Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

Soares, Leonardo Cavadas da Costa; Ribas, Denise; Spring, R.; Silva, Jean Marcelo Ferreira da; Miyague, Nelson Itiro

doi:10.1590/s0066-782x2010000100019

Cited by 26 publications

(17 citation statements)

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“…Patients suffering from SIRS have a higher risk to develop sepsis [ 28 ], ARDS, disseminated intravascular coagulation, acute renal failure or even die of SIRS [ 27 ]. Moreover, according to our data [ 20 ] and also demonstrated by others, SIRS is associated with both prolonged stay on PICU and extended MV [ 31 ]. In-line filtration represents the first preventive strategy reducing a systemic inflammation and comorbidities on PICU.…”

Section: Discussionsupporting

confidence: 80%

“…Hypothermia, contact of blood with foreign surfaces of the CPB circuit or ischemia–reperfusion injury due to aortic cross-clamping and endotoxins generated by splanchnic hypoperfusion all stimulate multiple inflammatory cascades with humoral and cellular reactions [ 10 ]. SIRS often leads to organ dysfunction or failure [ 9 , 31 ], increased mortality and prolonged stay on intensive care unit (ICU) [ 27 , 31 ]. Numerous strategies have been developed to minimize the inflammatory response to CPB such as corticosteroids, leukocyte depletion, hemofiltration, miniaturized CPB circuits, off-pump surgery and alterations of the coagulation/anticoagulation management [ 6 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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In-line Filtration Decreases Systemic Inflammatory Response Syndrome, Renal and Hematologic Dysfunction in Pediatric Cardiac Intensive Care Patients

et al. 2015

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Cardiac surgery with cardiopulmonary bypass (CPB) frequently leads to systemic inflammatory response syndrome (SIRS) with concomitant organ malfunction. Infused particles may exacerbate inflammatory syndromes since they activate the coagulation cascade and alter inflammatory response or microvascular perfusion. In a randomized, controlled, prospective trial, we have previously shown that particle-retentive in-line filtration prevented major complications in critically ill children. Now, we investigated the effect of in-line filtration on major complications in the subgroup of cardiac patients. Children admitted to tertiary pediatric intensive care unit were randomized to either control or filter group obtaining in-line filtration throughout complete infusion therapy. Risk differences and 95 % confidence intervals (CI) of several complications such as SIRS, sepsis, mortality, various organ failure and dysfunction were compared between both groups using the Wald method. 305 children (n = 150 control, n = 155 filter group) with cardiac diseases were finally analyzed. The majority was admitted after cardiac surgery with CPB. Risk of SIRS (−11.3 %; 95 % CI −21.8 to −0.5 %), renal (−10.0 %; 95 % CI −17.0 to −3.0 %) and hematologic (−8.1 %; 95 % CI −14.2 to −0.2 %) dysfunction were significantly decreased within the filter group. No risk differences were demonstrated for occurrence of sepsis, any other organ failure or dysfunctions between both groups. Infused particles might aggravate a systemic hypercoagulability and inflammation with subsequent organ malfunction in pediatric cardiac intensive care patients. Particle-retentive in-line filtration might be effective in preventing SIRS and maintaining renal and hematologic function. In-line filtration offers a novel therapeutic option to decrease morbidity in cardiac intensive care.Electronic supplementary materialThe online version of this article (doi:10.1007/s00246-015-1157-x) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

In-line Filtration Decreases Systemic Inflammatory Response Syndrome, Renal and Hematologic Dysfunction in Pediatric Cardiac Intensive Care Patients

et al. 2015

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“…Advances in CPB technique have resulted in reducing the stress response inherent to cardiac surgery in children (12, 13, 39–42). Together, smaller circuits and hemofiltration or ZBUF combine to reduce circulating levels of activated leukocytes, decrease transfusion requirements, decrease renal dysfunction, and decrease pulmonary inflammation, assisting with early extubation and improved neurological outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Role of Different Anesthetic Techniques in Altering the Stress Response During Cardiac Surgery in Children

