Respuesta inflamatoria sistémica en cirugía cardíaca pediátrica / Systemic inflammatory response in pediatric cardiac surgery

ABSTRACT

Systemic Inflammatory Response (SIR) constitutes generalized, non-specific response to tissue injury of whatever etiology, and is a rapid, highly amplified, controlled humeral and cellular response. Cardiopulmonary Bypass (CPB) is necessary in many cardiac surgery as in adults as children. Also we know the undesirable effects of SIR. The pediatric surgical team to treat of management very well if exist the threat of undesirable outcome after CPB. There are several key components of the inflammatory response to cardiac surgery involve the complement, immune and endothelial systems. Cytokines may exert either proinflammatory or antiinflammatory effects. Cytokines are essential for immunologic and physiologic homeostasis, are normally subject to thight homeostatic control, and are produced in response to a variety of physiologic and pathologic stimuli. An uncontrolled inflammatory response appears to play a significant role in the morbidity or mortality observed in patients undergoing CPB. The inflammatory response contributes to the pathogenesis of acute pulmonary, cardiovascular, neurologic, splanchnic, hematologic, and immune system dysfunction following cardiac surgery. The development of strategies to control the inflammatory response following cardiac surgery is currently the focus of considerable research efforts. Diverse techniques, including maintenance of hemodynamic stability, minimization of exposure to CPB circuitry, and pharmacologic and immunomodulatory agents have been studied. Also hemofiltration, leukodepletion, the use of serine protease inhibitors and corticosteroids. Molecular biology is revolutionizing medicine and the ability to assess the impact of genetic variability on disease characterization and perioperative outcome. Recent evidence suggests that the degree and severity of surgical-induced inflammation may be significantly influenced by genotype.