Tumor necrosis factor and clinical and metabolic courses after cardiac surgery in children.
OBJECTIVE
This study was undertaken to determine the relationship between plasma tumor necrosis factor concentrations and hemodynamic and metabolic parameters during the postoperative clinical course in children undergoing cardiac surgery.


METHODS
Tumor necrosis factor levels of 10 consecutive children undergoing surgery for repair of congenital heart defects were analyzed in blood samples drawn at predetermined time points during surgery and up to 24 hours thereafter. Clinical data were collected at these times for correlation to tumor necrosis factor levels.


RESULTS
All the patients survived. Tumor necrosis factor was detected in all 10 children. Tumor necrosis factor levels declined after induction of general anesthesia (201 +/- 65 pg/mL) steadily decreasing during surgery, reaching 80 +/- 50 pg/mL at 24 hours after the operation. Tumor necrosis factor levels were found to be inversely correlated with mean blood pressure values and indicators of acidosis (bicarbonate levels and base excess, P <.03). They were not correlated with the durations of cardiopulmonary bypass and aortic crossclamping.


CONCLUSIONS
Tumor necrosis factor released into the circulation during and after pediatric cardiac surgery under cardiopulmonary bypass may be related to the hemodynamic and acid-base changes observed after cardiac surgery. Elucidation of the relationship between tumor necrosis factor and patient outcome in high-risk patients awaits further studies.
Sason-Ton
Yokrat
Y
Department of Pediatric Intensive Care, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Ben Abraham
Ron
R
Lotan
Danny
D
Dagan
Ovadia
O
Prince
Tal
T
Barzilay
Zohar
Z
Paret
Gideon
G
D000293:Adolescent; D001639:Bicarbonates / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology; D002315:Cardiopulmonary Bypass; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D007557:Israel; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D013223:Statistics as Topic; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
D001639:Bicarbonates; D014409:Tumor Necrosis Factor-alpha