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Published on: July 18, 2014
Bioactive Oxylipins in Infants and Children With Congenital Heart Disease Undergoing Pediatric Cardiopulmonary Bypass
Nahmah Kim-Campbell1, Catherine Gretchen1, Vladimir B Ritov2
1Department of Critical Care Medicine, UPMC and University of Pittsburgh, Pittsburgh, PA.
Insights
Hydroxyoctadecadienoic acids (9-HODE and 13-HODE) increased during cardiopulmonary bypass in children and correlated with plasma hemoglobin and vasoactivity markers. These may indicate inflammatory effects and impact clinical outcomes.
Area of Science:
- Biochemistry and Molecular Biology
- Cardiovascular Surgery
- Pediatric Critical Care
Background:
- Cardiopulmonary bypass (CPB) in pediatric cardiac surgery can lead to systemic inflammation and organ dysfunction.
- Hydroxyoctadecadienoic acids (HODEs) are lipid peroxidation products with potential bioactive roles.
Purpose of the Study:
- To determine the production of 9-hydroxyoctadecadienoic acid (9-HODE) and 13-hydroxyoctadecadienoic acid (13-HODE) during pediatric CPB.
- To evaluate the association of HODEs with cell-free plasma hemoglobin, inflammation, vasoactivity, and clinical outcomes.
- To explore HODEs as potential biomarkers or therapeutic targets in CPB-related complications.
Main Methods:
- Prospective observational study in a pediatric cardiac ICU.
- Plasma samples collected from 34 children (1 month to 18 years) at the start and end of CPB.
- Measurements included 9-HODE, 13-HODE, plasma hemoglobin, white blood cell (WBC) count, and vasoactive-inotropic score (VIS).
Main Results:
- 9-HODE and 13-HODE, plasma hemoglobin, and WBC count increased during CPB.
- HODEs correlated with VIS, milrinone use, and WBC count, suggesting bioactivity.
- HODEs and plasma hemoglobin changes were associated with increased ICU/hospital length of stay and mechanical ventilation duration.
Conclusions:
- Pediatric CPB is associated with increased HODEs, which correlate with plasma hemoglobin and markers of inflammation and vasoactivity.
- HODEs may contribute to CPB-related dysfunction and represent a potential therapeutic target.
- Further research is needed to elucidate the role of HODEs in pediatric CPB outcomes.
Objectives:
To determine the production of 9-hydroxyoctadecadienoic acid and 13-hydroxyoctadecadienoic acid during cardiopulmonary bypass in infants and children undergoing cardiac surgery, evaluate their relationship with increase in cell-free plasma hemoglobin, provide evidence of bioactivity through markers of inflammation and vasoactivity (WBC count, milrinone use, vasoactive-inotropic score), and examine their association with overall clinical burden (ICU/hospital length of stay and mechanical ventilation duration).
Design:
Prospective observational study.
Setting:
Twelve-bed cardiac ICU in a university-affiliated children's hospital.
Patients:
Children were prospectively enrolled during their preoperative clinic appointments with the following criteria: greater than 1 month to less than 18 years old, procedures requiring cardiopulmonary bypass INTERVENTIONS:: None.
Measurements And Main Results:
Plasma was collected at the start and end of cardiopulmonary bypass in 34 patients. 9-hydroxyoctadecadienoic acid, 13-hydroxyoctadecadienoic acid, plasma hemoglobin, and WBC increased. 9:13-hydroxyoctadecadienoic acid at the start of cardiopulmonary bypass was associated with vasoactive-inotropic score at 2-24 hours postcardiopulmonary bypass (R = 0.25; p < 0.01), milrinone use (R = 0.17; p < 0.05), and WBC (R = 0.12; p < 0.05). 9:13-hydroxyoctadecadienoic acid at the end of cardiopulmonary bypass was associated with vasoactive-inotropic score at 2-24 hours (R = 0.17; p < 0.05), 24-48 hours postcardiopulmonary bypass (R = 0.12; p < 0.05), and milrinone use (R = 0.19; p < 0.05). 9:13-hydroxyoctadecadienoic acid at the start and end of cardiopulmonary bypass were associated with the changes in plasma hemoglobin (R = 0.21 and R = 0.23; p < 0.01). The changes in plasma hemoglobin was associated with milrinone use (R = 0.36; p < 0.001) and vasoactive-inotropic score less than 2 hours (R = 0.22; p < 0.01), 2-24 hours (R = 0.24; p < 0.01), and 24-48 hours (R = 0.48; p < 0.001) postcardiopulmonary bypass. Cardiopulmonary bypass duration, 9:13-hydroxyoctadecadienoic acid at start of cardiopulmonary bypass, and plasma hemoglobin may be risk factors for high vasoactive-inotropic score. Cardiopulmonary bypass duration, changes in plasma hemoglobin, 9:13-hydroxyoctadecadienoic acid, and vasoactive-inotropic score correlate with ICU and hospital length of stay and/mechanical ventilation days.
Conclusions:
In low-risk pediatric patients undergoing cardiopulmonary bypass, 9:13-hydroxyoctadecadienoic acid was associated with changes in plasma hemoglobin, vasoactive-inotropic score, and WBC count, and may be a risk factor for high vasoactive-inotropic score, indicating possible inflammatory and vasoactive effects. Further studies are warranted to delineate the role of hydroxyoctadecadienoic acids and plasma hemoglobin in cardiopulmonary bypass-related dysfunction and to explore hydroxyoctadecadienoic acid production as a potential therapeutic target.
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