8
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea Translated title: Clinical profile of systemic inflammatory response after pediatric cardiac surgery with cardiopulmonary bypass Translated title: Perfil clínico de la respuesta inflamatoria sistémica tras cirugía cardiaca pediátrica con circulación extracorpórea

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          FUNDAMENTO: O pós-operatório de correção de cardiopatias congênitas frequentemente é acompanhado por resposta inflamatória sistêmica. OBJETIVO: Avaliar a frequência e as manifestações clínicas da síndrome de resposta inflamatória sistêmica após circulação extracorpórea (SRIS-CEC) em crianças submetidas à cirurgia cardíaca. MÉTODOS: Coorte histórico incluindo pacientes com até 3 anos de idade, submetidos à correção cirúrgica eletiva de cardiopatias congênitas com utilização de circulação extracorpórea (CEC). Foram analisados 101 pacientes por meio de critérios clínicos de disfunção de órgãos sob forma de escore, comparando-se fatores predisponentes e morbidade agregada à presença de SRIS-CEC. RESULTADOS: Foram identificados 22 pacientes (21,9%) que preencheram os critérios estabelecidos para SRIS-CEC. O sexo ou tipo de cardiopatia não diferiu entre os grupos (p =NS). Pacientes com SRIS-CEC (comparados aos pacientes sem SRIS-CEC) apresentavam idade média menor (6,8 ± 5,5 vs. 10,8 ± 5,1 meses, p < 0,05), menor peso (5,3 ± 1,9 vs. 6,9 ± 2,0 quilogramas, p < 0,05), maior tempo CEC (125,1 ± 49,5 vs. 93,9 ± 33,1 minutos, p < 0,05). Observou-se respectivamente maior tempo em mediana de ventilação mecânica (120,0 vs. 13,0 horas, p < 0,05), maior tempo de internação em unidade de cuidados intensivos (UCI) (265,0 vs. 107,0 horas, p < 0,05) e internação hospitalar (22,0 vs. 10,0 dias, p < 0,05). Em análise multivariada, maior peso (OR = 0,68, p = 0,01) foi identificado como fator de proteção. CONCLUSÃO: Os critérios clínicos adotados identificaram um grupo de risco para SRIS-CEC. Esse grupo tem como fatores predisponentes: menor peso e maior tempo de CEC. Pacientes com SRIS-CEC permanecem maior tempo em ventilação mecânica, internados em unidade de cuidados intensivos e em hospital.

          Translated abstract

          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.

          Translated abstract

          FUNDAMENTO: El postoperatorio de corrección de cardiopatías congénitas está acompañado frecuentemente por una respuesta inflamatoria sistémica. OBJETIVO: Evaluar la frecuencia y las manifestaciones clínicas del síndrome de respuesta inflamatoria sistémica tras la circulación extracorpórea (SRIS-CEC) en niños sometidos a una cirugía cardiaca. MÉTODOS: Cohorte histórica de pacientes con hasta 3 años de edad, sometidos a la corrección quirúrgica electiva de cardiopatías congénitas con utilización de circulación extracorpórea (CEC). Fueron analizados 101 pacientes mediante criterios clínicos de disfunción de órganos bajo forma de escore, comparando factores predisponentes y morbilidad agregada a la presencia de SRIS-CEC. RESULTADOS: Fueron identificados 22 pacientes (21,9%) que cumplieron los criterios establecidos para el SRIS-CEC. El sexo o tipo de cardiopatía no difirió entre los grupos (p =NS). Pacientes con SRIS-CEC (comparados a los pacientes sin SRIS-CEC) presentaban un menor promedio de edad (6,8 ± 5,5 vs 10,8 ± 5,1 meses, p < 0,05), menor peso (5,3 ± 1,9 vs 6,9 ± 2,0 kilogramos, p < 0,05), mayor tiempo de CEC (125,1 ± 49,5 vs 93,9 ± 33,1 minutos, p < 0,05). Se observó respectivamente mayor tiempo promedio de ventilación mecánica (120,0 vs 13,0 horas, p < 0,05), mayor tiempo de internación en unidad de cuidados intensivos (UCI) (265,0 vs 107,0 horas, p < 0,05) e internación hospitalaria (22,0 vs 10,0 días, p < 0,05). En el análisis multivariado, el mayor peso (OR = 0,68, p = 0,01) fue identificado como factor de protección. CONCLUSIÓN: Los criterios clínicos adoptados identificaron un grupo de riesgo para SRIS-CEC. Ese grupo tiene como factores predisponentes: menor peso y mayor tiempo de CEC. Pacientes con SRIS-CEC permanecen mayor tiempo en ventilación mecánica, internados en unidad de cuidados intensivos y en hospital.

          Related collections

          Most cited references33

          • Record: found
          • Abstract: found
          • Article: not found

          Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest.

