Sepsis in the Pediatric Cardiac Intensive Care Unit

Derek S. Wheeler; Howard E. Jeffries; Jerry J. Zimmerman; Hector R. Wong; Joseph A. Carcillo

doi:10.1177/2150135111403781

Sepsis in the Pediatric Cardiac Intensive Care Unit

Derek S. Wheeler^*, Howard E. Jeffries, Jerry J. Zimmerman, Hector R. Wong, Joseph A. Carcillo

^*Corresponding author for this work

Pediatrics

Research output: Contribution to journal › Article › peer-review

25 Scopus citations

Abstract

The survival rate for children with congenital heart disease (CHD) has increased significantly coincident with improved techniques in cardiothoracic surgery, cardiopulmonary bypass and myocardial protection, and perioperative care. Cardiopulmonary bypass, likely in combination with ischemia—reperfusion injury, hypothermia, and surgical trauma, elicits a complex, systemic inflammatory response that is characterized by activation of the complement cascade, release of endotoxin, activation of leukocytes and the vascular endothelium, and release of proinflammatory cytokines. This complex inflammatory state causes a transient immunosuppressed state, which may increase the risk of hospital-acquired infection in these children. Postoperative sepsis occurs in nearly 3% of children undergoing cardiac surgery and has been associated with longer length of stay and mortality risks in the pediatric cardiac intensive care unit. Herein, we review the epidemiology, pathobiology, and management of sepsis in the pediatric cardiac intensive care unit.

Original language	English (US)
Pages (from-to)	393-399
Number of pages	7
Journal	World Journal for Pediatric and Congenital Heart Surgery
Volume	2
Issue number	3
DOIs	https://doi.org/10.1177/2150135111403781
State	Published - Jul 2011

Funding

ACCP American College of Chest Physicians AKI acute kidney injury CA-BSIs catheter-associated bloodstream infections CA-UTIs catheter-associated urinary tract infections CHD congenital heart disease CI confidence interval CICU cardiac intensive care unit GM-CSF granulocyte-macrophage colony-stimulating factor HAIs hospital-acquired infections LPS lipopolysaccharide MODS multiple organ dysfunction syndrome RR relative risk SCCM Society of Critical Care Medicine SIRS systemic inflammatory response syndrome SSIs surgical site infections ScvO 2 superior vena cava oxygen saturation VARIs ventilator-associated respiratory infections Presented at the Eighth International Meeting of The Pediatric Cardiac Intensive Care Society, Miami, USA, December 8–11, 2010. The author(s) declared no conflicts of interest with respect to the authorship and/or publication of this article. The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: the National Institutes of Health, 5KO8GM077432 (DSW).

Keywords

PIRO
congenital heart disease
immunoparalysis
pediatric cardiac surgery
pediatrics
sepsis
septic shock
severe sepsis
systemic inflammatory response syndrome (SIRS)

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Surgery
Pediatrics, Perinatology, and Child Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1177/2150135111403781

Cite this

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title = "Sepsis in the Pediatric Cardiac Intensive Care Unit",

abstract = "The survival rate for children with congenital heart disease (CHD) has increased significantly coincident with improved techniques in cardiothoracic surgery, cardiopulmonary bypass and myocardial protection, and perioperative care. Cardiopulmonary bypass, likely in combination with ischemia—reperfusion injury, hypothermia, and surgical trauma, elicits a complex, systemic inflammatory response that is characterized by activation of the complement cascade, release of endotoxin, activation of leukocytes and the vascular endothelium, and release of proinflammatory cytokines. This complex inflammatory state causes a transient immunosuppressed state, which may increase the risk of hospital-acquired infection in these children. Postoperative sepsis occurs in nearly 3% of children undergoing cardiac surgery and has been associated with longer length of stay and mortality risks in the pediatric cardiac intensive care unit. Herein, we review the epidemiology, pathobiology, and management of sepsis in the pediatric cardiac intensive care unit.",

keywords = "PIRO, congenital heart disease, immunoparalysis, pediatric cardiac surgery, pediatrics, sepsis, septic shock, severe sepsis, systemic inflammatory response syndrome (SIRS)",

author = "Wheeler, {Derek S.} and Jeffries, {Howard E.} and Zimmerman, {Jerry J.} and Wong, {Hector R.} and Carcillo, {Joseph A.}",

note = "Funding Information: ACCP American College of Chest Physicians AKI acute kidney injury CA-BSIs catheter-associated bloodstream infections CA-UTIs catheter-associated urinary tract infections CHD congenital heart disease CI confidence interval CICU cardiac intensive care unit GM-CSF granulocyte-macrophage colony-stimulating factor HAIs hospital-acquired infections LPS lipopolysaccharide MODS multiple organ dysfunction syndrome RR relative risk SCCM Society of Critical Care Medicine SIRS systemic inflammatory response syndrome SSIs surgical site infections ScvO 2 superior vena cava oxygen saturation VARIs ventilator-associated respiratory infections Presented at the Eighth International Meeting of The Pediatric Cardiac Intensive Care Society, Miami, USA, December 8–11, 2010. The author(s) declared no conflicts of interest with respect to the authorship and/or publication of this article. The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: the National Institutes of Health, 5KO8GM077432 (DSW). ",

year = "2011",

month = jul,

doi = "10.1177/2150135111403781",

language = "English (US)",

volume = "2",

pages = "393--399",

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issn = "2150-1351",

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AU - Jeffries, Howard E.

AU - Zimmerman, Jerry J.

AU - Wong, Hector R.

AU - Carcillo, Joseph A.

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N2 - The survival rate for children with congenital heart disease (CHD) has increased significantly coincident with improved techniques in cardiothoracic surgery, cardiopulmonary bypass and myocardial protection, and perioperative care. Cardiopulmonary bypass, likely in combination with ischemia—reperfusion injury, hypothermia, and surgical trauma, elicits a complex, systemic inflammatory response that is characterized by activation of the complement cascade, release of endotoxin, activation of leukocytes and the vascular endothelium, and release of proinflammatory cytokines. This complex inflammatory state causes a transient immunosuppressed state, which may increase the risk of hospital-acquired infection in these children. Postoperative sepsis occurs in nearly 3% of children undergoing cardiac surgery and has been associated with longer length of stay and mortality risks in the pediatric cardiac intensive care unit. Herein, we review the epidemiology, pathobiology, and management of sepsis in the pediatric cardiac intensive care unit.

AB - The survival rate for children with congenital heart disease (CHD) has increased significantly coincident with improved techniques in cardiothoracic surgery, cardiopulmonary bypass and myocardial protection, and perioperative care. Cardiopulmonary bypass, likely in combination with ischemia—reperfusion injury, hypothermia, and surgical trauma, elicits a complex, systemic inflammatory response that is characterized by activation of the complement cascade, release of endotoxin, activation of leukocytes and the vascular endothelium, and release of proinflammatory cytokines. This complex inflammatory state causes a transient immunosuppressed state, which may increase the risk of hospital-acquired infection in these children. Postoperative sepsis occurs in nearly 3% of children undergoing cardiac surgery and has been associated with longer length of stay and mortality risks in the pediatric cardiac intensive care unit. Herein, we review the epidemiology, pathobiology, and management of sepsis in the pediatric cardiac intensive care unit.

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KW - immunoparalysis

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KW - severe sepsis

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Sepsis in the Pediatric Cardiac Intensive Care Unit

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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