title: Microcirculatory changes in children undergoing cardiac surgery: a prospective observational study.
abstract: The effects of cardiac surgery on the microcirculation of children are unknown. The aim of this study was to assess the microcirculatory changes in children undergoing surgery for correction of congenital heart disease.
  
  
  
  We used a videomicroscope (Sidestream Dark Field, SDF) in a convenience sample of 24 children <five yr old. Total vascular density (TVD, vessels mm(-2)), microvascular flow index (MFI, arbitrary units), proportion of perfused small vessels (PPV, percentage), and perfused vessel density (PVD) were obtained after induction of anaesthesia (T1), at the end of the surgical procedure (T2), after intensive care unit (ICU) admission (T3), and at six h (T4) and 12h (T5) after ICU admission.
  
  
  
  Microcirculatory variables did not significantly change over time. Haemodynamic parameters and microcirculatory variables were not correlated. In a subanalysis conducted for cyanotic (n=7) and acyanotic (n=17) children, repeated measures ANOVA showed a significant interaction between time and the presence of cyanosis for PPV (P=0.03), TVD (P=0.03), and PVD (P=0.03). Weak inverse correlations were found between storage time of transfused red blood cell (RBCs) and MFI at T3 (r=-0.63, P=0.01) and T4 (r=-0.53, P=0.03).
  
  
  
  Microcirculatory variables have a different time-related trend in cyanotic and acyanotic children undergoing cardiac surgery. The storage time of transfused RBCs seems to negatively impact the microcirculation. Further and larger studies are warranted to prove the potential implications of this study.
authors.affiliation: Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Via Bracci 1, Siena 53100, Italy sabino.scolletta@dbm.unisi.it.
authors.forename: S
authors.initials: S
authors.lastname: Scolletta
authors.affiliation: Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Via Bracci 1, Siena 53100, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Marianello
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Isgrò
authors.affiliation: Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Via Bracci 1, Siena 53100, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Dapoto
authors.affiliation: Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Via Bracci 1, Siena 53100, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Terranova
authors.affiliation: Department of Medical Biotechnologies, Anesthesiology and Intensive Care, University Hospital of Siena, Via Bracci 1, Siena 53100, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Franchi
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Baryshnikova
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Carlucci
authors.affiliation: Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ranucci
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery*; D006439:Hemodynamics / Q000276:immunology; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D018715:Microscopy, Video; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: cardiac surgery; congenital heart disease; microcirculation; paediatric intensive care units