Prevention of infectious complications after heart surgery in children: procalcitonin-guided strategy.
BACKGROUND
Infectious complications remain a significant problem of modern cardiac surgery. New prevention strategies, based on the pathogenesis of such complications occurring after cardiopulmonary bypass (CPB) procedures, should be evaluated.


OBJECTIVE
To evaluate the effectiveness of a procalcitonin (PCT)-guided strategy involving the use of IgM-enriched intravenous immunoglobulins (IVIGs) in children with congenital heart disease with systemic inflammation during the early postoperative period.


METHODS
Sixty consecutive patients aged 25 (21-30) months who underwent cardiac surgery with CPB and had blood PCT levels > 2 ng/mL on the 1(st) postoperative day were enrolled in this single-center prospective randomized clinical trial. The patients were randomized into two groups, comparable in terms of the severity of their initial condition, age, and CPB time. IgM-enriched IVIGs (Pentaglobin, Biotest Pharma GmbH, Germany) were administered during the first 3 postoperative days (5 mL/kg each day) in the study group (n = 30) in addition to the standard treatment, which was also provided to the control group (n = 30). The data are presented as medians with 25-75(th) percentiles; they were compared by the Mann-Whitney U-test, and p values of < 0.05 were considered as statistically significant.


RESULTS
Postoperatively, 1/30 (3.3%) patients in the study group and 8/30 (26.7%) in the control group suffered from infectious complications (study group: urinary tract infection [UTI] - 1; control group: pneumonia - 4, pneumonia and sepsis - 2, peritonitis with multiorgan failure - 1, UTI - 1), p = 0.03. The length of hospital stay in the study group was shorter than in the control group: 19 (16-23) days vs. 24 (19-29) days, p = 0.002, as was the length of intensive care unit (ICU) stay: 3 (2-4) days vs. 4 (2-8) days, p = 0.03.


CONCLUSIONS
High PCT levels on the 1st postoperative day are associated with an increased risk of infectious complications after cardiac surgery. Early administration of IgM-enriched IVIGs can prevent the development of infectious complications.
Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russian Federation.
Dmitry
D
Popov
Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russian Federation.
Michail
M
Yaroustovsky
Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russian Federation.
Galina
G
Lobacheva
cardiac surgery; immunoglobulins; infectious complications; procalcitonin