains profound wisdom on the nature of health, healing, and the relationships both within and without that are necessary to the good practice of medicine. The practices described in its lines are antidotes for much of what ails modern medicine.
The Hippocratic Oath
The Linacre Quarterly, Mar 2, 2022
Abstract 321: Sodium Bicarbonate Use During In-hospital Pediatric Cardiopulmonary Resuscitation - A Report From the American Heart Association Get With The Guidelines-Resuscitation®
Circulation: Cardiovascular Quality and Outcomes, 2013
OBJECTIVES: The 2005 and 2010 Pediatric Advanced Life Support (PALS) Guidelines do not recommend ... more OBJECTIVES: The 2005 and 2010 Pediatric Advanced Life Support (PALS) Guidelines do not recommend using sodium bicarbonate (SB) during cardiopulmonary resuscitation (CPR) except for select resuscitation situations. We hypothesize that SB is used frequently during in-hospital pediatric CPR and its use is associated with worse survival to hospital discharge when given outside of these recommended resuscitation situations. PATIENTS AND METHODS: We analyzed data from 8602 consecutive pediatric CPR events (patients < 18 yrs) submitted to the American Heart Association Get With The Guidelines-Resuscitation from January 2000 through September 2010. The primary outcome was survival to hospital discharge. Secondary outcomes included event survival, 24 hr survival, and neurologic outcome. Multivariable logistic regression was performed to analyze the association between SB use and outcomes. RESULTS: SB was used in 3923 (46%) of 8602 events. The incidence of SB use between 2000-2005 vs. 2006...
Mechanical Ventilation, Cardiopulmonary Interactions, and Pulmonary Issues in Children with Critical Cardiac Disease
Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care, 2013
The respiratory care of the child with critical heart disease has profound effects on overall out... more The respiratory care of the child with critical heart disease has profound effects on overall outcome. While often simplified or ignored, a focus on the intricacies and vagaries of pulmonary issues and their management can help pediatric cardiac surgical patients. The intent of this chapter is to describe specific pulmonary and ventilatory issues that arise most frequently during the care of a child with critical heart disease. First, a thorough description of the relevant cardiopulmonary interactions involved in caring for the ventilated patient with critical heart disease is attempted, including the effects of positive pressure ventilation on both right and left heart performance, as well as detailed information on the effects of blood gas manipulation on cardiac and circulatory function. Second, practical management strategies for patients with specific cardiac conditions are described, including the management of patients with cardiopulmonary bypass-induced lung injury, passive pulmonary circulation, open sternum,pulmonary hypertension and right ventricular dysfunction, tetralogy of Fallot with absent pulmonary valve, diaphragmatic injury, and others. Finally, specific, practical, evidence-based management strategies are provided for ventilator management, ventilator
Annals of the New York Academy of Sciences, 2012
Neonates and infants undergoing heart surgery with cardioplegic arrest experience both inflammati... more Neonates and infants undergoing heart surgery with cardioplegic arrest experience both inflammation and myocardial ischemia-reperfusion (IR) injury. These processes provoke myocardial apoptosis and oxygen-free radical formation that result in cardiac injury and dysfunction. Thymosin 4 (T4) is a naturally occurring peptide that has cardioprotective and antiapoptotic effects. Similarly, dexrazoxane provides cardioprotection by reduction of toxic reactive oxygen species (ROS) and suppression of apoptosis. We propose a pilot pharmacokinetic/safety trial of T4 and dexrazoxane in children less than one year of age, followed by a randomized, double-blind, clinical trial of T4 or dexrazoxane versus placebo during congenital heart surgery. We will evaluate postoperative time to resolution of organ failure, development of low cardiac output syndrome, length of cardiac ICU and hospital stays, and echocardiographic indices of cardiac dysfunction. Results could establish the clinical utility of T4 and/or dexrazoxane in ameliorating ischemia-reperfusion injury during congenital heart surgery.
Sodium bicarbonate use during in-hospital pediatric pulseless cardiac arrest - A report from the American Heart Association Get With The Guidelines(®)-Resuscitation
Resuscitation, 2015
Despite limited recommendations for using sodium bicarbonate (SB) during cardiopulmonary resuscit... more Despite limited recommendations for using sodium bicarbonate (SB) during cardiopulmonary resuscitation (CPR), we hypothesized that SB continues to be used frequently during pediatric in-hospital cardiac arrest (IHCA) and that its use varies by hospital-specific, patient-specific, and event-specific characteristics. We analyzed 3719 pediatric (<18 years) index pulseless CPR events from the American Heart Association Get With The Guidelines-Resuscitation database from 1/2000 to 9/2010. SB was used in 2536 (68%) of 3719 CPR events. Incidence of SB use between 2000 and 2005 vs. 2006 and 2010 was 71.1% vs. 66.2% (P=0.002). The primary outcome was survival to discharge. Secondary outcomes included 24-h survival and neurologic outcome. Multivariable logistic regression analyzed the association between SB use and outcomes. SB had increased use an ICU location, metabolic/electrolyte disturbance, prolonged CPR, pVT/VF, and concurrently with other pharmacologic interventions. Adjusting for ...
Advancement of a standardised enteral feeding protocol in functional single ventricle patients following stage I palliation using cerebro-somatic near-infrared spectroscopy
Introduction: Infants with single ventricle following stage I palliation are at risk for poor nut... more Introduction: Infants with single ventricle following stage I palliation are at risk for poor nutrition and growth failure. We hypothesise a standardised enteral feeding protocol for these infants that will result in a more rapid attainment of nutritional goals without an increased incidence of gastrointestinal co-morbidities. Materials and methods: Single-centre cardiac ICU, prospective case series with historical comparisons. Feeding cohort consisted of consecutive patients with a single ventricle admitted to cardiac ICU over 18 months following stage I palliation (n = 33). Data were compared with a control cohort and admitted to the cardiac ICU over 18 months before feeding protocol implementation (n = 30). Feeding protocol patients were randomised: (1) protocol with cerebro-somatic near-infrared spectroscopy feeding advancement criteria (n = 17) or (2) protocol without cerebro-somatic near-infrared spectroscopy feeding advancement criteria (n = 16). Results: Median time to achie...
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Papers by William Stigall