Intraoperative Hyperglycemia and Postoperative Bacteremia in the Pediatric Cardiac Surgery Patient

O’Brien, James E.; Marshall, Jennifer; Tarrants, M.; Stroup, Richard E.; Lofland, Gary K.

doi:10.1016/j.athoracsur.2009.10.054

Cited by 13 publications

(12 citation statements)

References 29 publications

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“…However, only those readily available at the bedside were included in the analyses, and these were subsequently dichotomized (into a yes/no variable) using accepted thresholds from the literature. The eligible variables were age less than 6 months [2, 4, 9–11, 13, 14, 16]; preoperative admission at the PICU [3, 4, 9, 10, 13, 16]; surgical complexity [2–4, 10, 15]; previous cardiac surgery with the use of CPB [3, 4, 10, 14]; duration of surgery (timed from first incision until closure) greater than 3 h [9, 14]; CPB duration greater than 2 h [2, 3, 9, 14, 17, 18]; lowest nasopharyngeal temperature less than 25°C [16, 19, 20]; use of inotropes [2, 11, 13], endotracheal tube [5, 11, 13, 14], open sternum, and rethoracotomy [2, 3, 5, 12, 14, 16]; PICU stay longer than 48 h postoperatively [2, 3, 5, 6, 11, 13]; red blood cell transfusion (total of intra- and postoperative transfusion) greater than 50 mL/kg [3, 11, 14, 16, 17]; and peak glucose greater than 10 mmol/L in the first 24 h postoperatively [21, 22]. Surgical complexity was the only variable to be categorized into three groups, which was a simplified version of the RACHS-1 and Aristotle score [23, 24].…”

Section: Methodsmentioning

confidence: 99%

Bedside prediction rule for infections after pediatric cardiac surgery

et al. 2012

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PurposeInfections after pediatric cardiac surgery are a common complication, occurring in up to 30% of cases. The purpose of this study was to develop a bedside prediction rule to estimate the risk of a postoperative infection.MethodsAll consecutive pediatric cardiac surgery procedures between April 2006 and May 2009 were retrospectively analyzed. The primary outcome variable was any postoperative infection, as defined by the Center of Disease Control (2008). All variables known to the clinician at the bedside at 48 h post cardiac surgery were included in the primary analysis, and multivariable logistic regression was used to construct a prediction rule.ResultsA total of 412 procedures were included, of which 102 (25%) were followed by an infection. Most infections were surgical site infections (26% of all infections) and bloodstream infections (25%). Three variables proved to be most predictive of an infection: age less than 6 months, postoperative pediatric intensive care unit (PICU) stay longer than 48 h, and open sternum for longer than 48 h. Translation into prediction rule points yielded 1, 4, and 1 point for each variable, respectively. Patients with a score of 0 had 6.6% risk of an infection, whereas those with a maximal score of 6 had a risk of 57%. The area under the receiver operating characteristic curve was 0.78 (95% confidence interval 0.72–0.83).ConclusionsA simple bedside prediction rule designed for use at 48 h post cardiac surgery can discriminate between children at high and low risk for a subsequent infection.

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Section: Methodsmentioning

confidence: 99%

Bedside prediction rule for infections after pediatric cardiac surgery

et al. 2012

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“…25,31 Hyperglycemia has been associated with a high incidence of postoperative infections in both the pediatric and adult cardiac surgery population. 32,33 Increasing blood glucose concentrations have been shown to dampen innate immunologic processes. 34 In contrast to findings in our unpublished adult study, elevated blood glucose levels were not identified as potential risk factors for developing BSI in this cohort of children on HPN.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

Mohammed

Zhao

Shane

et al. 2011

J Parenter Enteral Nutr

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Background: Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter‐associated bloodstream infections (CA‐BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA‐BSI in children receiving HPN are limited. Objective: To determine the incidence and characteristics of CA‐BSI in children receiving HPN. Methods: Medical records of 44 children receiving HPN during a 3‐year period were reviewed. End points were CA‐BSI during the initial 6 months after discharge. CA‐BSI was defined as isolation of pathogens from blood requiring antimicrobial therapy. Results: The primary indication for HPN was short bowel syndrome (46%), and 59 BSI were documented during the initial 6 months of HPN in 29 (66%) children. Of CA‐BSI, polymicrobial infections accounted for 52%; gram‐positive, 29%; gram‐negative, 17%; and fungal, 2%. CA‐BSI incidence per 1000 catheter‐days was highest during the first month posthospital discharge (72 episodes; 95% confidence interval [CI], 45.4–109.6). CA‐BSI incidence density ratio for children receiving HPN for >90 days compared with those receiving HPN for <30 days was 2.2 (P < .05). Logistic regression revealed that Medicaid insurance and age <1 year were associated with increased risk for CA‐BSI (odds ratio [OR], 4.4 [95% CI, 1.13–16.99] and 6.6 [1.50–28.49], respectively; P < .05). Conclusions: The incidence of CA‐BSI in children receiving HPN is highest during the first month posthospital discharge. Strategies to address care in the immediate posthospital discharge period may reduce the burden of infectious complications of HPN.

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“…68,69 Cardiopulmonary bypass is thought to result in SH through a combination of inflammatory cytokine release, vasoactive infusion use, pancreatic β-cell dysfunction, hypothermia with insulin resistance, and steroid use. 68 While some studies have demonstrated the association of SH with poor outcomes in children undergoing cardiac surgery 14,29,30,69,70 , other studies have not shown any impact of SH on long-term neurodevelopmental outcomes following cardiac surgery involving CPB. [71][72][73] Similar to CPB, ECLS is also associated with development of SH in critically ill children.…”

Section: Cardiopulmonary Bypass/extracorporeal Life Support and Stresmentioning

confidence: 99%

“…[10][11][12][13][14][15][16] Additionally, SH is associated with longer periods of ICU and hospital stay and more frequent nosocomial infections, including surgical site infections in critically ill children. [2][3][4][5][6]29,30 While all these studies demonstrate strong associations between SH and poor clinical outcomes, they do not necessarily demonstrate a cause and effect relationship, because SH tends to be more marked in patients with greater illness severity. Table 1 summarizes key pediatric studies that have examined the association between SH and mortality in critically ill children.…”

Section: Stress Hyperglycemia In Pediatric Critical Illnessmentioning

confidence: 99%

Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress!

Srinivasan

2012

J Diabetes Sci Technol

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Abbreviations: (BG), blood glucose, (CBP) cardiopulmonary bypass, (EN) enteral nutrition, (ECLS) extracorporeal life support, (FFA) free fatty acids, (GIR) glucose infusion rate, (GLUT) glucose transporter protein, (GH) growth hormone, (IGF-1) insulin-like growth factor-1, (ICU) intensive care unit, (IL-1) interleukin-1, (IL-6) interleukin-6, (PN) parenteral nutrition, (ROS) reactive oxygen species, (RRT) renal replacement therapy, (SH) stress hyperglycemia, (TGC) tight glucose control, (TNF-α) tumor necrosis factor-α

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Intraoperative Hyperglycemia and Postoperative Bacteremia in the Pediatric Cardiac Surgery Patient

Cited by 13 publications

References 29 publications

Bedside prediction rule for infections after pediatric cardiac surgery

Bedside prediction rule for infections after pediatric cardiac surgery

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress!

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