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Endocrinal complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

Part of: The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD)

Published online by Cambridge University Press:  01 December 2008

Heather Dickerson ,
David S. Cooper ,
Paul A. Checchia  and
David P. Nelson
Heather Dickerson*
Affiliation:
Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
David S. Cooper
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Division of Critical Care, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Florida Pediatric Associates, Saint Petersburg and Tampa, Florida, United States of America
Paul A. Checchia
Affiliation:
St. Louis Children’s Hospital, Washington University School of Medicine, Missouri, United States of America
David P. Nelson
Affiliation:
Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
*
Correspondence to: Heather Dickerson, MD, Assistant Professor of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St, MC 19345-C, Houston, TX 77030, United States of America. Tel: 001-832-826-5637; Fax: 001-832-825-5630; E-mail: [email protected]
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Abstract

A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.

The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the endocrine system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.

As surgical survival in children with congenital cardiac disease has improved in recent years, focus has necessarily shifted to reducing the morbidity of congenital cardiac malformations and their treatment. A comprehensive list of endocrinal complications is presented. This list is a component of a systems-based compendium of complications that will standardize terminology and thereby allow the study and quantification of morbidity in patients with congenital cardiac malformations. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment.

Keywords

Congenital heart diseasequality improvementpatient safetyoutcomesregistryoperative morbiditypaediatricsurgerycongenital abnormalitiescardiac surgical proceduresendocrine complicationsthyroid dysfunctionadrenal dysfunctionhyperglycaemiavasopressincardiac post-operative
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue S2: Databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease , December 2008 , pp. 256 - 264
Copyright
Copyright © Cambridge University Press 2008

