Objectives
Although neonates and infants undergoing cardiac surgery on cardiopulmonary bypass
(CPB) are at high risk of developing perioperative morbidity and mortality, including
lung injury, the intraoperative profile of lung injury in this cohort is not well-described.
Given that the postoperative course of patients in the pediatric cardiac surgical
arena has become increasingly expedited, the objective of this study was to characterize
the profiles of postoperative mechanical ventilatory support in neonates and infants
undergoing cardiac surgery on CPB and to examine the characteristics of lung mechanics
and lung injury in this patient population who are potentially amendable to early
postoperative recovery in a single tertiary pediatric institution.
Design
A retrospective data analysis of neonates and infants who underwent cardiac surgery
on cardiopulmonary bypass.
Setting
A single-center, university teaching hospital.
Participants
The study included 328 neonates and infants who underwent cardiac surgery on cardiopulmonary
bypass.
Interventions
A subset of 128 patients were studied: 58 patients undergoing ventricular septal defect
(VSD) repair, 36 patients undergoing complete atrioventricular canal (CAVC) repair,
and 34 patients undergoing bidirectional Glenn (BDG) shunt surgery.
Measurements and Main Results
Of the entire cohort, 3.7% experienced in-hospital mortality. Among all surgical procedures,
VSD repair (17.7%) was the most common, followed by CAVC repair (11.0%) and BDG shunt
surgery (10.4%). Of patients who underwent VSD repair, CAVC repair, and BDG shunt
surgery, 65.5%, 41.7%, and 67.6% were off mechanical ventilatory support within 24
hours postoperatively, respectively. In all three of the surgical repairs, lung compliance
decreased after CPB compared to pre-CPB phase. Sixty point three percent of patients
with VSD repair and 77.8% of patients with CAVC repair showed a PaO2/FIO2 (P/F) ratio of <300 after CPB. Post- CPB P/F ratios of 120 for VSD patients and 100
for CAVC patients were considered as optimal cutoff values to highly predict prolonged
(>24 hours) postoperative mechanical ventilatory support. A higher volume of transfused
platelets also was associated with postoperative ventilatory support ≥24 hours in
patients undergoing VSD repair, CAVC repair, and BDG shunt surgery.
Conclusions
There was a high incidence of lung injury after CPB in neonates and infants, even
in surgeries amendable for early recovery. Given that CPB-related factors (CPB duration,
crossclamp time) and volume of transfused platelet were significantly associated with
prolonged postoperative ventilatory support, the underlying cause of cardiac surgery-related
lung injury can be multi-factorial.
Key Words
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Article info
Publication history
Published online: April 25, 2021
Footnotes
Financial support: CHMC Anesthesia Foundation (K.Yuki).
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
