Children undergoing heart transplant are at increased risk for postoperative vasodilatory shock

James S. Killinger, Daphne T. Hsu, Charles L. Schleien, Ralph S. Mosca, George E. Hardart

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective: To determine the incidence of vasodilatory shock (VDS) in children after cardiopulmonary bypass (CPB), and to describe this syndrome of post-CPB VDS in children. Design: Prospective, observational. Setting: Pediatric and neonatal intensive care units in a tertiary care, children's hospital. Patients: Three hundred children undergoing CPB. nterventions: None. Measurements and Main Results: Three hundred subjects undergoing CPB were evaluated for clinical evidence of VDS following CPB. The incidence of post-CPB VDS was 3%. Characteristics of children who developed VDS: higher peak lactate (6.2 ± 2.6 vs. 3.0 ± 2.1 mmol/L; p = 0.0002), higher peak serum blood urea nitrogen (18.5 ± 4.6 vs. 15.6 ± 7.2 mg/dL; p = 0.04), lower urine output (1.7 ± 0.8 vs. 2.6 ± 0.2 mL/kg/hr; p = 0.04), and fewer intensive care unit free days (14.9 ± 9.0 vs. 21.1 ± 7.2 days; p = 0.01). Univariate predictors for the development of post-CPB VDS included children who had heart transplantation (HT) (relative risk [RR], 9.8; 95% confidence interval [CI], 2.7-35.2) or ventricular assist device (VAD) placed (RR, 17.9; 95% CI, 3.8-84.1), a cardiomyopathy diagnosis (RR, 8.5; 95% CI, 2.3-31), age >12 years (RR, 4.5; 95% CI, 1.2-17.0), CPB time >180 minutes (RR, 7.1; 95% CI, 1.9-26.2), and preoperative ventricular dysfunction (RR, 3.7; 95% CI, 1.0-13.4). By stratified analysis, the only independent predictor for the development of VDS was undergoing HT/VAD. Conclusions: Post-CPB VDS is uncommon in children. However, children who undergo HT or VAD placement are at high risk for developing post-CPB VDS. Recognition that the overall incidence of post-CPB is low-except in the HT/VAD population-may help guide therapy in the pediatric post-CPB patient.

Original languageEnglish (US)
Pages (from-to)335-340
Number of pages6
JournalPediatric Critical Care Medicine
Volume10
Issue number3
DOIs
StatePublished - May 1 2009
Externally publishedYes

Fingerprint

Cardiopulmonary Bypass
Shock
Transplants
Heart-Assist Devices
Confidence Intervals
Heart Transplantation
Incidence
Ventricular Dysfunction
Pediatric Intensive Care Units
Blood Urea Nitrogen
Neonatal Intensive Care Units
Tertiary Healthcare
Cardiomyopathies
Intensive Care Units
Lactic Acid
Urine
Pediatrics

Keywords

  • Cardiopulmonary bypass
  • Heart transplantation
  • Pediatric
  • Shock

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Children undergoing heart transplant are at increased risk for postoperative vasodilatory shock. / Killinger, James S.; Hsu, Daphne T.; Schleien, Charles L.; Mosca, Ralph S.; Hardart, George E.

In: Pediatric Critical Care Medicine, Vol. 10, No. 3, 01.05.2009, p. 335-340.

Research output: Contribution to journalArticle

Killinger, James S. ; Hsu, Daphne T. ; Schleien, Charles L. ; Mosca, Ralph S. ; Hardart, George E. / Children undergoing heart transplant are at increased risk for postoperative vasodilatory shock. In: Pediatric Critical Care Medicine. 2009 ; Vol. 10, No. 3. pp. 335-340.
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abstract = "Objective: To determine the incidence of vasodilatory shock (VDS) in children after cardiopulmonary bypass (CPB), and to describe this syndrome of post-CPB VDS in children. Design: Prospective, observational. Setting: Pediatric and neonatal intensive care units in a tertiary care, children's hospital. Patients: Three hundred children undergoing CPB. nterventions: None. Measurements and Main Results: Three hundred subjects undergoing CPB were evaluated for clinical evidence of VDS following CPB. The incidence of post-CPB VDS was 3{\%}. Characteristics of children who developed VDS: higher peak lactate (6.2 ± 2.6 vs. 3.0 ± 2.1 mmol/L; p = 0.0002), higher peak serum blood urea nitrogen (18.5 ± 4.6 vs. 15.6 ± 7.2 mg/dL; p = 0.04), lower urine output (1.7 ± 0.8 vs. 2.6 ± 0.2 mL/kg/hr; p = 0.04), and fewer intensive care unit free days (14.9 ± 9.0 vs. 21.1 ± 7.2 days; p = 0.01). Univariate predictors for the development of post-CPB VDS included children who had heart transplantation (HT) (relative risk [RR], 9.8; 95{\%} confidence interval [CI], 2.7-35.2) or ventricular assist device (VAD) placed (RR, 17.9; 95{\%} CI, 3.8-84.1), a cardiomyopathy diagnosis (RR, 8.5; 95{\%} CI, 2.3-31), age >12 years (RR, 4.5; 95{\%} CI, 1.2-17.0), CPB time >180 minutes (RR, 7.1; 95{\%} CI, 1.9-26.2), and preoperative ventricular dysfunction (RR, 3.7; 95{\%} CI, 1.0-13.4). By stratified analysis, the only independent predictor for the development of VDS was undergoing HT/VAD. Conclusions: Post-CPB VDS is uncommon in children. However, children who undergo HT or VAD placement are at high risk for developing post-CPB VDS. Recognition that the overall incidence of post-CPB is low-except in the HT/VAD population-may help guide therapy in the pediatric post-CPB patient.",
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AU - Killinger, James S.

