SIRS in Cyanotic and Acyanotic Children in Cardiac Surgery
Condition: SIRS; Pediatric Cardiac Surgery
Study type: Observational [Patient Registry]

Summary: 
      Systemic inflammatory response syndrome (SIRS) is frequently observed in children after
      open-heart surgery and has been associated with both cardiopulmonary bypass and surgical
      trauma. Children with congenital cyanotic heart disease (CCHD) have complex changes in all
      blood values and clotting profiles due to chronic hypoxemia. Increased erythrocyte count
      decreases plasma and coagulation factors, platelet count and function. Therefore, blood and
      blood products transfusion may increase during intraoperative and postoperative periods. In
      addition, durations of cardiopulmonary bypass may prolong due to the complex defects of
      children with CCHD. The aim of this study is to investigate postoperative SIRS rates and risk
      factors in cyanotic and acyanotic children undergoing open heart surgery for congenital heart
      disease.
    

Detailed description: 
      Systemic inflammatory response syndrome (SIRS) in adults has been defined as a non-specific
      systemic inflammatory process in the absence of infection, following incidents such as
      trauma, burns, pancreatitis, or major surgery. For children, age-specific SIRS criteria were
      established by the International Pediatric Sepsis Consensus Conference in 2005. SIRS was
      defined as presence of at least two out of four parameters, one of which must be an abnormal
      temperature or leukocyte count. The two other criteria consist of either an elevated heart
      rate or respiratory rate. SIRS is frequently observed in children after open-heart surgery
      and has been associated with both cardiopulmonary bypass and surgical trauma. Following
      cardiac surgery the pathophysiological mechanisms of SIRS involve a cytokine-mediated general
      capillary leakage followed by intravascular volume depletion, generalized edema, circulatory
      compromise, and altered microcirculation. The inflammatory process may further impair the
      function of the lung, myocardium, kidney, liver, intestine, and brain.

      Children with congenital cyanotic heart disease (CCHD) have complex changes in all blood
      values and clotting profiles due to chronic hypoxemia. Increased erythrocyte count decreases
      plasma and coagulation factors, platelet count and function. Therefore, blood and blood
      products transfusion may increase during intraoperative and postoperative periods. In
      addition, durations of cardiopulmonary bypass may prolong due to the complex defects of
      children with CCHD. Previous studies have reported that the duration of CPB and the amount of
      fresh frozen plasma transfusion increase SIRS formation.

      The aim of this study is to investigate postoperative SIRS rates and risk factors in cyanotic
      and acyanotic children undergoing open heart surgery for congenital heart disease.

      Patients aged between 0-16 years and undergoing open heart surgery for cyanotic and acyanotic
      congenital heart disease will be included in the study. Patients with preoperative renal
      failure or hepatic disease will be excluded. Patient's age, weight, comorbidities, details of
      previous operation will be recorded. Preoperative hematocrit value, white blood cell and
      platelet counts, biochemical parameters (blood urea nitrogen, creatinine, electrolyte
      values), diagnosis of CCHD, RACHS1 (risk adjustment for surgery for congenital heart disease)
      will be recorded. In intraoperative period; operation time, CPB time, aortic cross-clamp
      time, circulatory arrest time, body temperature and lowest body temperature reached during
      CPB, cardioplegia amount, The ACT (activated coagulation time), urine amount will be
      recorded. Intraoperative blood gas values, lactate, mean arterial pressure, glucose values
      will be recorded at 30 min intervals. The amount of crystalloid and colloid, erythrocyte,
      fresh frozen plasma, platelet and cryoprecipitate used in intraoperative period will be
      recorded. Heparin and protamine doses administered will be recorded. Vasoactive agents
      (dopamine, dobutamine, adrenaline, nitroglycerine) used in intraoperative period will be
      recorded.

      During the postoperative intensive care period; arterial blood gases and lactate, hematocrit,
      liquid (crystalloid and colloid) and blood products administered will be monitored at 6th,
      24th and 48th hours. The vasoactive agents used, the inotropic score, the amount of urine and
      the use of diuretics will be recorded. Length of stay ICU, duration of mechanical
      ventilation, length of stay hospital will be recorded.

      Diagnosis of SIRS; in the postoperative period, the age-specific SIRS criteria determined by
      the International Pediatric Sepsis Consensus Conference will be used. Patients will be
      evaluated for the diagnosis of SIRS at postoperative 6th, 12th, 24th and 48th hours. SIRS
      rates and risk factors in cyanotic and acyanotic patients will be determined.
    

Intervention name(s): Sevoflurane
Intervention type(s): Drug
Intervention description(s): Sevoflurane inhalation for anesthesia
Intervention MeSH terms: Sevoflurane
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Pediatric patients with congenital heart disease