Date of Award

2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Shannon Phillips

Second Advisor

Martina Mueller

Third Advisor

Ravi Thiagarajan

Abstract

(CHD) describes the most common congenital defect and represents a significant health burden worldwide. Yearly, there are more than a million newborns diagnosed with congenital heart disease, many of the defects require surgical correction. The cost of surgical correction can be significant, of the ten congenital defects with the highest hospital cost, six are CHD. Cardiac arrest, like other postoperative complications, can increase the length of intensive care and hospital stay, and is associated with hospital-acquired infections, errors, and poorer long-term outcomes. Several studies included physiological data and hemodynamic monitoring or assigned causation for cardiac arrest to broad categories, such as respiratory, arrhythmia, metabolic or central nervous system, but did not describe specific clinical signs of impending cardiac arrest with the exception of rising serum lactate. The paucity of data in this area demonstrates a gap in the literature on cardiac arrest in children following cardiac surgery. The first manuscript in this dissertation describes the current literature on the effect of endotracheal suctioning in pediatrics, guided by the Neuman Systems model. The second manuscript, using the Knowledge-to-Action theoretical framework, explores available tools for risk adjustment in congenital heart surgery. Lastly, the third manuscript describes the hemodynamic variability preceding cardiac arrest associated with endotracheal suctioning in children following surgery for congenital heart defects compared to others. This dissertation establishes a basis for further research and interventions to avert cardiac arrest in the vulnerable child with congenital heart disease.

Rights

All rights reserved. Copyright is held by the author.

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