Preoperative Identification of Risk Patients for Postoperative Edema and Effusion (POEE) in Children Cardiac Surgery
1. Background: Postoperative edema and effusion (POEE) may aggravate into post cardiotomy syndrome (PCS) or capillary leak syndrome (CLS) as unwanted postoperative complication in children cardiac surgery e.g. for septum defects or open Ductus Botalli. Permanent lung damage besides requirement for substantial intensive care treatment may result in affected children.
2. Goal: The cause for POEE/PCS/CLS development is unknown. It could result either from preoperative or from operative conditions. The goal of this investigation was to screen blood samples for various leukocyte CD antigens as well as for changes in cytokines, soluble adhesion molecules, complement components, histamine, neopterin, CRP, kreatinin, blood cell differentials as potential preoperative indicators for the occurrence of POEE.
3. Methods: The resulting database contained 59 preoperatively measured parameters for each of 9 POEE patients and 9 complication free patients (L4) Data were exported from Microsoft Excel format as dBase3 files, imported into the standardized multiparameter data classification program CLASSIF1 (L5) and subjected to iterative data pattern analysis.
4. Results: The retrospectively prospective classification (L4) shows that all (100%) CLS patients can be preoperatively identified from a pattern of 10 of the 59 parameters. Increased age, weight, IL-10, soluble ICAM-1, E-selectin, PECAM, serum and urine histamine, % and absolute granulocyte counts in combination with a decrease of C1-inhibitor concentration are preoperative indicators for postoperative POEE occurrence. The preoperative parameter changes in the risk patients are compatible with the existence of a latent preoperative infection.
4. Conclusion: The CLASSIF1 triple matrix analysis provides a preoperative risk indicator, a hypothesis how POEE/PCS/CLS may be generated and a means for therapy control (L1-L4). Provided the above hypothesis is correct, preoperative antibiotic treatment and recontrol of the data pattern at several days interval should permit to follow the normalization of the above parameter pattern. In case the parameter pattern has normalized the POEE risk should be reduced.
L1 Bocsi J, Hambsch J, Osmancik P, Schneider P, Valet G, Tarnok A. Preoperative prediction of pediatric patients with effusions and edema following cardiopulmonary bypass surgery by serological and routine laboratory data. Critical Care 6:226-233(2002) (pdf)
L2 Tarnok A, Bocsi J, Pipek M, Osmancik P, Valet G. Preoperative prediction of postoperative edema and effusion in pediatric cardiac surgery by altered antigen expression patterns on granulocytes and monocytes. Cytometry (CCC) 46:247-253(2001) (pdf).
L3 Tarnok A, Pipek M, Valet G, Richter J, Hambsch J, Schneider P. Children with post-surgical capillary leak syndrome can be distinguished by antigen expression on neutrophils and monocytes, In: Progress in Biomedical Optics, Proceedings Systems and Technologies for Clinical Diagnostics and Drug Discovery II, Eds: GE Cohn, JC Owicki, SPIE Vol.3603:61-71(1999) (pdf)
L4 Tarnok A, Hambsch J, Borte M, Valet G, Schneider P. Immunological and serological discrimination of children with and without post-surgical capillary leak syndrome. In: The Immune Consequences of Trauma, Shock and Sepsis, Ed. Faist E, Monduzzi Editore, Bologna 1997, p 845-849 (pdf)
L5 Valet G, Valet M, Tschöpe D, Gabriel H, Rothe G, Kellermann W, Kahle H. White cell and thrombocyte disorders: Standardized, self-learning flow cytometric list mode data classification with the CLASSIF1 Program System. Ann.NY Acad.Sci 677:233-251(1993) (pdf)
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