AU - Hsu, Daphne T.

AU - Schleien, Charles L.

AU - Mosca, Ralph S.

AU - Hardart, George E.

PY - 2009/5/1

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N2 - Objective: To determine the incidence of vasodilatory shock (VDS) in children after cardiopulmonary bypass (CPB), and to describe this syndrome of post-CPB VDS in children. Design: Prospective, observational. Setting: Pediatric and neonatal intensive care units in a tertiary care, children's hospital. Patients: Three hundred children undergoing CPB. nterventions: None. Measurements and Main Results: Three hundred subjects undergoing CPB were evaluated for clinical evidence of VDS following CPB. The incidence of post-CPB VDS was 3%. Characteristics of children who developed VDS: higher peak lactate (6.2 ± 2.6 vs. 3.0 ± 2.1 mmol/L; p = 0.0002), higher peak serum blood urea nitrogen (18.5 ± 4.6 vs. 15.6 ± 7.2 mg/dL; p = 0.04), lower urine output (1.7 ± 0.8 vs. 2.6 ± 0.2 mL/kg/hr; p = 0.04), and fewer intensive care unit free days (14.9 ± 9.0 vs. 21.1 ± 7.2 days; p = 0.01). Univariate predictors for the development of post-CPB VDS included children who had heart transplantation (HT) (relative risk [RR], 9.8; 95% confidence interval [CI], 2.7-35.2) or ventricular assist device (VAD) placed (RR, 17.9; 95% CI, 3.8-84.1), a cardiomyopathy diagnosis (RR, 8.5; 95% CI, 2.3-31), age >12 years (RR, 4.5; 95% CI, 1.2-17.0), CPB time >180 minutes (RR, 7.1; 95% CI, 1.9-26.2), and preoperative ventricular dysfunction (RR, 3.7; 95% CI, 1.0-13.4). By stratified analysis, the only independent predictor for the development of VDS was undergoing HT/VAD. Conclusions: Post-CPB VDS is uncommon in children. However, children who undergo HT or VAD placement are at high risk for developing post-CPB VDS. Recognition that the overall incidence of post-CPB is low-except in the HT/VAD population-may help guide therapy in the pediatric post-CPB patient.

AB - Objective: To determine the incidence of vasodilatory shock (VDS) in children after cardiopulmonary bypass (CPB), and to describe this syndrome of post-CPB VDS in children. Design: Prospective, observational. Setting: Pediatric and neonatal intensive care units in a tertiary care, children's hospital. Patients: Three hundred children undergoing CPB. nterventions: None. Measurements and Main Results: Three hundred subjects undergoing CPB were evaluated for clinical evidence of VDS following CPB. The incidence of post-CPB VDS was 3%. Characteristics of children who developed VDS: higher peak lactate (6.2 ± 2.6 vs. 3.0 ± 2.1 mmol/L; p = 0.0002), higher peak serum blood urea nitrogen (18.5 ± 4.6 vs. 15.6 ± 7.2 mg/dL; p = 0.04), lower urine output (1.7 ± 0.8 vs. 2.6 ± 0.2 mL/kg/hr; p = 0.04), and fewer intensive care unit free days (14.9 ± 9.0 vs. 21.1 ± 7.2 days; p = 0.01). Univariate predictors for the development of post-CPB VDS included children who had heart transplantation (HT) (relative risk [RR], 9.8; 95% confidence interval [CI], 2.7-35.2) or ventricular assist device (VAD) placed (RR, 17.9; 95% CI, 3.8-84.1), a cardiomyopathy diagnosis (RR, 8.5; 95% CI, 2.3-31), age >12 years (RR, 4.5; 95% CI, 1.2-17.0), CPB time >180 minutes (RR, 7.1; 95% CI, 1.9-26.2), and preoperative ventricular dysfunction (RR, 3.7; 95% CI, 1.0-13.4). By stratified analysis, the only independent predictor for the development of VDS was undergoing HT/VAD. Conclusions: Post-CPB VDS is uncommon in children. However, children who undergo HT or VAD placement are at high risk for developing post-CPB VDS. Recognition that the overall incidence of post-CPB is low-except in the HT/VAD population-may help guide therapy in the pediatric post-CPB patient.

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