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

2022 ◽  
Vol 2022 ◽  
pp. 1-12
Author(s):  
Maria Francilene S. Souza ◽  
Juliano G. Penha ◽  
Nair Y. Maeda ◽  
Filomena R. B. G. Galas ◽  
Kelly C. O. Abud ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Arterial Pressure ◽  
Pediatric Patients ◽  
Heart Defects ◽  
Pressure Ratio ◽  
Interleukin 1 ◽  
Systemic Inflammatory Response ◽  
Pulmonary Hemodynamics ◽  
Entire Cohort ◽  
Postoperative Serum

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/SAPIPO, 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 / SA P IPO ≤ 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 / SA P 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.

scholarly journals Treatment of systemic inflammatory response syndrome following on-pump pediatric congenital heart surgery

2021 ◽  
Vol 10 (2) ◽  
pp. 113-124
Author(s):  
D. V. Borisenko ◽  
A. A. Ivkin ◽  
D. L. Shukevich
Keyword(s):  
Cardiopulmonary Bypass ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Heart Defects ◽  
Surgical Techniques ◽  
Congenital Heart Surgery ◽  
Systemic Inflammatory Response ◽  
Preventive Strategies

Highlights. The article discusses the pathophysiological aspects of cardiopulmonary bypass and the mechanisms underlying the development of the systemic inflammatory response in children following congenital heart surgery. We summarize and report the most relevant preventive strategies aimed at reducing the systemic inflammatory response, including both, CPB-related methods and pharmacological ones.The growing number of children with congenital heart defects requires the development of more advanced technologies for their surgical treatment. However, cardiopulmonary bypass is required in almost all surgical techniques. Despite the tremendous progress and recent advances in cardiopulmonary bypass techniques, the systemic inflammatory response syndrome associated with these surgeries remains unresolved. The review summarizes the causes and mechanisms underlying its development. The most commonly used preventive strategies are reported, including standard and modified ultrafiltration, leukocyte filters, and pharmacological agents (systemic glucocorticoids, aprotinin, and antioxidants).The role of cardioplegia and hypothermia in the reduction of systemic inflammation is defined. Cardiac surgery centers around the world use a variety of techniques and pharmacological approaches, drawing on the results of randomized clinical studies. However, there are no clear and definite clinical guidelines aimed at reducing the systemic inflammatory response during cardiopulmonary bypass in children. It remains a significant problem for pediatric intensive care by aggravating their postoperative status, prolonging the length of the in-hospital stay, and reducing the survival rates.

Procalcitonin kinetics in pediatric patients with systemic inflammatory response after open heart surgery

2006 ◽  
Vol 32 (6) ◽  
pp. 881-887 ◽  
Author(s):  
Serdar Celebi ◽  
Ozge Koner ◽  
Ferdi Menda ◽  
Huriye Balci ◽  
Alican Hatemi ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Heart Surgery ◽  
Pediatric Patients ◽  
Open Heart Surgery ◽  
Systemic Inflammatory Response ◽  
Open Heart

Oxidative stress precedes peak systemic inflammatory response in pediatric patients undergoing cardiopulmonary bypass operation

2005 ◽  
Vol 38 (10) ◽  
pp. 1323-1332 ◽  
Author(s):  
Stephan Christen ◽  
Barbara Finckh ◽  
Jens Lykkesfeldt ◽  
Peter Gessler ◽  
Manuela Frese-Schaper ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Pediatric Patients ◽  
Systemic Inflammatory Response ◽  
Bypass Operation

Association of Systemic Inflammatory Response Syndrome with Clinical Outcomes of Pediatric Patients with Pneumonia

2015 ◽  
Vol 108 (11) ◽  
pp. 665-669 ◽  
Author(s):  
Steven Barron Frazier ◽  
Robert Sepanski ◽  
Christopher Mangum ◽  
Christine Bovat ◽  
Arno Zaritsky ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Systemic Inflammatory Response

scholarly journals a Phase I Trial of Bendamustine in Combination with Clofarabine and Etoposide in Pediatric Patients with Relapsed or Refractory Hematologic Malignancies

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1628-1628 ◽  
Author(s):  
Sima Jeha ◽  
Monika L. Metzger ◽  
Kristine R Crews ◽  
Patrick Campbell ◽  
Raul C. Ribeiro ◽  
...  
Keyword(s):  
T Cell ◽  
Inflammatory Response ◽  
Hodgkin Lymphoma ◽  
Dose Level ◽  
Pediatric Patients ◽  
Hematologic Malignancies ◽  
Systemic Inflammatory Response ◽  
Cross Resistance ◽  
Combination Regimen ◽  
Platelet Recovery

Abstract Introduction: Bendamustine is an alkylator with anti-metabolite properties that shows incomplete cross resistance with other alkylators such as cyclophosphamide. The combination of cyclophosphamide, clofarabine and etoposide is often used in the treatment of children with relapsed leukemia, most of whom have significant prior exposure to cyclophosphamide. We evaluated the maximum tolerated dose (MTD) and safety profile of bendamustine when used in combination with clofarabine and etoposide in pediatric patients with relapsed or refractory hematologic malignancies. Methods: Patients are eligible if they are younger than 22 years-old, have relapsed or refractory hematologic malignancies following 2 or more prior regimens, and have adequate organ function. Using the rolling 6 design, participants received bendamustine at one of 3 dose levels (escalating doses of 30, 40, or 60mg/m2/day) on Days 1-5 in combination with clofarabine (40 mg/m2/day), etoposide (100 mg/m2/day), and dexamethasone (8 mg/m2/day) daily on Days 1-5. We obtained pharmacokinetic (PK) studies to assess for potential time-dependent changes in bendamustine clearance over the 5 day course in this combination regimen since most PK studies of bendamustine have been conducted in adult patients with dose schedules of 90-120 mg/m2/day for 2 days. Results: Sixteen patients (12 males and 4 females) with median age 11 years (range 4 to 17 years) were enrolled: 10 B-cell acute lymphoblastic leukemia (B-ALL), 1 early T-cell precursor (ETP) leukemia, 1 gamma delta T-cell ALL, 2 Hodgkin lymphoma, and 2 T-cell non-Hodgkin lymphoma. Six patients were treated on dose level 1, six on dose level 2, and four on dose level 3. One patient with hyperleukocytosis died from severe systemic inflammatory response syndrome (SIRS). Dose limiting toxicity was failure to recover peripheral blood counts on Day 42. The recommended dose of bendamustine in this combination is 30mg/m2 daily over 5 days. Ten responses were observed: 6 complete remissions (CR), 1 durable minimal residual disease (MRD)-negative CR without platelet recovery in the patient with ETP-ALL, and 3 partial remissions. Eight patients proceeded to transplant. Nine patients died (5 from progressive disease, 2 from transplant complications, 1 from SIRS and 1 from complications of subsequent salvage chemotherapy). Six patients are alive at a median follow up of 12 months (range 2 to 29 months). Conclusions: Bendamustine is well tolerated in combination with clofarabine and etoposide and shows efficacy in multiple relapsed and refractory hematologic malignancies. Dose reductions on the first day of therapy are warranted in patients at risk of tumor lysis syndrome to avoid severe systemic inflammatory response. Disclosures Bhojwani: Amgen: Other: Blinatumumab global pediatric advisory board 2015.

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