An index for evaluating results in paediatric cardiac intensive care

Abstract

We found that surgery undertaken in the neonatal period, weight below the 5th percentile, the presence of associated clinical risk factors, operations of higher complexity, and more than 90 minutes of cardiopulmonary bypass were all significantly associated with mortality. Our suggested new index showed a linear correlation with mortality, and in our current experience, has proved a valuable tool for predicting adverse outcomes.

Avaliação da aprotinina na redução da resposta inflamatória sistêmica em crianças operadas com circulação extracorpórea

“…The good surgical outcome was reinforced by the clinicalsurgical index, more recently, proposed in Brazil [15], whose scores (5.5 vs. 5) correspond to risks of death from 11.70% to 23.98%, due mainly to the prevalence of low body weight, indicative of malnutrition, and genetic syndromes, pulmonary hypertension and congestive heart failure, which certainly influenced the morbidity. These similar indices and scores of the operated groups confirm the homogeneity needed for analysis, highlighting the variability in the weights, which are incompatible with regard to age, especially due to the nutritional changes resulting from heart diseases.…”

“…Retrospectively, we calculated the index recently proposed by Mattos et al [15] in 2006. The times of use of inotropic and EV vasoactive drugs, time of use of nitric oxide, and duration of stay in PICU in adittion to the elapsed until discharge or death were measured, as well as the duration of mechanical ventilation (MV).…”

“…The 19 patients included in this study were considered, therefore, a representative sample of the population of individuals who present this heart disease and undergo surgery in our hospital, because such population is not large. The newborns were excluded due to their greater propensity to complications of CPB [15] secondary to the intense neuroendocrine response to tissue injury, the large release of cytokines and lower neutrophil response [17] compared to children older than 1 month old.…”

Aprotinina preserva plaquetas em crianças com cardiopatia congênita acianogênica operadas com circulação extracorpórea?

“…Retrospectively, we calculated the index recently proposed by Mattos et al [3] in 2006. The times of use of inotropes, IV vasoactive drugs, nitric oxide, and stay in the PICU and elapsed time until discharge or death were measured as well as the duration of mechanical ventilation (MV)…”

“…Strategies to anticipate them, avoid them or fight them are of intense interest, especially the preoperative scores of risk stratification, the anesthetic and surgical refinement, and the optimization of CPB circuits. The use of Aprotinin (Trasylol®, Bayer Pharmaceuticals Corporation), a nonspecific serine proteases inhibitor, consisting of the polypeptide chain of 6512 Daltons, hydrophilic and basic, was one of these pharmacological strategies, whose hemostatic property reduces blood loss after cardiopulmonary bypass procedure [1][2][3]. Recently, in 2006, Arnold et al [4], in a meta-analysis of 12 randomized studies involving 612 children undergoing CPB, observed, with Aprotinin, 33% reduction in the rate of transfusion.…”