title: Children undergoing heart transplant are at increased risk for postoperative vasodilatory shock.
abstract: OBJECTIVE
  To determine the incidence of vasodilatory shock (VDS) in children after cardiopulmonary bypass (CPB), and to describe this syndrome of post-CPB VDS in children.
  
  
  METHODS
  Prospective, observational.
  
  
  METHODS
  Pediatric and neonatal intensive care units in a tertiary care, children's hospital.
  
  
  METHODS
  Three hundred children undergoing CPB.
  
  
  METHODS
  None.
  
  
  RESULTS
  Three hundred subjects undergoing CPB were evaluated for clinical evidence of VDS following CPB. The incidence of post-CPB VDS was 3%. Characteristics of children who developed VDS: higher peak lactate (6.2 +/- 2.6 vs. 3.0 +/- 2.1 mmol/L; p = 0.0002), higher peak serum blood urea nitrogen (18.5 +/- 4.6 vs. 15.6 +/- 7.2 mg/dL; p = 0.04), lower urine output (1.7 +/- 0.8 vs. 2.6 +/- 0.2 mL/kg/hr; p = 0.04), and fewer intensive care unit free days (14.9 +/- 9.0 vs. 21.1 +/- 7.2 days; p = 0.01). Univariate predictors for the development of post-CPB VDS included children who had heart transplantation (HT) (relative risk [RR], 9.8; 95% confidence interval [CI], 2.7-35.2) or ventricular assist device (VAD) placed (RR, 17.9; 95% CI, 3.8-84.1), a cardiomyopathy diagnosis (RR, 8.5; 95% CI, 2.3-31), age >12 years (RR, 4.5; 95% CI, 1.2-17.0), CPB time >180 minutes (RR, 7.1; 95% CI, 1.9-26.2), and preoperative ventricular dysfunction (RR, 3.7; 95% CI, 1.0-13.4). By stratified analysis, the only independent predictor for the development of VDS was undergoing HT/VAD.
  
  
  CONCLUSIONS
  Post-CPB VDS is uncommon in children. However, children who undergo HT or VAD placement are at high risk for developing post-CPB VDS. Recognition that the overall incidence of post-CPB is low-except in the HT/VAD population-may help guide therapy in the pediatric post-CPB patient.
authors.affiliation: Department of Pediatrics, Division of Critical Care Medicine, Columbia University, College of Physicians and Surgeons, Bronx, NY, USA. jkilling@montefiore.org
authors.forename: James S
authors.initials: JS
authors.lastname: Killinger
authors.forename: Daphne T
authors.initials: DT
authors.lastname: Hsu
authors.forename: Charles L
authors.initials: CL
authors.lastname: Schleien
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Mosca
authors.forename: George E
authors.initials: GE
authors.lastname: Hardart