[Evaluation of the postoperative systemic response in congenital heart defects].


Different postoperative prognostic markers have been identified in patients that have undergone congenital heart defect surgery, such as venous oxygen saturation and lactate levels. Cardiac surgery with extracorporeal circulation (ECC) produces an inflammatory response consisting of hyperglycaemia and elevated C-reactive protein (CRP) and troponin (Tp) levels. The purpose of this study was to determine the impact of these parameters on postoperative morbidity. We conducted a prospective observational study of a cohort of 101 patients in a paediatric intensive care unit (ICU). The inclusion criteria were: (a) age more than 1 month and (b) surgery with ECC. The exclusion criteria were: (a) refusal to give informed consent and (b) use of corticosteroids or insulin. The preoperative variables were type of heart defect and surgical risk (RACHS-1). The postoperative variables were glycaemia (mg/dL), CRP (mg/L), and Tp (ng/L). Four venous blood samples were collected in order to measure these variables, at admission, at 4 and 8 h from admission, and at 8 am the following morning. Troponin was determined with the high sensitivity cardiac troponin T assay, and a level above 100 ng/L was considered pathological. We also measured other variables, such as duration of mechanical ventilation and length of ICU stay. We classified the patients according to the RACHS-1 scoring system, and attributed to them a high surgical complexity (HSC) when their RACHS-1 score was higher than or equal to 3. We defined sustained hyperglycaemia (SHG) as glycaemia higher than 126 mg/dL in all four measurements. We defined prolonged mechanical ventilation (PMV) as a duration higher than or equal to 72 h; and a prolonged stay (PS) as a length of stay higher than or equal to 5 days. A total of 22 children (22%) presented SHG associated with a PS (chi square = 7.3; P < .05). The patients with the highest levels of Tp were the ones that had PMV (Mann--Whitney = 161; P < .001) and a PS (Mann--Whitney = 518; P < .001). We also found a direct correlation between Tp levels and duration of mechanical ventilation (r = 0.7; P < .01) (Fig. 1) and length of stay (r = 0.5; P < .01). The most frequent mean value of the RACHS-1 was category 3 (42%). The RACHS-1 score was correlated with the duration of mechanical ventilation (r = 0.5; P < .01), and HSC

DOI: 10.1016/j.anpedi.2014.12.009

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Cite this paper

@article{GarcaHernndez2015EvaluationOT, title={[Evaluation of the postoperative systemic response in congenital heart defects].}, author={Juan A Garc{\'i}a-Hern{\'a}ndez and M Fern{\'a}ndez-El{\'i}as and Adoraci{\'o}n I Mart{\'i}nez-L{\'o}pez and Aurelio Cayuela-Dom{\'i}nguez and J Cano-Franco}, journal={Anales de pediatria}, year={2015}, volume={82 6}, pages={435-6} }