Vol. 20 JA2016 - cardiac

C-03 – Early systemic inflammatory response syndrome after elective cardiac surgery with cardiopulmonary bypass

novembre 29, 2016
Auteur correspondant : Michel Kindo

Michel Kindo, Tam Hoang Minh, Stéphanie Perrier, Jonathan Bentz, Clément Schneider, Dharmesh Ramlugun, Gharib Ajob, Mircea Cristinar, Ollivier Collange, Sandrine Marguerite, Anne-Lorraine Bourquiaux, Arnaud Mommerot, Philippe Billaud, Jean-Philippe Mazzucotelli

Institution : Service de chirurgie cardiaque, hôpitaux universitaires de Strasbourg

Objectives : The systemic inflammatory response syndrome (SIRS) is associated with significant mortality and morbidity. The aim of this study was to evaluate the incidence, the risk factors, the hemodynamic impact and the morbi-mortality of the early SIRS (<24 hours) after elective cardiac surgery with cardiopulmonary bypass (CPB) in adults.

Methods : This prospective observational study included 500 patients who underwent elective cardiac surgery with CPB (ClinicalTrials.gov Identifier: NCT00699673). The mean age was 68.1±11.5 years. The predicted mortality by the EuroSCORE II was 2.5±3.2%. The SIRS was defined as a body temperature >38°C and leucocyte count > 12000 109/l during the first 24 hours. Two groups were defined (control group and SIRS group). Using a multivariate logistical analysis, SIRS risk factors were identified.

Results : An early SIRS was observed in 85 patients (17.2%). The postoperative temperature peak occurred at 7.9±5.1 hours. The pre- and peroperative risk factors of SIRS in the multivariate analysis were age (OR=0.964; 95%CI=0.943-0.986; P=0.001) and preoperative leucocyte count (OR=1.260; 95%CI=1.095-1.449; P=0.001). The mean arterial pressure at the temperature peak was significantly lower in the SIRS group than in the control group (77.9±12.7 mmHg vs. 72.9±11.3 mmHg respectively; P=0.001). No significant differences were observed regarding the inotropic or vasopressor supports. The hospital mortality was 1.2% and 3.5% in the control and SIRS groups respectively (P=0.144). The lengths of mechanical ventilation and intensive care unit stay did not significantly differ between the two groups as well as for the postoperative glomerular filtration rate peak. Furthermore, no significant differences were observed between the 2 groups regarding the cardiac, pulmonary, neurological and infectious morbidities.

Conclusion : The early SIRS after elective cardiac surgery under CPB is a frequent complication without significant impact on hospital morbidity and mortality.