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[Clinical profile of systemic inflammatory response after pediatric cardiac surgery with cardiopulmonary bypass]
Leonardo Cavadas da Costa Soares1, Denise Ribas, Regine Spring
1Hospital Infantil Pequeno Príncipe, PR, Brasil. leo.cavadas@ yahoo.com.br
Insights
Systemic inflammatory response syndrome after cardiopulmonary bypass (SIRS-CPB) affects 21.9% of pediatric cardiac surgery patients. Lower weight and longer CPB duration are risk factors for SIRS-CPB, leading to prolonged recovery.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Postoperative systemic inflammatory response is common after congenital heart defect correction.
- Understanding the incidence and clinical picture of SIRS-CPB in children is crucial.
Purpose of the Study:
- To determine the frequency of systemic inflammatory response syndrome after cardiopulmonary bypass (SIRS-CPB) in pediatric cardiac surgery patients.
- To identify clinical manifestations and predisposing factors associated with SIRS-CPB.
Main Methods:
- Historical cohort study of 101 children under 3 years undergoing corrective surgery for congenital heart disease with CPB.
- Assessment of organ dysfunction using clinical criteria and score tests.
- Comparison of predisposing factors and morbidity between patients with and without SIRS-CPB.
Main Results:
- SIRS-CPB occurred in 21.9% of patients.
- SIRS-CPB patients were younger and lighter, with longer CPB durations.
- SIRS-CPB was associated with longer mechanical ventilation, ICU, and hospital stays.
- Higher weight was a protective factor against SIRS-CPB.
Conclusions:
- Clinical criteria effectively identified a risk group for SIRS-CPB.
- Lower weight and longer CPB duration are predisposing factors for SIRS-CPB.
- SIRS-CPB significantly prolongs recovery, including ventilation and hospitalization times.
Background:
the postoperative period of congenital cardiomyopathies correction is frequently accompanied by systemic inflammatory response.
Objective:
To assess the frequency of occurrence and clinical manifestations of the systemic inflammatory response syndrome after cardiopulmonary bypass (SIRS-CPB) in children submitted to cardiac surgery.
Methods:
Historical cohort study including patients up to 3 years old that were submitted to elective corrective surgeries for congenital cardiopathies with cardiopulmonary bypass (CPB). A total of 101 patients were assessed by means of clinical criteria of organ dysfunction through score tests, as comparing predisponent factors and aggregated morbidity to the presence of SIRS-CPB.
Results:
Twenty-two patients (21.9%) fulfilled the criteria for SIRS-CPB. The sex or type of cardiopathy did not differ between groups (p = NS). Patients diagnosed with SIRS-CPB (compared to patients without SIRS-CPB) presented lower mean age (6.8 +/- 5.5 versus 10.8 +/- 5.1 months, p < 0.05), lower weight (5.3 +/- 1.9 versus 6.9 +/- 2.0 kg, p < 0.05), and longer CPB duration (125.1 +/- 49.5 versus 93.9 +/- 33.1 minutes, p < 0.05). Longer median duration of mechanical ventilation (120.0 versus 13.0 hours, p < 0.05), longer stay in Intensive Care Unit (ICU) (265.0 versus 107.0 hours, p < 0.05) and in hospital (22.0 versus 10.0 days, p < 0.05) were observed. In the multivariate analysis, higher weight (OR = 0.68, p = 0.01) was identified as a protection factor.
Conclusion:
The adopted clinical criteria identified a risk group for SIRS-CPB, which presented lower weight and longer CPB duration as predisponent factors. Patients with SIRS-CPB remain in mechanical ventilation, in ICU and in hospitalization for a longer period of time.
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