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The systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children
1Department of Anaesthesiology and Institute of Experimental Clinical Research, Aarhus University Hospital, Denmark. vbc@iekf.au.dk
Insights
Pediatric cardiac surgery using cardiopulmonary bypass (CPB) triggers a systemic inflammatory response. Understanding this response in children is crucial for improving outcomes and reducing complications.
Area of Science:
- Pediatric cardiac surgery
- Cardiopulmonary bypass (CPB)
- Systemic inflammatory response
Background:
- Cardiopulmonary bypass (CPB) in pediatric cardiac surgery induces a complex systemic inflammatory response.
- This response involves activation of complement and coagulation systems, cytokine release, and endothelial dysfunction.
- Observed inflammatory markers in pediatric patients differ from adults, necessitating organ-level investigation.
Purpose of the Study:
- To review the systemic inflammatory response following pediatric cardiac surgery with CPB.
- To explore insights from experimental CPB models for a better understanding of pediatric responses.
Main Methods:
- Review of clinical and experimental studies on systemic inflammation after CPB in children.
- Focus on organ-level pathological events and inflammatory mediators.
Main Results:
- CPB elicits significant inflammatory changes including neutrophil and platelet activation.
- Postoperative organ dysfunction, morbidity, and mortality are linked to these inflammatory changes.
- Peripheral blood inflammatory markers in children may not fully represent the systemic response.
Conclusions:
- The systemic inflammatory response to CPB in children is multifaceted and impacts postoperative outcomes.
- Experimental models offer valuable insights into organ-specific inflammatory processes.
- Further research into pediatric-specific inflammatory pathways is warranted to mitigate CPB-related complications.
Abstract:
Paediatric cardiac surgery often requires cardiopulmonary bypass (CPB) during the surgical intervention. CPB is known to elicit a systemic inflammatory response with activation of the complement and coagulation systems, stimulation of cytokine production, cellular entrapment in organs, neutrophil activation with degranulation, platelet activation, and endothelial dysfunction. These changes are associated with a risk of postoperative organ dysfunction and increased morbidity and mortality in the postoperative period. Clinical studies have concentrated on measurement of inflammatory markers and mediators in peripheral blood, where the systemic inflammatory response in the paediatric cardiac patient seems to be different from the adult case. Looking at the organ level, experimental studies have the advantage of providing information contributing to a better understanding of the pathological events that may lead to the deteriorated organ function. This review focuses on the systemic inflammatory response after cardiac surgery with CPB in children and experimental CPB models.