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Prognostic indicators after cardiac surgery in children and their relationship with the oxidative stress response
R Gil-Gómez1, J Blasco-Alonso2, R Castillo-Martín3
1Unidad de Gestión Clínica de Cuidados Críticos y Urgencias Pediátricos, Hospital Regional Universitario de Málaga, Málaga, España.
Insights
Paediatric cardiovascular surgery increases oxidative stress markers like malondialdehyde, while decreasing antioxidant glutathione. Longer surgical times correlate with greater oxidative stress and inflammatory response syndrome, impacting recovery.
Area of Science:
- Biochemistry
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Oxidative stress is a significant concern in pediatric patients undergoing cardiovascular surgery.
- Lipid peroxidation and antioxidant responses are key indicators of this stress.
Purpose of the Study:
- To analyze trends in lipid peroxidation and antioxidant response after pediatric cardiovascular surgery.
- To compare these markers with clinical prognostic indicators.
Main Methods:
- Prospective study of 30 children (1 month-14 years) undergoing cardiopulmonary bypass.
- Measured malondialdehyde (lipid peroxidation) and total glutathione (antioxidant response) preoperatively and postoperatively.
- Assessed clinical variables for systemic inflammatory response syndrome (SIRS).
Main Results:
- Malondialdehyde levels increased, and glutathione levels decreased post-surgery.
- Strong correlation between extracorporeal circulation time and glutathione decrease.
- Postoperative glutathione levels correlated with mechanical ventilation duration and SIRS.
Conclusions:
- Cardiopulmonary bypass in children activates inflammatory mediators, peaking after aortic clamping.
- Oxidative stress levels are dependent on surgical duration.
- SIRS development is linked to longer ventilation, ICU stay, and surgical times; higher glutathione indicates less inflammation.
Objectives:
To analyse the trend in lipid peroxidation and antioxidant response as key markers of oxidative stress after paediatric cardiovascular surgery, and compare them with other internationally accepted clinical prognostic indicators.
Patients And Methods:
A prospective study was conducted on 30 children aged one month to 14 years, weight>5 kg, undergoing cardiopulmonary bypass surgery. Blood samples were taken just before the intervention, immediately after surgery, and after 18-20 h. Cell membrane lipid peroxidation was analysed by quantifying malondialdehyde, as well as measuring total glutathione (oxidized and reduced), as representatives of antioxidant response. An analysis was also performed on clinical variables for establishing a score for the systemic inflammatory response syndrome associated with cardiopulmonary bypass.
Results:
The study included 30 children with a mean age of 4.1 years old (interquartile range [IQR]: 2.7; 8.0). Of these, 62.1% were girls. The standard deviation of the median weight was -0.39 (IQR: -0.76; 0.24), the median height was -0.22 (IQR: -0.74; 0.27), and the median BMI was -0.43 (IQR: -1; 0.45). The final surgery times were divided into 2 parts: total time of extracorporeal circulation, with a mean of 79 min (IQR: 52.5; 125.5), and the clamping time, a measurement included in the previous figure with a mean value of 38.5 min (IQR: 22; 59). Malondialdehyde increased and glutathione decreased in postoperative time, with clear, statistically significant direct correlation between time of extracorporeal circulation and percentage decrease in total glutathione between preoperative and immediate postoperative time, and a decline between the preoperative and late postoperative. There was a statistical correlation between total glutathione levels at 18-20 h postoperatively and the duration of mechanical ventilation and inflammatory systemic response syndrome.
Conclusions:
Surgery with extracorporeal circulation performed in children activates inflammatory mediators, being maximum after aortic clamping, and improving after the first 24h. The level of oxidative stress activation depends on surgical times. The development of systemic inflammatory response syndrome is associated with longer duration of mechanical ventilation, longer stay in intensive care, higher scores in the Aristotle model and longer surgical times. Those who do not meet criteria for inflammatory response have higher levels of glutathione in first 24h.
