Risk Factors for Mortality in Pediatric Cardiac Intensive Care Unit

Abstract

Congenital heart defect commonly requires care in pediatric intensive care unit (PICU). They are a heterogeneous group of disorders with an annual incidence of 25,757 new cases in Brazil, 12 cases per 1,000 inhabitants 1. In this paper, Guimarães et al., 2 published a cross-sectional study to describe the epidemiology of patients admitted to PICU from a tertiary hospital in Brazil. In this editorial, we review recent progress in understanding the risk factors for mortality in PICU. The editorial was produced by searching Pubmed and Scielo, using the terms "PICU", "RACHS", "CHD", and "mortality". Congenital heart defects (CHD) are serious and common conditions that have a significant impact on morbidity, mortality and healthcare costs in both children and adults. 3 It is estimated that at least 32,000 infants in the United States will be affected each year by CHD. 3 Of these, approximately 25%, or 2.4 per 1,000 live births require invasive treatment in the first year of life. While advances in treatment in the last decades have decreased infant mortality, they have also led to an increase in the number of children and adults with CHD. 4 Despite these advances and developments in interventional and surgical techniques, heart disease in children remains an important cause of morbidity and mortality. 5

Risk Factors of Mortality in the Intensive Care Unit Following Cardiac Surgery for Congenital Heart Diseases in Children

“…Thrombocytopenia may occur because of the inflammatory response to CPB, the activation of inflammatory cytokines, and autoimmune reactions (9). A higher RACHS-1 level is also directly related to increased postoperative complications (10). In our study, the RACHS-1 score was not significantly related to mortality.…”

“…It was concluded that age, weight, RACHS-1 score, and need for CPB had no significant relationship with the mortality rates (11). Some studies have mentioned that CPB can initiate the inflammatory response (9) and linked a longer CPB time and more complicated surgery (higher RACHS-1) with more postoperative complications (10). The different activities of the surgical centers can justify the contrasting results of the studies.…”

“…Since CHDs are a heterogeneous group of severe disorders with different surgical and nonsurgical outcomes (10,17), each patient with a specific anomaly should be examined individually. Our study found a significant relationship between the type of anomaly and outcomes.…”