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Sakai W, Chaki T, Nawa Y, Oyasu T, Ichisaka Y, Nawa T, Asai H, Ebuoka N, Oba J, Yamakage M. Head cooling wrap could suppress the elevation of core temperature after cardiac surgery during forced-air warming in a pediatric intensive care unit: a randomized clinical trial. J Anesth 2023; 37:596-603. [PMID: 37272969 DOI: 10.1007/s00540-023-03210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE The main aim of the current trial was to explore our hypothesis that cooling head wraps lower the core temperature more effectively than ice packs on the head during forced-air warming after pediatric cardiac surgeries. METHODS This study was a single-center Randomized Controlled Trial. Participants were children with a weight ≤ 10 kg and hyperthermia during forced-air warming after cardiac surgeries. When the core temperature reached 37.5 °C, ice packs on the head (group C) or a cooling head wrap (group H) were used as cooling devices to decrease the core temperature. The primary outcome was the core temperature. The secondary outcomes were the foot surface temperature and heart rate. We measured all outcomes every 30 min for 240 min after the patient developed hyperthermia. We conducted two-way ANOVA as a pre-planned analysis and also the Bonferroni test as a post hoc analysis. RESULTS Twenty patients were randomly assigned to groups C and H. The series of core temperatures in group H were significantly lower than those in group C (p < 0.0001), and post hoc analysis showed that there was no significant difference in core temperatures at T0 between the two groups and statistically significant differences in all core temperatures at T30-240 between the two groups. There was no difference between the two groups' surface temperatures and heart rates. CONCLUSIONS Compared to ice packs on the head, head cooling wraps more effectively suppress core temperature elevation during forced-air warming after pediatric cardiac surgery.
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Affiliation(s)
- Wataru Sakai
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan.
- Department of Anesthesiology, Sapporo Medical University School of Medicine, East 17, South 1, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan.
| | - Tomohiro Chaki
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Anesthesiology, Sapporo Medical University School of Medicine, East 17, South 1, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Yuko Nawa
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Anesthesiology, Sapporo Medical University School of Medicine, East 17, South 1, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan
| | - Takayoshi Oyasu
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Yuki Ichisaka
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Tomohiro Nawa
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Hidetsugu Asai
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Noriyoshi Ebuoka
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Junichi Oba
- Pediatric Intensive Care Unit, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
- Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, 006-0041, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, East 17, South 1, Chuo-Ku, Sapporo, Hokkaido, 060-8556, Japan
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Lee JJ, Kim JH, Jeon JH, Kim MJ, Park BG, Jung SK, Jeon SR, Roh SW, Park JH. A retrospective controlled study of postoperative fever after posterior lumbar interbody fusion due to degenerative lumbar disease. Medicine (Baltimore) 2022; 101:e29231. [PMID: 35608425 PMCID: PMC9276243 DOI: 10.1097/md.0000000000029231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/15/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Postoperative fever is a common feature of spinal surgery. When fever occurs postoperatively in patients, surgeons are eager to rule out an infection. There are many reports about postoperative fever and infection; however, only a few have described the relationship between degenerative spinal disease and postoperative fever. This study aimed to investigate the causes of postoperative fever in patients with degenerative lumbar disease undergoing posterior screw fixation and interbody fusion and compare patients with non-pathologic fever and infected febrile patients. METHODS From March 2015 to February 2016, 263 patients with degenerative lumbar disease underwent posterior lumbar screw fixation and interbody fusion surgery in our institution. We performed risk factor analysis by categorizing patients as afebrile and febrile. Comparisons were made between afebrile patients and patients with non-pathologic fever, and an analysis was performed between patients with non-pathologic fever and patients with febrile infection. We compared each group by examining the demographic factors before surgery, surgery features, drain duration, and postoperative transfusion. The postoperative day (POD) of fever onset, postoperative fever duration, and blood sample results in patients with fever were investigated. RESULTS The drain duration was found to be an important factor between the afebrile febrile groups and between the non-pathologic fever and afebrile groups. POD of fever occurred earlier in the non-pathologic group than in the infection group (p = 0.04), and the duration of fever was shorter in the non-pathologic fever group than in the infection group (p = 0.01). Higher procalcitonin levels were observed at POD 5 in the infection group than in the non-pathologic fever group. (p < 0.01) The accidental dural rupture rate was higher in the infected group (p = 0.02); this was thought to be caused by the long non-ambulatory period after surgery. CONCLUSION This study identified risk factors and differences between infectious diseases associated with postoperative fever. A significant risk factor for postoperative non-pathological fever was a shorter catheter drainage period. Fever after 3 days, fever for more than 4 days and higher procalcitonin levels after surgery suggest infection.
