학술논문
Effect of preoperative pulmonary hemodynamic and cardiopulmonary bypass on lung function in children with congenital heart disease.
Document Type
Academic Journal
Author
Simonato M; Department of Women's and Children's Health, University of Padova, Corso Stati Uniti 4, 35127, Padua, Italy.; PCare Laboratory, Fondazione Istituto Di Ricerca Pediatrica, 'Città Della Speranza', Padua, Italy.; Padalino M; Pediatric and Congenital Cardiac Surgical Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.; Vedovelli L; Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy.; Carollo C; Anesthesiology and Intensive Care Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy.; Sartori A; Department of Women's and Children's Health, University of Padova, Corso Stati Uniti 4, 35127, Padua, Italy. anna.sartori.10@phd.unipd.it.; Vida V; Pediatric and Congenital Cardiac Surgical Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.; Gregori D; Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy.; Carnielli V; Division of Neonatology, Polytechnic University of Marche and 'G. Salesi' Children's Hospital, Ancona, Italy.; Cogo P; Department of Medicine, University Hospital S. Maria Della Misericordia, University of Udine, Udine, Italy.
Source
Publisher: Springer Verlag Country of Publication: Germany NLM ID: 7603873 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1076 (Electronic) Linking ISSN: 03406199 NLM ISO Abbreviation: Eur J Pediatr Subsets: MEDLINE
Subject
Language
English
Abstract
In children with congenital heart disease (CHD), pulmonary blood flow (Qp) contributes to alterations of pulmonary mechanics and gas exchange, while cardiopulmonary bypass (CPB) induces lung edema. We aimed to determine the effect of hemodynamics on lung function and lung epithelial lining fluid (ELF) biomarkers in biventricular CHD children undergoing CPB. CHD children were classified as high Qp (n = 43) and low Qp (n = 17), according to preoperative cardiac morphology and arterial oxygen saturation. We measured ELF surfactant protein B (SP-B) and myeloperoxidase activity (MPO) as indexes of lung inflammation and ELF albumin as index of alveolar capillary leak in tracheal aspirate (TA) samples collected before surgery and in 6 hourly intervals within 24 h after surgery. At the same time points, we recorded dynamic compliance and oxygenation index (OI). The same biomarkers were measured in TA samples collected from 16 infants with no cardiorespiratory diseases at the time of endotracheal intubation for elective surgery. Preoperative ELF biomarkers in CHD children were significantly increased than those found in controls. In the high Qp, ELF MPO and SP-B peaked 6 h after surgery and tended to decrease afterward, while they tended to increase within the first 24 h in the low Qp. ELF albumin peaked 6 h after surgery and decreased afterwards in both CHD groups. Dynamic compliance/kg and OI significantly improved after surgery only in the High Qp. Conclusion: In CHD children, lung mechanics, OI, and ELF biomarkers were significantly affected by CPB, according to the preoperative pulmonary hemodynamics. What is Known: • Congenital heart disease children, before cardiopulmonary run, exhibit changes in respiratory mechanics, gas exchange, and lung inflammatory biomarkers that are related to the preoperative pulmonary hemodynamics. • Cardiopulmonary bypass induces alteration of lung function and epithelial lining fluid biomarkers according to preoperative hemodynamics. What is New: • Our findings can help to identify children with congenital heart disease at high risk of postoperative lung injury who may benefit of tailored intensive care strategies, such as non-invasive ventilation techniques, fluid management, and anti-inflammatory drugs that can improve cardiopulmonary interaction in the perioperative period.
(© 2023. The Author(s).)
(© 2023. The Author(s).)