Key result
Proposed perioperative algorithm for CHD and URI prioritizes clinical exam, cardiac physiology, and selective viral testing.
Why the study?
How should clinicians manage children with congenital heart disease and upper respiratory illness presenting for elective procedures requiring anesthesia?
How should clinicians manage children with congenital heart disease and upper respiratory illness presenting for elective procedures requiring anesthesia?
This paper proposes a novel perioperative decision algorithm specifically tailored for children with congenital heart disease and upper respiratory illness to safely guide elective procedure management.
Answers are grounded in this paper and cite their sources.
May inform perioperative decisions in congenital heart disease; extends general algorithms but leaves validation to prospective studies.
Background Children presenting for elective procedures with upper respiratory illness (URI) represent a common clinical dilemma. While several decision algorithms exist to guide perioperative management in the general pediatric surgical population, to our knowledge, no published perioperative decision frameworks specifically address children with congenital heart disease (CHD) presenting for elective procedures with URI, despite their unique physiology and perioperative risk. Methods A review of the pediatric and congenital cardiac anesthesia literature was performed to evaluate established clinical algorithms used to guide decisions to proceed with elective cases requiring anesthesia in children with URIs. We also reviewed the literature assessing risk associated with URI symptoms in children with CHD undergoing procedures requiring anesthesia. Results Several clinical algorithms exist to help clinicians decide whether to proceed with elective procedures in children with URI symptoms. These algorithms emphasize symptom severity, comorbid pulmonary disease, and surgical factors when determining whether to proceed with anesthesia. However, no current decision algorithms address pediatric patients with heart disease. Existing algorithms do not account for these patients’ diverse cardiac physiologies and risks. We propose an algorithm emphasizing the severity of respiratory illness, the patient's cardiac physiology, and selective, deliberate viral testing in specific clinical circumstances. Conclusions Children with cardiac disease undergoing cardiac procedures with URI symptoms represent a unique population not addressed by existing decision algorithms. The proposed algorithm prioritizes clinical examination, the patient's cardiac physiology, and judicious viral testing. This algorithm may reduce postponement of cardiac procedures in this patient population while maintaining favorable clinical outcomes.
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Ricketts et al. (2026) conducted a review in Children with congenital heart disease (CHD) presenting for elective procedures with upper respiratory illness (URI). Proposed clinical algorithm was evaluated. A proposed clinical algorithm for children with congenital heart disease and upper respiratory illness prioritizes clinical examination, cardiac physiology, and judicious viral testing.
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