Impact of viral respiratory pathogens on outcomes after pediatric cardiac surgery

Moynihan, Katie, Barlow, Andrew, Alphonso, Nelson, Anderson, Ben, Johnson, Janelle, Nourse, Clare, Schlebusch, Sanmarié, Karl, Tom R. and Schlapbach, Luregn J. (2017) Impact of viral respiratory pathogens on outcomes after pediatric cardiac surgery. Pediatric Critical Care Medicine, 18 3: 219-227. doi:10.1097/PCC.0000000000001083


Author Moynihan, Katie
Barlow, Andrew
Alphonso, Nelson
Anderson, Ben
Johnson, Janelle
Nourse, Clare
Schlebusch, Sanmarié
Karl, Tom R.
Schlapbach, Luregn J.
Title Impact of viral respiratory pathogens on outcomes after pediatric cardiac surgery
Journal name Pediatric Critical Care Medicine   Check publisher's open access policy
ISSN 1947-3893
1529-7535
Publication date 2017-01-01
Sub-type Article (original research)
DOI 10.1097/PCC.0000000000001083
Open Access Status Not yet assessed
Volume 18
Issue 3
Start page 219
End page 227
Total pages 9
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Abstract Viral respiratory infection is commonly considered a relative contraindication to elective cardiac surgery. We aimed to determine the frequency and outcomes of symptomatic viral respiratory infection in pediatric cardiac surgical patients.

Retrospective cohort study of children undergoing cardiac surgery. Symptomatic children were tested using a multiplex Polymerase Chain Reaction (respiratory virus polymerase chain reaction) panel capturing nine respiratory viruses. Tests performed between 72 prior to and 48 hours after PICU admission were included. Mortality, length of stay in PICU, and intubation duration were investigated as outcomes.

Tertiary PICU providing state-wide pediatric cardiac services.

Children less than 18 years admitted January 1, 2008 to November 29, 2014 for cardiac surgery.

Respiratory virus polymerase chain reaction was positive in 73 (4.2%) of 1,737 pediatric cardiac surgical admissions, including 13 children with multiple viruses detected. Commonly detected viruses included rhino/enterovirus (48%), adenovirus (32%), parainfluenza virus 3 (10%), and respiratory syncytial virus (3%). Pediatric Index of Mortality 2, Aristotle scores, and cardiopulmonary bypass times were similar between virus positive and negative/untested cohorts. Respiratory virus polymerase chain reaction positive patients had a median 2.0 days greater PICU length of stay (p < 0.001) and longer intubation duration (p < 0.001). Multivariate analysis adjusting for age, Aristotle score, cardiopulmonary bypass duration, and need for preoperative PICU admission confirmed that virus positive patients had significantly greater intubation duration and PICU length of stay (p < 0.001). Virus positive patients were more likely to require PICU admission greater than 4 days (odds ratio, 3.5; 95% CI, 1.9-6.2) and more likely to require intubation greater than 48 hours (odds ratio, 2.5; 95% CI, 1.4-4.7). There was no difference in mortality. No association was found between coinfection and outcomes.

Pediatric cardiac surgical patients with a respiratory virus detected at PICU admission had prolonged postoperative recovery with increased length of stay and duration of intubation. Our results suggest that postponing cardiac surgery in children with symptomatic viral respiratory infection is appropriate, unless the benefits of early surgery outweigh the risk of prolonged ventilation and PICU stay.
Formatted abstract
Objectives: Viral respiratory infection is commonly considered a relative contraindication to elective cardiac surgery. We aimed to determine the frequency and outcomes of symptomatic viral respiratory infection in pediatric cardiac surgical patients.

Design: Retrospective cohort study of children undergoing cardiac surgery. Symptomatic children were tested using a multiplex Polymerase Chain Reaction (respiratory virus polymerase chain reaction) panel capturing nine respiratory viruses. Tests performed between 72 prior to and 48 hours after PICU admission were included. Mortality, length of stay in PICU, and intubation duration were investigated as outcomes. SETTING:: Tertiary PICU providing state-wide pediatric cardiac services.

Patients: Children less than 18 years admitted January 1, 2008 to November 29, 2014 for cardiac surgery.

Measurements and main results: Respiratory virus polymerase chain reaction was positive in 73 (4.2%) of 1,737 pediatric cardiac surgical admissions, including 13 children with multiple viruses detected. Commonly detected viruses included rhino/enterovirus (48%), adenovirus (32%), parainfluenza virus 3 (10%), and respiratory syncytial virus (3%). Pediatric Index of Mortality 2, Aristotle scores, and cardiopulmonary bypass times were similar between virus positive and negative/untested cohorts. Respiratory virus polymerase chain reaction positive patients had a median 2.0 days greater PICU length of stay (p < 0.001) and longer intubation duration (p < 0.001). Multivariate analysis adjusting for age, Aristotle score, cardiopulmonary bypass duration, and need for preoperative PICU admission confirmed that virus positive patients had significantly greater intubation duration and PICU length of stay (p < 0.001). Virus positive patients were more likely to require PICU admission greater than 4 days (odds ratio, 3.5; 95% CI, 1.9–6.2) and more likely to require intubation greater than 48 hours (odds ratio, 2.5; 95% CI, 1.4–4.7). There was no difference in mortality. No association was found between coinfection and outcomes.

Conclusions: Pediatric cardiac surgical patients with a respiratory virus detected at PICU admission had prolonged postoperative recovery with increased length of stay and duration of intubation. Our results suggest that postponing cardiac surgery in children with symptomatic viral respiratory infection is appropriate, unless the benefits of early surgery outweigh the risk of prolonged ventilation and PICU stay.
Keyword Cardiac surgery
Congenital heart defects
Intensive care units
Pediatric
Virus
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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