Effect of perfusate oxygenation on inflammatory response in congenital heart disease children from low versus high altitude

Liu, Hong; Hu, Yi-Jin; Zheng, Siming; Chen, Tao; Zeng, Zhipeng; Wu, Dongdong; Zhao, Shuang; Zeng, Bin; Liu, Zhigang; Shao, Yongfeng

doi:10.1016/j.jtcvs.2020.05.108

Cited by 6 publications

(7 citation statements)

References 28 publications

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“…Meanwhile, this study provides clinical evidence with regard to the relationship of hypoxic‐reoxygenation injury with cardiovascular disorder. Therefore, the results of this study suggest that the control and modulation of reoxygenation should not be limited to the initial CPB stage, but also be extended to the whole CPB process in the treatment of cyanotic CHD 19,20 …”

Section: Discussionmentioning

confidence: 96%

Association of perfusate oxygenation with cardiovascular disorder in tetralogy of fallot children: A nested case–control study

Liu

Zhang

et al. 2021

Journal of Cardiac Surgery

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Background: Little is known regarding whether hyperoxic reoxygenation was associated with higher risk of cardiovascular disorder following tetralogy of Fallot repair. Methods:We performed a nested case-control study among patients aged 1 month-18 years undergoing complete repair of tetralogy of Fallot in 2012-2018.We measured the highest perfusate oxygenation (PpO2) during aortic occlusion in 107 cardiovascular disorder cases and in 321 controls matched 1:3 to the cases on date of surgery, sex, and area of residence. We analyzed the association between PpO2 and outcome using multivariable conditional logistic regression adjusted for covariates. We further identified and integrated the risk covariates to build prediction nomograms. Results: Cases had higher percentage of exposure to PpO2 > 200 mmHg (86.0% vs. 76.1%, p = .019) than controls. Patients with PpO2 > 200 mmHg had an increased risk of cardiovascular disorder compared to those with PpO2 ≤ 200 mmHg (odd ratio [OR] = 2.075, 95% confidence interval [CI] = 1.035, 4.158, p = .039) adjusted for matching, clinical and procedural covariates. Categorical PpO2, lower body mass index, lower SpO2, untreated minor aortopulmonary collateral arteries, high immediately postoperative central venous pressure, and longer cardiopulmonary bypass time were independent risk factors for cardiovascular disorder (all p < .05). Combining PpO2 nomogram slightly improved discrimination compared with covariate-based nomogram alone for training cohort (area under receiver operating characteristic curve [AUC] = 0.768 vs. 0.761) and for internal validation (AUC = 0.759 vs. 0.753). Conclusion:Our findings suggest association exists between high PpO2 during aortic occlusion and cardiovascular disorder risk, and nomogram integrating clinical and procedural factors may be useful in management of patients with tetralogy of Fallot.

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Section: Discussionmentioning

confidence: 96%

Association of perfusate oxygenation with cardiovascular disorder in tetralogy of fallot children: A nested case–control study

Liu

Zhang

et al. 2021

Journal of Cardiac Surgery

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“…The primary outcome variable was severe systemic inflammatory response syndrome (SIRS), which we defined as the time of onset of SIRS from admission to the intensive care unit (ICU), postoperative day 5, or discharge [ 10 ]. According to the definition of pediatric SIRS or sepsis, as well as the diagnostic criteria used clinically in our center, severe SIRS is defined by the satisfaction of four criteria below: (1) Body temperature over 38 or under 36 degrees Celsius; (2) Mean heart rate > 2 standard deviations (SD) beyond normal for age; (2) Mean respiratory rate > 2 SD above normal for age; (3) Elevated or reduced age-specific leukocyte count or > 10% immature neutrophils [ 3 , 11 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

Effect of CPB glucose levels on inflammatory response after pediatric cardiac surgery

Zeng

Liu

et al. 2022

BMC Cardiovasc Disord

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Background Systemic inflammatory response syndrome (SIRS) is a common complication after cardiac surgery. There are no definite optimal glycemic threshold for pediatric patients receiving open-heart surgery with CPB. The study aimed to investigate the optimal cardiopulmonary bypass (CPB) glucose in patients undergoing cardiac surgery. Methods We enrolled children with congenital heart disease who underwent surgical repair between June 2012 and December 2020. We included only patients who underwent cardiac surgery with CPB. The primary outcome was severe SIRS. A two-piece-wise regression model was applied to examine threshold effect of CPB glucose on severe SIRS. Results A total of 7350 patients were enrolled in the present study, of whom 3895 (52.99%) are female. After potential confounders were adjusted, non-linear relationship was detected between CPB glucose and severe SIRS, whose turning point was 8.1. With CPB glucose < 8.1 mmol/L, the estimated dose–response curve was consistent with a horizontal line. However, the prevalence of severe SIRS increased with increasing glucose up to the turning point (Glucose > 8.1 mmol/L); the odds ratio (OR) of the Glucose was 1.35 (95% CI 1.21, 1.50). Conclusions The present study indicates the association of CPB glucose with inflammatory response after pediatric cardiac surgery. The patients might have the best outcomes with the optimal CPB glucose no more than 8.1 mmol/L.

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“…Most children undergoing complex congenital heart repairs at altitude can tolerate early extubation in the operating room 32 . Interestingly, children born and residing at high altitude who undergo cardiopulmonary bypass appear to have a lower incidence of inflammatory response with higher levels of perfusate oxygenation on bypass, while those from low elevations had a greater likelihood of SIRS with higher PpO2 33 …”

Section: Pediatric Conditions and High Altitudementioning

confidence: 99%

Respiratory physiology at high altitude and considerations for pediatric patients

Bebic

Peterson

Polaner

2022

Pediatric Anesthesia

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There are over 150 million people that live at altitudes over 2500 m.More than half live in Asia and roughly one quarter in the Andes.A much greater number live at moderate altitudes of over 1500 m, and many people who live at low elevations come to high-altitude locations for recreation. A sizable percentage of these populations are children. Many physiological differences occur at moderate or high altitude that affect the health of this population, can affect the delivery of anesthetics in these locations, and can alter the reaction of our patients to anesthesia. This monograph will discuss the basics of altitude physiology and pathophysiology, how these affect the delivery of anesthetics, and some of the issues specific to pediatric patients in the high-altitude environment.As early as the mid-19th century, it has been appreciated that the administration of anesthesia at high altitudes poses a unique set of challenges, requiring the anesthesiologist to have an awareness and appreciation for both the physiologic adaptations and pharmacologic nuances that occur in a hypoxic environment. Firth provides a fascinating account of early anesthetics administered at high altitude. 1

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Effect of perfusate oxygenation on inflammatory response in congenital heart disease children from low versus high altitude

Cited by 6 publications

References 28 publications

Association of perfusate oxygenation with cardiovascular disorder in tetralogy of fallot children: A nested case–control study

Association of perfusate oxygenation with cardiovascular disorder in tetralogy of fallot children: A nested case–control study

Effect of CPB glucose levels on inflammatory response after pediatric cardiac surgery

Respiratory physiology at high altitude and considerations for pediatric patients

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