Endothelial-Dependent Vasomotor Dysfunction in Infants After Cardiopulmonary Bypass
| Autor: | Ryan J. Stark, David P. Bichell, Luke T Krispinsky, John B. Pietsch, Liming Luan, David A. Parra, Fred S. Lamb |
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| Rok vydání: | 2020 |
| Předmět: |
Heart Defects
Congenital medicine.medical_specialty Endothelium Vasodilator Agents Pilot Projects 030204 cardiovascular system & hematology Nitric Oxide Critical Care and Intensive Care Medicine Severity of Illness Index Article Microcirculation law.invention 03 medical and health sciences Postoperative Complications 0302 clinical medicine law Internal medicine medicine Cardiopulmonary bypass Humans Prospective Studies Cardiac Surgical Procedures Endothelial dysfunction Child Prospective cohort study Cardiopulmonary Bypass Vasomotor business.industry Infant 030208 emergency & critical care medicine medicine.disease Acetylcholine Vasomotor System medicine.anatomical_structure Cardiovascular Diseases Child Preschool Pediatrics Perinatology and Child Health Vascular resistance Cardiology Cytokines Vascular Resistance Endothelium Vascular business Perfusion Biomarkers |
| Zdroj: | Pediatr Crit Care Med |
| ISSN: | 1529-7535 |
| DOI: | 10.1097/pcc.0000000000002049 |
| Popis: | Objectives Cardiopulmonary bypass-induced endothelial dysfunction has been inferred by changes in pulmonary vascular resistance, alterations in circulating biomarkers, and postoperative capillary leak. Endothelial-dependent vasomotor dysfunction of the systemic vasculature has never been quantified in this setting. The objective of the present study was to quantify acute effects of cardiopulmonary bypass on endothelial vasomotor control and attempt to correlate these effects with postoperative cytokines, tissue edema, and clinical outcomes in infants. Design Single-center prospective observational cohort pilot study. Setting Pediatric cardiac ICU at a tertiary children's hospital. Patients Children less than 1 year old requiring cardiopulmonary bypass for repair of a congenital heart lesion. Intervention None. Measurements and main results Laser Doppler perfusion monitoring was coupled with local iontophoresis of acetylcholine (endothelium-dependent vasodilator) or sodium nitroprusside (endothelium-independent vasodilator) to quantify endothelial-dependent vasomotor function in the cutaneous microcirculation. Measurements were obtained preoperatively, 2-4 hours, and 24 hours after separation from cardiopulmonary bypass. Fifteen patients completed all laser Doppler perfusion monitor (Perimed, Jarfalla, Sweden) measurements. Comparing prebypass with 2-4 hours postbypass responses, there was a decrease in both peak perfusion (p = 0.0006) and area under the dose-response curve (p = 0.005) following acetylcholine, but no change in responses to sodium nitroprusside. Twenty-four hours after bypass responsiveness to acetylcholine improved, but typically remained depressed from baseline. Conserved endothelial function was associated with higher urine output during the first 48 postoperative hours (R = 0.43; p = 0.008). Conclusions Cutaneous endothelial dysfunction is present in infants immediately following cardiopulmonary bypass and recovers significantly in some patients within 24 hours postoperatively. Confirmation of an association between persistent endothelial-dependent vasomotor dysfunction and decreased urine output could have important clinical implications. Ongoing research will explore the pattern of endothelial-dependent vasomotor dysfunction after cardiopulmonary bypass and its relationship with biochemical markers of inflammation and clinical outcomes. |
| Databáze: | OpenAIRE |
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