Postoperative Pulmonary Hemodynamics and Systemic Inflammatory Response in Pediatric Patients Undergoing Surgery for Congenital Heart Defects

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art_SOUZA_Postoperative_Pulmonary_Hemodynamics_and_Systemic_Inflammatory_Response_in_2022.PDF (668.34 KB)
Citações na Scopus
3
Tipo de produção
article
Data de publicação
2022
DOI
Scopus
Web of Science
PubMed
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Título do Volume
Editora
HINDAWI LTD
Autores
Citação
MEDIATORS OF INFLAMMATION, v.2022, article ID 3977585, 12p, 2022
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
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/SAP(IPO), 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/SAP(IPO)& LE;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/SAP(IPO)> 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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https://observatorio.fm.usp.br/handle/OPI/46988
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCG
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/08
Artigos e Materiais de Revistas Científicas - LIM/31
Artigos e Materiais de Revistas Científicas - ODS/03