          The neurological morbidity associated with prolonged periods of circulatory arrest has led some cardiac surgical teams to promote continuous low-flow cardiopulmonary bypass as an alternative strategy. The nonneurological postoperative effects of both techniques have been previously studied only in a limited fashion. We compared the hemodynamic profile (cardiac index and systemic and pulmonary vascular resistances), intraoperative and postoperative fluid balance, and perioperative course after deep hypothermia and support consisting predominantly of total circulatory arrest or low-flow cardiopulmonary bypass in a randomized, single-center trial. Eligibility criteria included a diagnosis of transposition of the great arteries and a planned arterial switch operation before the age of 3 months. Of the 171 patients, 129 (66 assigned to circulatory arrest and 63 to low-flow bypass) had an intact ventricular septum and 42 (21 assigned to circulatory arrest and 21 to low-flow bypass) had an associated ventricular septal defect. There were 3 (1.8%) hospital deaths. Patients assigned to low-flow bypass had significantly greater weight gain and positive fluid balance compared with patients assigned to circulatory arrest. Despite the increased weight gain in the infants assigned to low-flow bypass, the duration of mechanical ventilation, stay in the intensive care unit, and hospital stay were similar in both groups. Hemodynamic measurements were made in 122 patients. During the first postoperative night, the cardiac index decreased (32.1 +/- 15.4%, mean +/- SD), while pulmonary and systemic vascular resistance increased. The measured cardiac index was < 2.0 L.min-1.m-2 in 23.8% of the patients, with the lowest measurement typically occurring 9 to 12 hours after surgery. Perfusion strategy assignment was not associated with postoperative hemodynamics or other nonneurological postoperative events. After heart surgery in neonates and infants, both low-flow bypass and circulatory arrest perfusion strategies have comparable effects on the nonneurological postoperative course and hemodynamic profile.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia.

            Complement activation during cardiopulmonary bypass (CPB) surgery is considered to result from interaction of blood with the extracorporeal circuit. We investigated whether additional mechanisms may contribute to complement activation during and after CPB and, in particular, focused on a possible role of the acute-phase protein C-reactive protein (CRP). In 19 patients enrolled for myocardial revascularization, perioperative and postoperative levels of complement activation products, interleukin-6 (IL-6), CRP, and complement-CRP complexes, reflecting CRP-mediated complement activation in vivo, were measured and related to clinical symptoms. A biphasic activation of complement was observed. The ratio between the areas under the curve of perioperative and postoperative C3b/c and C4b/c were 3:2 and 1:46, respectively. IL-6 levels reached a maximum at 6 hours post-surgery. CRP levels peaked on the second postoperative day. Each complement-CRP complex had peak levels on the second or third postoperative day. By multivariate analysis, maximum levels of CRP on the second postoperative day were mainly explained by C4b/c levels after protamine administration, leukocyte count on the second postoperative day, and preoperative levels of CRP. Peak levels of C4b/c after protamine administration (P=.0073) and on the second postoperative day correlated with the occurrence of arrhythmia on the same day (P=.0065). Cardiac surgery with CPB causes a biphasic complement activation. The first phase occurs during CPB and results from the interaction of blood with the extracorporeal circuit. The second phase, which occurs during the first 5 days after surgery, involves CRP, is related to baseline CRP levels, and is associated with clinical symptoms such as arrhythmia.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Pulmonary dysfunction after cardiac surgery.

              Postoperative lung injury is one of the most frequent complications of cardiac surgery that impacts significantly on health-care expenditures and largely has been believed to result from the use of cardiopulmonary bypass (CPB). However, recent comparative studies between conventional and off-pump coronary artery bypass grafting have indicated that CPB itself may not be the major contributor to the development of postoperative pulmonary dysfunction. In our study, we review the associated physiologic, biochemical, and histologic changes, with particular reference to the current understanding of underlying mechanisms. Intraoperative modifications aiming at limiting lung injury are discussed. The potential benefits of maintaining ventilation and pulmonary artery perfusion during CPB warrant further investigation.
                Bookmark

                Author and article information

                Journal
                abc
                Arquivos Brasileiros de Cardiologia
                Arq. Bras. Cardiol.
                Sociedade Brasileira de Cardiologia - SBC (São Paulo, SP, Brazil )
                0066-782X
                1678-4170
                January 2010
                : 94
                : 1
                : 127-133
                Affiliations
                [02] PR orgnameUniversidade Federal do Paraná Curitiba Brasil
                [01] PR orgnameHospital Infantil Pequeno Príncipe Brasil
                Article
                S0066-782X2010000100019 S0066-782X(10)09400119
                7d415e28-970b-476c-9727-8e960d32cbb0

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 10 March 2008
                : 26 January 2009
                : 12 May 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 33, Pages: 7
                Categories
                Artigos Originais

                thoracic surgery,circulação extracorpórea,cirurgia cardíaca,Síndrome de resposta inflamatória sistêmica,circulación extracorpórea,cirugía cardiaca,Síndrome de respuesta inflamatoria sistémica,cardiopulmonary bypass,Systemic inflammatory response syndrome

                Comments

                Comment on this article