Mods in children after cardiac surgery with extracorporeal circulation

Abstract

Introduction: Cardiac surgery with extracorporeal circulation (ECC) is associated with systemic inflammatory response (SIRS) that can evolve up to multiple organ dysfunction syndrome (MODS) and death. Children are at increased risk o f developing MODS, due to the particularities related to ECC and immature organ systems. The mortality is directly correlated to the number of failed organ system s: 30-40% if one organ system fails, 50-60% if two organ systems fail and 80- 100% when three or more organ systems fail. Purpose and Objectives: Determination of incidence and mortality of MODS in children after cardiac surgery and particularity analysis of the organ insufficiencies. Materials and Methods: From 421 children undergoing various cardiac surgeries during the period 2010-2013, treated in the department of cardiac Intensive Care of Republican Clinical Hospital Chisinau, were selected 16 (3.8% ) children who developed MODS background of SIRS, with or without subsequent association of sepsis. The diagnosis was confirmed by clinical and explorative complex criteria. Results: Average age of patients was 21.95 months, of which: under 1 year - 8 (50%), from 1 to 3 years - 6 (37.5%), from 3 to 6 years - 2 (12.5%) children, respectively. There was a predominance of girls (10 girls versus 6 boys). Respiratory failure was developed in 15 (93.7%) patients. The average duration of artificial ventilation was 8.87 +/- 6.95 days, statistical significant difference between the duration of artificial ventilation in patients treated and died were not been determined. Malabsorption syndrome, paresis associated with intestinal failure was determined in 12 (75%) patients. The renal system was involved in 14 (87.5%) patients, 7 (43.75%) show signs of acute kidney injury, and 6 (37.5%) develop acute renal failure. Cerebral insufficiency was found to be in 9 (56.25%) patients, systemic intravascular coagulation syndrome in 5 (31.25%) patients. In 5 (31.25%) patients with MODS the sepsis was associated, confirmed by positive blood cultures and procalcitonin >10 ng/ml. Conclusions: Mortality of children with MODS was the 37.5% (6 children) correlated to the number of affected systems, often developed into respiratory failure, gastrointestinal, cerebral and renal. Statistical differences between ECC duration and aorta clam ping in deceased patients and MODS treated were not been determined.