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Systemic inflammation increases energy expenditure following pediatric cardiopulmonary bypass
Alejandro A Floh1, Masayuki Nakada, Gustavo La Rotta
11Labatt Family Heart Centre, Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada. 2Labatt Family Heart Centre, Division of Cardiology, Cardiac Critical Care, Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada. 3Labatt Family Heart Centre, Division of Cardiology, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada. 4Labatt Family Heart Centre, Division of Cardiovascular Surgery, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
Resting energy expenditure (REE) decreases after pediatric cardiac surgery. Higher REE in children is linked to increased inflammation and cardiac output, and inversely related to anti-inflammatory treatments.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular surgery
- Metabolic research
Background:
- Pediatric cardiac surgery often involves cardiopulmonary bypass (CPB), which can trigger systemic inflammation.
- Understanding the metabolic response, specifically resting energy expenditure (REE), post-CPB is crucial for patient management.
Purpose of the Study:
- To investigate the association between CPB-related systemic inflammation and REE in pediatric patients after cardiac surgery.
- To identify factors influencing REE in this vulnerable population.
Main Methods:
- A prospective cohort study was conducted in a pediatric cardiac critical care unit.
- REE was measured using indirect calorimetry and the modified Weir equation via respiratory mass spectrometry for up to 72 hours post-CPB.
- Plasma interleukin-6 (IL-6), glucose delivery, feeding status, and cardiac output were monitored.
Main Results:
- 111 children undergoing CPB surgery were studied.
- REE decreased from 51 kcal/kg/d to 45 kcal/kg/d post-CPB.
- Increased plasma IL-6 (p=0.001) and higher cardiac output (p<0.0001) were positively associated with REE.
- Preoperative methylprednisolone use was inversely associated with REE (p=0.003).
Conclusions:
- Pediatric REE post-CPB typically ranges from 40-60 kcal/kg/d and declines over time.
- REE is directly associated with inflammation and cardiac output, and inversely with anti-inflammatory strategies.
- Further research is needed to optimize caloric delivery in pediatric cardiac surgery patients.
Objectives:
To examine the association between cardiopulmonary bypass-related systemic inflammation and resting energy expenditure in pediatric subjects following cardiac surgery.
Design:
Single-center, prospective cohort study.
Setting:
Pediatric cardiac critical care unit in Toronto, Canada.
Patients:
Children with congenital heart disease undergoing cardiopulmonary bypass surgery.
Interventions:
Resting energy expenditure was determined by indirect calorimetry and the modified Weir equation, using VO2 and VCO2 measured by in-line respiratory mass spectrometry. Measurements were taken at baseline and 6-hour intervals from separation from cardiopulmonary bypass for a maximum of 72 hours. Plasma interleukin-6, glucose delivery, feeding status, and cardiac output (calculated by Fick equation) were monitored at each resting energy expenditure measurement.
Measurements And Main Results:
We studied 111 subjects at a median (interquartile range) age of 5.3 months (0.8-10.5 mo), weighing 5.7 kg (3.9-8.1 kg), of whom 88% underwent biventricular repair. Resting energy expenditure decreased from 51 kcal/kg/d to 45 kcal/kg/d during the study period. Resting energy expenditure was positively associated with increased plasma interleukin-6 (estimate variable, 1.76; p = 0.001) and inversely associated with preoperative methylprednisolone use (estimate variable, -6.7; p = 0.003) even after accounting for other predictors. Increase in cardiac output was also associated (estimate variable, 13.7; p < 0.0001) with higher resting energy expenditure.
Conclusions:
Resting energy expenditure ranges between 40 and 60 kcal/kg/d and decreases progressively in children following cardiopulmonary bypass surgery. It is directly associated with increased inflammation and higher cardiac output and inversely associated with anti-inflammatory strategies. Further studies are required to predict the appropriate caloric delivery in this cohort.
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