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Affiliation(s)
- Jung Jae Lee
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jeong Hee Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju Hee Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myeong Jong Kim
- Department of Neurosurgery, Seongnam Citizens Medical Center, Seongnam, Korea
| | - Byong Gon Park
- Department of Physiology, College of Medicine, Catholic Kwandong University, Gangneung-si, Gangwon-do 270-701, Republic of Korea
| | - Sang Ku Jung
- Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang Ryong Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Woo Roh
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Juliana J, Sembiring YE, Rahman MA, Soebroto H. Mortality Risk Factors in Tetralogy of Fallot Patients Undergoing Total Correction. FOLIA MEDICA INDONESIANA 2021. [DOI: 10.20473/fmi.v57i2.22107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A total correction is a preferred treatment for Tetralogy of Fallot patients in every part of the world. However, the mortality in developing countries was as high as 6.9% to 15.3%. This was a retrospective analytic study that analyzed pre and post-operative risk factors that affected mortality on TOF patients that were performed total correction in Indonesia. A total of 47 TOF patients that were performed total correction from January 2016 to September 2019 were enrolled in this study based on the inclusion criteria. Preoperative and post-operative data were obtained from medical records. In this research, the majority of mortality was found in male patients (39.3%), while the female’s rate was lower (36.8%). Overall mortality was 38.3% and one operative death was found. The average age of patients was 84.12 months (12-210 months), whereas the average height (85.56 ± 36.17cm vs. 112.93 ± 21.73) and weight (17.22kg vs. 28.21kg) were lower for mortality patients. Some significant preoperative variables were identified as mortality risk factors such as: age below 60 months (p=0.047), smaller weight and height (p=0.008; p=0.002), abnormal hematocrit (p=0.002), and oxygen saturation below 75% (p=0.018). Significant post-operative risk factors included: temperature above 38.5⁰C (p=0.000), and ventilator time of more than 48 hours (p=0.033). In conclusion, the mortality of TOF patients undergoing a total correction in developing countries was quite high. It was associated with some risk factors, such as younger age, lower weight and height, low oxygen saturation, post-operative fever, and prolonged ventilator time.
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Shaker R, Arabi M, Khafaja S, Fayad D, Casals AA, Lteif M, Shamseddine S, Taqa MA, Charafeddine F, Rassi IE, Al-Halees Z, Bitar F, Hanna-Wakim R, Dbaibo G. Placement of Labcor Pulmonary Conduit Results in a High Incidence of Postoperative Fever. World J Pediatr Congenit Heart Surg 2021; 12:55-60. [PMID: 33407033 DOI: 10.1177/2150135120956995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fever in the postoperative period in cardiac patients is common. The purpose of this study is to recognize the risk factors for prolonged postoperative fever in cardiac patients with pulmonary conduit insertion. METHODS Patients were identified retrospectively by looking at the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code for pulmonary conduit insertion between June 2009 and December 2015 at the American University of Beirut Medical Center. Data about preoperative, perioperative, and postoperative variables were collected. Data entry and analysis were performed using SPSS version 22. RESULTS The study identified 59 patients. The most common type of pulmonary conduit used was the Contegra type (57.6%) (n = 34), followed by the Labcor type (20.3%; n = 12). Postoperative fever occurred in 61% of patients (n = 36). Fourteen patients (38.8%) had a prolonged fever that lasted for more than seven days. Prolonged postoperative fever was significantly associated with the Labcor pulmonary conduit (P value < .001) and a longer duration of pacing wires (P value: .039). Significantly prolonged fever that lasted for more than 21 days occurred in five patients who all had inserted the Labcor pulmonary conduit. CONCLUSIONS The Labcor pulmonary conduit type is a risk factor for prolonged postoperative fever. The protracted use of pacing wires could be a consequence of the prolonged fever rather than a cause. In the absence of a demonstrable infectious etiology for prolonged postoperative fever in cardiac patients with pulmonary conduit insertion, the Labcor pulmonary conduit could be the underlying cause. Alternative management of such cases may lead to decreased antibiotic use and morbidity.
