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Published on: November 26, 2018
Postoperative Pulmonary Hemodynamics and Systemic Inflammatory Response in Pediatric Patients Undergoing Surgery for
Maria Francilene S Souza1, Juliano G Penha1, Nair Y Maeda2
1Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil.
Insights
Postoperative pulmonary hemodynamics and inflammation are linked in pediatric heart surgery patients. Early monitoring of pulmonary/systemic arterial pressure ratio and inflammatory markers can predict adverse cardiopulmonary events.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
- Immunology
Background:
- Limited data exists on the interplay between postoperative pulmonary hemodynamics, inflammation, and clinical outcomes in pediatric patients undergoing surgery for congenital heart defects.
- Pediatric patients with congenital cardiac communications are at risk for postoperative pulmonary hypertension.
Purpose of the Study:
- To investigate the relationship between early postoperative pulmonary hemodynamics, systemic inflammatory response, and clinical outcomes in pediatric patients at risk for pulmonary hypertension after cardiac surgery.
Main Methods:
- Prospective study of 40 pediatric patients (median age 11 months) with congenital cardiac communications at risk for pulmonary hypertension.
- Monitored pulmonary/systemic mean arterial pressure ratio (PAP/SAPIPO) in the early postoperative period.
- Assessed serum levels of 15 inflammatory markers and mean platelet volume.
Main Results:
- Immediate postoperative PAP/SAPIPO correlated with intraoperative measurements (r = 0.68, p < 0.001).
- Patients with PAP/SAPIPO > 0.40 exhibited elevated pre- and postoperative levels of granulocyte colony-stimulating factor, interleukin-1 receptor antagonist, interleukin-6, and interleukin-21, along with increased mean platelet volume.
- Elevated PAP/SAPIPO (> 0.40) and high macrophage migration inhibitory factor levels predicted significant postoperative cardiopulmonary events.
Conclusions:
- Early postoperative pulmonary hemodynamics and systemic inflammation are closely interconnected in pediatric cardiac surgery patients.
- The early postoperative PAP/SAP ratio and specific inflammatory markers serve as valuable predictors of adverse cardiopulmonary outcomes.
Abstract:
There is scarce information about the relationships between postoperative pulmonary hemodynamics, inflammation, and outcomes in pediatric patients with congenital cardiac communications undergoing surgery. We prospectively studied 40 patients aged 11 (8-17) months (median with interquartile range) with a preoperative mean pulmonary arterial pressure of 48 (34-54) mmHg who were considered to be at risk for postoperative pulmonary hypertension. The immediate postoperative pulmonary/systemic mean arterial pressure ratio (PAP/SAPIPO, mean of first 4 values obtained in the intensive care unit, readings at 2-hour intervals) was correlated directly with PAP/SAP registered in the surgical room just after cardiopulmonary bypass (r = 0.68, p < 0.001). For the entire cohort, circulating levels of 15 inflammatory markers changed after surgery. Compared with patients with PAP/SAPIPO ≤ 0.40 (n = 22), those above this level (n = 18) had increased pre- and postoperative serum levels of granulocyte colony-stimulating factor (p = 0.040), interleukin-1 receptor antagonist (p = 0.020), interleukin-6 (p = 0.003), and interleukin-21 (p = 0.047) (panel for 36 human cytokines) and increased mean platelet volume (p = 0.018). Using logistic regression analysis, a PAP/SAPIPO > 0.40 and a heightened immediate postoperative serum level of macrophage migration inhibitory factor (quartile analysis) were shown to be predictive of significant postoperative cardiopulmonary events (respective hazard ratios with 95% CIs, 5.07 (1.10-23.45), and 3.29 (1.38-7.88)). Thus, the early postoperative behavior of the pulmonary circulation and systemic inflammatory response are closely related and can be used to predict outcomes in this population.
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