Post-cardiopulmonary bypass hypoxaemia in paediatric patients undergoing congenital heart disease surgery: risk factors, features, and postoperative pulmonary complications

• Published in: BMC cardiovascular disorders 2022-09, Vol.22 (1), p.1-430, Article 430
• Main Authors: Sun, Yuan, Deng, Xiao-Ming, Cai, Ying, Shen, Sai-E, Dong, Li-Ya
• Format: Article
• Language: English
• Subjects: Cardiopulmonary bypass; Cardiovascular disease; Care and treatment; Child; Complications; Complications and side effects; Congenital diseases; Congenital heart disease; Coronary artery disease; Demographic aspects; Edema; Extubation; Fentanyl; Heart diseases; Heart surgery; Hypotheses; Hypoxaemia; Hypoxemia; Laboratories; Lung diseases; Lungs; Morbidity; Ostomy; Oxygen tension; Patients; Pediatrics; Pleural cavity; Pulmonary arteries; Respiration; Risk factors; Veins & arteries; Ventilators; Weaning
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-022-02838-9

Background Hypoxemia after cardiopulmonary bypass (CPB) is the quantifiable manifestation of pulmonary dysfunction. This retrospective study was designed to investigate the risk factors for post-cardiopulmonary bypass hypoxaemia and the features of hypoxaemia and pulmonary complications in paediatric congenital heart disease surgery involving CPB. Methods Data including demographics, preoperative pulmonary or cardiac parameters, and intraoperative interventions were retrospectively collected from 318 paediatric patients who underwent radical surgery with CPB for congenital heart disease. Among them, the factors that were significant by univariate analysis were screened for multivariate Cox regression. The lowest ratio of arterial oxygen tension and the inspiratory oxygen fraction (PaO.sub.2/FiO.sub.2), hypoxaemia (PaO.sub.2/FiO.sub.2 [less than or equai to] 300) insult time, duration of hypoxaemia, extubation time, and pulmonary complications were also analysed postoperatively. Results The morbidity of post-cardiopulmonary bypass hypoxaemia was 48.4% (154/318). Months (6 < months [less than or equai to] 12, 12 < months [less than or equai to] 36 and 36 < months compared with 0 [less than or equai to] months [less than or equai to] 6: HR 0.582, 95% CI 0.388-0.873; HR 0.398, 95% CI 0.251-0.632; HR 0.336, 95% CI 0.197-0.574, respectively; p < 0.01), preoperative intracardiac right-to-left shunting (HR 1.729, 95% CI 1.200-2.493, p = 0.003) and intraoperative pleural cavity entry (HR 1.582, 95% CI 1.128-2.219, p = 0.008) were identified as independent risk factors for the development of post-cardiopulmonary bypass hypoxaemia. Most hypoxaemia cases (83.8%, 129/154) occurred within 2 h, and the rate of moderate hypoxaemia (100 < PaO.sub.2/FiO.sub.2 [less than or equai to] 200) was 60.4% (93/154). Conclusion The morbidity of post-cardiopulmonary bypass hypoxaemia in paediatric congenital heart disease surgery was considerably high. Most hypoxaemia cases were moderate and occurred in the early period after CPB. Scrupulous management should be employed for younger infants or children with preoperative intracardiac right-to-left shunting or intraoperative pleural cavity entry. Keywords: Congenital heart disease, Cardiopulmonary bypass, Hypoxaemia, Complications, Child