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Affiliation(s)
- Rouba Shaker
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah Khafaja
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Danielle Fayad
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Aia Assaf Casals
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Mireille Lteif
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah Shamseddine
- Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Abu Taqa
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Fatmeh Charafeddine
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Issam El Rassi
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Zoheir Al-Halees
- Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Heart Center, 37852King Faisal Specialist Hospital and Research center, Riyadh, Saudi Arabia
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Hanna-Wakim
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghassan Dbaibo
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, 66984American University of Beirut Medical Center, Beirut, Lebanon
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Ding W, Liu J, Zhou X, Miao Q, Zheng H, Zhou B, Dou G, Tong Y, Long Y, Su L. Clinical Multi-Omics Study on the Gut Microbiota in Critically Ill Patients After Cardiovascular Surgery Combined With Cardiopulmonary Bypass With or Without Sepsis (MUL-GM-CSCPB Study): A Prospective Study Protocol. Front Med (Lausanne) 2020; 7:269. [PMID: 32733902 PMCID: PMC7360671 DOI: 10.3389/fmed.2020.00269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 05/15/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction: Fever of unknown origin (FUO) and hemodynamic instability are complications that develop after cardiac surgery combined with cardiopulmonary bypass (CPB) for heart disease. Patients who develop fever with hemodynamic instability after cardiac surgery may have systemic inflammatory response syndrome or sepsis. Cardiopulmonary bypass (CPB) is a technique that temporarily takes over the function of the heart and lungs during cardiac surgery. Recent reports suggest that early bloodstream infections of patients undergoing CPB are due to gram-negative bacteria that are present in the intestinal flora. The theory of intestinal flora translocation has growing evidence. Intestinal ischemia-reperfusion that occurs during cardiac surgery with CPB will induce a systemic inflammatory reaction and may cause intestinal flora translocation. Does this systemic reaction cause sepsis? We therefore propose this protocol to determine whether the changes in the intestinal flora in patients after cardiac surgery with CPB are related to sepsis. Methods and Analysis: This study is a prospective observational case-control study to analyze the variation in the intestinal microflora and metabolites in patients undergoing cardiac surgery with CPB and to observe the outcomes of patients with routine clinical interventions. The control group will include healthy people without intestinal illness. Feces and blood samples will be acquired 1 day before cardiac surgery and within 24-72 h after cardiac surgery, and will be used for genomics and metabolomics analyses. Demographic data describing age, sex, main diagnosis, and past medical history and data related to the CPB time and application of antibiotics are available. Sequential (sepsis-related) organ failure assessment, infection-related laboratory items, infection site, and pathogenic microorganisms, and nutrition, and gastrointestinal function assessment are additionally recorded. Group analysis of data will be conducted according to the outcomes (sepsis vs. non-sepsis and survivors vs. non-survivors). Ethics and Dissemination: This protocol has been ethically approved by the Ethics Committee of Peking Union Medical College (ID: ZS-1612). Informed consent will be obtained before subject enrolment, and data will be stored in a secured database. The results will be submitted to international peer-reviewed journals and presented at international conferences. Trial Registration Number: NCT04032938.
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Affiliation(s)
- Wenyan Ding
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianzhou Liu
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiang Zhou
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Miao
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Haibo Zheng
- Department of Cardiac Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Guifang Dou
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, China
| | - Yigang Tong
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering (BAIC-SM) College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Longxiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Abstract
BAKGROUND Systemic inflammatory response syndrome, which is marked by fever, is a possible complication after open-heart surgery for CHD. The inflammatory response following the use of cardiopulmonary bypass shows similar clinical signs with sepsis. Therefore serial measurements of procalcitonin, an early infection marker, can be helpful to differentiate between sepsis and systemic inflammatory response syndrome. OBJECTIVES To evaluate serial levels of procalcitonin in children who underwent open-heart surgery for cyanotic and acyanotic CHD, and identify factors associated with elevated level of procalcitonin. METHODS Children and infants who had open-heart surgery and showed fever within 6 hours after surgery were recruited. Procalcitonin levels were serially measured along with leukocyte and platelet count. Other data were also recorded, including diagnosis, age, body weight, axillary temperature, aortic clamp time, bypass time, duration of mechanical ventilation, risk adjustment for congenital heart surgery score-1, and length of stay in Cardiac ICU. The patients were categorised into cyanotic and acyanotic CHD groups. RESULTS High mean of procalcitonin level suggested the presence of bacterial infection. Cyanotic CHD group had significantly higher mean of procalcitonin level compared to acyanotic CHD group in the first two measurements. Both groups had no leukocytosis, though platelet count results were significantly different between the two groups. There was no significant difference of procalcitonin level observed in culture results and adverse outcomes. CONCLUSION Serial procalcitonin measurement can be helpful to determine the cause of fever. Meanwhile other conventional markers such as leukocyte and platelet should be assessed thoroughly.