Naguib

Tobias

Hall

et al. 2013

Pediatric Critical Care Medicine

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Objectives Our goal was to evaluate the role of three anesthetic techniques in altering the stress response in children undergoing surgery for repair of congenital heart diseases utilizing cardiopulmonary bypass in the setting of fast tracking or early tracheal extubation. Furthermore, we wanted to evaluate the correlation between blunting the stress response and the perioperative clinical outcomes. Design Prospective, randomized, double-blinded study. Setting Single center from December 2008 to May of 2011. Patients Forty-eight subjects (low-dose fentanyl plus placebo, n = 16; high-dose fentanyl plus placebo, n = 17; low-dose fentanyl plus dexmedetomidine, n = 15) were studied between ages 30 days to 3 years old who were scheduled to undergo repair for a ventricular septal defect, atrioventricular septal defect, or Tetralogy of Fallot. Methods Children undergoing surgical repair of congenital heart disease were randomized to receive low-dose fentanyl (10 mcg/kg; low-dose fentanyl), high-dose fentanyl (25mcg/kg; high-dose fentanyl), or low-dose fentanyl plus dexmedetomidine (as a 1 mcg/kg loading dose followed by infusion at 0.5mcg/kg/hr until separation from cardiopulmonary bypass. In addition, patients received a volatile anesthetic agent as needed to maintain hemodynamic stability. Blood samples were tested for metabolic, hormonal and cytokine markers at baseline, after sternotomy, after the start of cardiopulmonary bypass, at the end of the procedure and at 24 hours postoperatively. Measurements and Main Results Forty-eight subjects (low-dose fentanyl plus placebo, n = 16; high-dose fentanyl plus placebo, n = 17; low-dose fentanyl plus dexmedetomidine, n = 15) were studied. Subjects in the low-dose fentanyl plus placebo group had significantly higher levels of adrenocorticotropic hormone, cortisol, glucose, lactate, and epinephrine during the study period. The lowest levels of stress markers were seen in the high-dose fentanyl plus placebo group both over time (adrenocorticotropic hormone, p = 0.01; glucose, p = 0.007) and at individual time points (cortisol and lactate at the end of surgery, epinephrine poststernotomy; p < 0.05). Subjects in the low-dose fentanyl plus dexmedetomidine group had lower lactate levels at the end of surgery compared with the low-dose fentanyl plus placebo group (p < 0.05). Although there were no statistically significant differences in plasma cytokine levels between the three groups, the low-dose fentanyl plus placebo group had significantly higher interleukin-6:interleukin-10 ratio at 24 hours postoperatively (p < 0.0001). In addition, when compared with the low-dose fentanyl plus placebo group, the low-dose fentanyl plus dexmedetomidine group showed lower norepinephrine level from baseline at poststernotomy, after start of cardiopulmonary bypass, and end of surgery (p ≤ 0.05). Subjects in the low-dose fentanyl plus placebo group had more postoperative narcotic requirement (p = 0.004), higher prothrombin time (p ≤ 0.03), and more postoperative chest tube output (p < ...

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“…Esta pesquisa teve como relevância subsidiar a elaboração de protocolos para a etapa de preparo de instrumentais cirúrgicos limpos. (GERGELY et al, 1997;JOHNSON et al, 2007;McILWAIN et al, 2010;SOARES et al, 2010) (ALFA et al, 1996;CDC, 2008), bem como podem agir como barreira física, protegendo os microrganismos (LEWIS, ARENS,1995).…”

Section: Resumo Introduçãounclassified

“…Considerando-se ainda que a umidade ajuda a transferir os microrganismos da microbiota transitória (MARPLES, TOWERS, 1979;PATRICK, FINDON, MILLER, 1997, SATTAR et al, 2001, e que existe a opção de secagem manual no preparo dos instrumentais, a preocupação com o aumento da carga microbiana nesses produtos fica evidente. (RUUTU et al, 1985;CRITCHLOW et al, 1989;CERIBELLI et al, 1998;WANG et al, 2008;SANTOS et al, 2010) Existem relatos e estudos (GERGELY et al, 1997;JOHNSON et al, 2007;McILWAIN et al, 2010;SOARES et al, 2010) (GERGELY et al, 1997;JOHNSON et al, 2007;McILWAIN et al, 2010;SOARES et al, 2010)…”

Section: Introductionunclassified

O impacto do uso de diferentes tipos de luvas e das mãos nuas na inspeção e preparo do instrumento cirúrgico limpo

Bruna¹

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A minha querida orientadora Profª Drª Kazuko Uchikawa Graziano, por ser responsável pela minha formação como pesquisadora e por ser meu eterno exemplo, pela humildade, dedicação, conhecimento, pelo orgulho que me faz sentir de ser enfermeira e de fazer parte de seu grupo. Ainda me lembro da primeira vez que a ouvi palestrar, pensei "Um dia, quero ser como ela"! A Prof a Maria Clara Padoveze pela imensa perspicácia e lucidez com que avalia os trabalhos do grupo de pesquisa. É sempre um aprendizado ouvi-la! A meu amigo Rafa, pela paciência, por ser incansável na pesquisa e pela imensurável ajuda com a parte citotóxica. A meus amigos do grupo de pesquisa, Flávia, Alda, Giovana, Maíra e Alexandra, pela ajuda incondicional e pelo companheirismo. À toda equipe do Laboratório da Faculdade de Ciências Médicas da Santa Casa, sobretudo, Cely e Suzete, pela realização das leituras microbiológicas e pela paciência e disponibilidade. Ao Núcleo de Cultura de Células do Instituto Adolfo Lutz, especialmente, Doutoras Áurea e Claudia pela realização dos testes de citotoxicidade, pela paciência e presteza com que sempre me atenderam. Ao CME do Hospital Universitário da USP. Em especial, a enfermeira Cristiane, por ceder o espaço e os funcionários para realização de parte da pesquisa. A meu marido Paulo, pela ajuda incondicional, pelo amor e paciência. A meus filhos, Gabriela e Leonardo, por todo o tempo que deixei de estar ao lado deles para que a realização deste estudo pudesse se concretizar. Vocês são o que tenho de mais importante na vida, são meus motivos e minha força. São minha vida e minha alegria! A meus sogros, Sr Paulo e Gilda, pelo apoio e por acreditarem no caminho acadêmico.

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Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

Abstract: Background: The postoperative period of congenital cardiomyopathies correction is frequently accompanied by systemic inflammatory response.

Cited by 26 publications

References 35 publications

In-line Filtration Decreases Systemic Inflammatory Response Syndrome, Renal and Hematologic Dysfunction in Pediatric Cardiac Intensive Care Patients

In-line Filtration Decreases Systemic Inflammatory Response Syndrome, Renal and Hematologic Dysfunction in Pediatric Cardiac Intensive Care Patients

The Role of Different Anesthetic Techniques in Altering the Stress Response During Cardiac Surgery in Children

O impacto do uso de diferentes tipos de luvas e das mãos nuas na inspeção e preparo do instrumento cirúrgico limpo

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