Chaiwiriyawong Pornnicha, Jarutach Jirayut, Saelim Kantara, Duangpakdee Pongsanae, Vichitkunakorn Polathep, Prasertsan Pharsai
Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Division of Cardiovascular and Thoracic Surgeon, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Front Pediatr. 2025 May 23;13:1536089. doi: 10.3389/fped.2025.1536089. eCollection 2025.
Low-cardiac-output syndrome (LCOS) after cardiac surgery may lead to poor postoperative outcomes. The venous-to-arterial carbon dioxide partial pressure difference (VACO) showed association with poor outcomes in adults with cardiac surgery, but it's validity in pediatric population is uncertain. We evaluated the association of VACO with LCOS-related outcomes and the correlation with other surrogate markers such as lactate levels and oxygen extraction ratio.
This prospective cohort study was conducted at an intensive care unit in a tertiary academic hospital. Children aged 1 day-18 years old undergoing elective cardiac surgery with cardiopulmonary bypass between August 2021 and December 2023 were included. Arterial and venous blood gases were collected at intensive care unit admission and at 6, 12, and 24 h postoperatively. The LCOS-related outcomes were defined as at least two of the following criteria being met within 24 h postoperatively: vasopressor-inotropic score ≥20, ejection fraction <50% on echocardiography, need for serious post-operative intervention, and death.
Of the 127 included patients (median age: 44.4 months), 37 (29.1%) had a Risk Adjustment for Congenital Heart Surgery score ≥3, and 26 (20.4%) had LCOS-related outcomes. Linear mixed model regression analysis revealed that the VACO did not significantly differ between patients with and without LCOS-related outcomes at all four time points. VACO showed a fair-to-weak correlation with the oxygen extraction ratio ( = 0.58; < 0.001, = 0.22; = 0.015, and = 0.19; = 0.045, at 6, 12, and 24 h postoperatively, respectively) but showed no correlation with lactate levels. A persistently high VACO (≥6 mmHg) at 6 h postoperatively was significantly associated with fewer 28-day inotrope-free and intensive care unit-free days.
VACO was not significantly associated with LCOS-related outcomes in children after cardiac surgery with cardiopulmonary bypass. A persistently high VACO at 6 h postoperatively was correlated with prolonged inotrope use and a prolonged intensive care unit stay.
心脏手术后的低心排血量综合征（LCOS）可能导致术后预后不良。静脉-动脉二氧化碳分压差值（VACO）在接受心脏手术的成人中显示与不良预后相关，但在儿科人群中的有效性尚不确定。我们评估了VACO与LCOS相关结局的关联以及与其他替代指标（如乳酸水平和氧摄取率）的相关性。
这项前瞻性队列研究在一家三级学术医院的重症监护病房进行。纳入2021年8月至2023年12月期间接受择期心脏手术并使用体外循环的1日龄至18岁儿童。在重症监护病房入院时以及术后6、12和24小时采集动脉和静脉血气。LCOS相关结局定义为术后24小时内至少满足以下标准中的两项：血管活性药物-正性肌力药物评分≥20、超声心动图显示射血分数<50%、需要进行严重的术后干预以及死亡。
在127例纳入患者（中位年龄：44.4个月）中，37例（29.1%）先天性心脏病手术风险调整评分≥3，26例（20.4%）有LCOS相关结局。线性混合模型回归分析显示，在所有四个时间点，有和没有LCOS相关结局的患者之间VACO没有显著差异。VACO与氧摄取率呈中度至弱相关性（分别在术后6、12和24小时，r = 0.58；P < 0.001，r = 0.22；P = 0.015，r = 0.19；P = 0.045），但与乳酸水平无相关性。术后6小时持续高VACO（≥6 mmHg）与28天无血管活性药物和无重症监护病房天数减少显著相关。
在接受体外循环心脏手术的儿童中，VACO与LCOS相关结局无显著关联。术后6小时持续高VACO与血管活性药物使用时间延长和重症监护病房住院时间延长相关。