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Corkum KS, Hunter CJ, Grabowski JE, Lautz TB. Early postoperative fever workup in children: utilization and utility. J Pediatr Surg 2018; 53:1295-1300. [PMID: 28693850 DOI: 10.1016/j.jpedsurg.2017.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/24/2017] [Accepted: 06/15/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early postoperative fever is common. Adult data indicate that workup is unnecessary in the early postoperative period, but comparable data in children is limited. The objectives are to determine the incidence of fever and the utilization and yield of tests ordered in children. METHODS Single-institution, retrospective analysis of surgical patients undergoing an elective inpatient/observational surgery between 2011 and 2015 was performed. Early fever was defined >38.0°C within two days post-procedure. Encounters were queried for all blood cultures (BC), urinalysis (UA), urine cultures (UC), chest radiographs (CXR), and respiratory viral panels (RVP) obtained. RESULTS We identified 6943 patients, of whom 30.6% developed fever. UA was positive in 19.8% of patients tested. UC was positive in 15.7% of patients and 92.0% had a urinary catheter during surgery. BC was positive in 0.69% of patients, all with a central venous catheter. CXRs were considered infectious in 3.0% of patients tested. Patients with PICU stay and/or fever ≥38.9°C were more likely to undergo BC and UC, but no more likely to have a positive result compared those without PICU stay and/or fever <38.9°. CONCLUSION Early postoperative fever is common in pediatric surgical populations and rarely associated with an infectious source. Workup should be applied selectively. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Kristine S Corkum
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine J Hunter
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Julia E Grabowski
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Abstract
Postoperative fever after cardiac surgery is a common occurrence. Most fevers are benign and self-limiting resulting from inflammation caused by surgical trauma and blood contact with cardiopulmonary bypass circuit resulting in the release of cytokines. Only a small percentage of time is postoperative fever due to an infection complicating surgery. The presence of fever frequently triggers a battery of diagnostic tests that are costly, could expose the patient to unnecessary risks, and can produce misleading or inconclusive results. It is therefore important that fever be evaluated in a systematic, prudent, clinically appropriate, and cost-effective manner. This article focuses on the current evidence regarding pathophysiology, incidence, causes, evaluation, and management of fever in postoperative adult cardiac surgical patients.
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Adjtoutah D, Azhari A, Larabi Y, Dorigo E, Merlin C, Marcaggi X, Nana AS, Camilleri L, Azarnoush K. Advantages of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography in detecting post cardiac surgery infections. J Saudi Heart Assoc 2013; 26:57-61. [PMID: 24578602 DOI: 10.1016/j.jsha.2013.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/23/2013] [Accepted: 09/27/2013] [Indexed: 11/30/2022] Open
Abstract
UNLABELLED The 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) offers an excellent negative predictive value. Consequently, it is a reliable tool for excluding an infectious phenomenon in case of negativity. In case of persistent fever of unknown origin after cardiac surgery and in combination with other bacteriological examinations and medical imaging, we can rely on FDG-PET/CT to confirm or eliminate deep infections and prosthetic endocarditis. For this reason, FDG-PET/CT should be considered among the examinations to be performed in case of suspected infection after cardiac surgery. We have reported the case of a 76-year-old man who presented with a fever of unknown origin and recurrent septic shocks after a biological Bentall procedure combined with left anterior descending (LAD) coronary artery revascularization by the left internal thoracic artery. We performed a FDG-PET/CT which showed external iliac vein and right common femoral vein hyperfixation with infiltration of adjacent soft tissues, highly suspected to be an infectious process. LEARNING OBJECTIVE The aim of this case report is to show that FDG-PET/CT, in combination with other bacteriological examinations and medical imaging, can be extremely helpful in detecting deep infectious sources, even during the early postoperative period.
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Affiliation(s)
| | - Alaa Azhari
- Heart Surgery Department, University Hospital Center of Clermont-Ferrand
| | - Youcef Larabi
- Heart Surgery Department, University Hospital Center of Clermont-Ferrand
| | - Enrica Dorigo
- Heart Surgery Department, University Hospital Center of Clermont-Ferrand
| | - Charles Merlin
- Nuclear Medicine Department, Jean Perrin Cancer Center, Clermont-Ferrand
| | | | | | - Lionel Camilleri
- Heart Surgery Department, University Hospital Center of Clermont-Ferrand
| | - Kasra Azarnoush
- Heart Surgery Department, University Hospital Center of Clermont-Ferrand
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