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References

1.Jacobs, JP, Jacobs, ML, Mavroudis, C, et al. Executive summary: the Society of Thoracic Surgeons Congenital Heart Surgery Database – Fifth Harvest – (2002–2004). The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI). Duke University Medical Centre, Durham, North Carolina, USA, 2005.Google Scholar
2.Jacobs, JP, Jacobs, ML, Maruszewski, B, et al. Current status of the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg 2005; 80: 2278–2283.CrossRefGoogle Scholar
3.Jacobs, JP, Mavroudis, C, Jacobs, ML, et al. What is operative mortality? Defining death in a surgical registry database: a report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg 2006; 81: 1937–1941.CrossRefGoogle Scholar
4.Jacobs, JP, Jacobs, ML, Mavroudis, C, et al. What is operative morbidity? Defining complications in a surgical registry database: a report from the STS Congenital Database Task Force and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg 2007; 84: 1416–1421.CrossRefGoogle Scholar
5.Trimarchi, T. Endocrine problems in critically ill children: an overview. AACN Clin Issues 2006; 17: 66–78.CrossRefGoogle ScholarPubMed
6.Cooper, MS, Stewart, PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med 2003; 348: 727–734.CrossRefGoogle ScholarPubMed
7.Oelkers, W. Adrenal insufficiency. N Engl J Med 2007; 335: 1206–1212.CrossRefGoogle Scholar
8.Gomes, JA, Stevens, RD, Lewin, JJ 3rd, Mirski, MA, Bhardwaj, A. Glucocorticoid therapy in neurologic critical care. Crit Care Med 2005; 33: 1214–1224.CrossRefGoogle ScholarPubMed
9.Hamrahian, AH, Oseni, TS, Arafah, BM. Measurements of serum free cortisol in critically ill patients. N Engl J Med 2004; 350: 1629–1638.CrossRefGoogle ScholarPubMed
10.Sarthi, M, Lodha, R, Vivekanandhan, S, Arora, NK. Adrenal status in children with septic shock using low-dose stimulation test. Pediatr Crit Care Med 2007; 8: 23–28.CrossRefGoogle ScholarPubMed
11.Annane, D, Sebille, V, Charpentier, C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002; 288: 862–871.CrossRefGoogle ScholarPubMed
12.Annane, D, Sebille, V, Troche, G, Raphael, JC, Gajdos, P, Bellissant, E. A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA 2000; 283: 1038–1045.CrossRefGoogle ScholarPubMed
13.Rady, MY, Johnson, DJ, Patel, B, Larson, J, Helmers, R. Cortisol levels and corticosteroid administration fail to predict mortality in critical illness: the confounding effects of organ dysfunction and sex. Arch Surg 2005; 140: 661–668; discussion 669.CrossRefGoogle ScholarPubMed
14.Pizarro, CF, Troster, EJ, Damiani, D, Carcillo, JA. Absolute and relative adrenal insufficiency in children with septic shock. Crit Care Med 2005; 33: 855–859.CrossRefGoogle ScholarPubMed
15.Hatherill, M, Tibby, SM, Hilliard, T, Turner, C, Murdoch, IA. Adrenal insufficiency in septic shock. Arch Dis Child 1999; 80: 51–55.CrossRefGoogle ScholarPubMed
16.Loisa, P, Rinne, T, Kaukinen, S. Adrenocortical function and multiple organ failure in severe sepsis. Acta Anaesthesiol Scand 2002; 46: 145–151.CrossRefGoogle ScholarPubMed
17.Marik, PE, Zaloga, GP. Adrenal insufficiency during septic shock. Crit Care Med 2003; 31: 141–145.CrossRefGoogle ScholarPubMed
18.Menon, K, Clarson, C. Adrenal function in paediatric critical illness. Pediatr Crit Care Med 2002; 3: 112–116.CrossRefGoogle Scholar
19.Rothwell, PM, Udwadia, ZF, Lawler, PG. Cortisol response to corticotropin and survival in septic shock. Lancet 1991; 337: 582–583.CrossRefGoogle ScholarPubMed
20.Soni, A, Pepper, GM, Wyrwinski, PM, et al. Adrenal insufficiency occurring during septic shock: incidence, outcome, and relationship to peripheral cytokine levels. Am J Med 1995; 98: 266–271.CrossRefGoogle ScholarPubMed
21.Annane, D. Corticosteroids for septic shock. Crit Care Med 2001; 29: S117–S120.CrossRefGoogle ScholarPubMed
22.Sajan, I, Dent, C, Schwartz, SM, Nelson, DP. Adrenal dysfunction is common in children with congenital heart disease manifesting catecholamine-refractory low cardiac output syndrome. Crit Care Med 2004; 32: A6.CrossRefGoogle Scholar
23.Oppert, M, Reinicke, A, Graf, KJ, Barckow, D, Frei, U, Eckardt, KU. Plasma cortisol levels before and during “low-dose” hydrocortisone therapy and their relationship to hemodynamic improvement in patients with septic shock. Intensive Care Med 2000; 26: 1747–1755.CrossRefGoogle ScholarPubMed
24.Oppert, M, Schindler, R, Husung, C, et al. Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock. Crit Care Med 2005; 33: 2457–2464.CrossRefGoogle ScholarPubMed
25.Bollaert, PE, Charpentier, C, Levy, B, Debouverie, M, Audibert, G, Larcan, A. Reversal of late septic shock with supraphysiologic doses of hydrocortisone. Crit Care Med 1998; 26: 645–650.CrossRefGoogle ScholarPubMed
26.Briegel, J, Forst, H, Haller, M, et al. Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study. Crit Care Med 1999; 27: 723–732.CrossRefGoogle ScholarPubMed
27.Hallman, M, Peltoniemi, O, Saarela, T. Early neonatal hydrocortisone: study rather than treat. Pediatrics 2006; 118: 2540–2542.CrossRefGoogle ScholarPubMed
28.Lamberts, SW, Bruining, HA, de Jong, FH. Corticosteroid therapy in severe illness. N Engl J Med 1997; 337: 1285–1292.CrossRefGoogle ScholarPubMed
29.Seri, I, Tan, R, Evans, J. Cardiovascular effects of hydrocortisone in preterm infants with pressor-resistant hypotension. Pediatrics 2001; 107: 1070–1074.CrossRefGoogle ScholarPubMed
30.Donmez, A, Kaya, H, Haberal, A, Kutsal, A, Arslan, G. The effect of etomidate induction on plasma cortisol levels in children undergoing cardiac surgery. J Cardiothorac Vasc Anesth 1998; 12: 182–185.CrossRefGoogle ScholarPubMed
31.Absalom, A, Pledger, D, Kong, A. Adrenocortical function in critically ill patients 24 h after a single dose of etomidate. Anaesthesia 1999; 54: 861–867.CrossRefGoogle ScholarPubMed
32.Chrousos, GP. The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N Engl J Med 1995; 332: 1351–1362.CrossRefGoogle ScholarPubMed
33.Henzen, C, Kobza, R, Schwaller-Protzmann, B, Stulz, P, Briner, VA. Adrenal function during coronary artery bypass grafting. Eur J Endocrinol 2003; 148: 663–668.CrossRefGoogle ScholarPubMed
34.Dimmick, S, Badawi, N, Randell, T. Thyroid hormone supplementation for the prevention of morbidity and mortality in infants undergoing cardiac surgery. Cochrane Database Syst Rev 2004: CD004220.Google ScholarPubMed
35.Klein, I, Ojamaa, K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001; 344: 501–509.CrossRefGoogle ScholarPubMed
36.Gotzsche, LB. L-triiodothyronine acutely increases Ca2+ uptake in the isolated, perfused rat heart. Changes in L-type Ca2+ channels and beta-receptors during short- and long-term hyper- and hypothyroidism. Eur J Endocrinol 1994; 130: 171–179.CrossRefGoogle Scholar
37.Klein, I, Ojamaa, K. Thyroid hormone treatment of congestive heart failure. Am J Cardiol 1998; 81: 490–491.Google ScholarPubMed
38.Moruzzi, P, Doria, E, Agostoni, PG. Medium-term effectiveness of L-thyroxine treatment in idiopathic dilated cardiomyopathy. Am J Med 1996; 101: 461–467.CrossRefGoogle ScholarPubMed
39.Singh, S, Duggal, J, Molnar, J, Maldonado, F, Barsano, CP, Arora, R. Impact of subclinical thyroid disorders on coronary heart disease, cardiovascular and all-cause mortality: A meta-analysis. Int J Cardiol 2008; 125: 41–48.CrossRefGoogle ScholarPubMed
40.Chopra, IJ. Euthyroid sick syndrome: is it a misnomer? J Clin Endocrinol Metab 1997; 82: 329–334.CrossRefGoogle ScholarPubMed
41.Hamilton, MA, Stevenson, LW, Fonarow, GC, et al. Safety and hemodynamic effects of intravenous triiodothyronine in advanced congestive heart failure. Am J Cardiol 1998; 81: 443–447.CrossRefGoogle ScholarPubMed
42.Utiger, RD. Altered thyroid function in nonthyroidal illness and surgery. To treat or not to treat? N Engl J Med 1995; 333: 1562–1563.CrossRefGoogle ScholarPubMed
43.De Groot, LJ. Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab 1999; 84: 151–164.CrossRefGoogle Scholar
44.Katzeff, HL, Powell, SR, Ojamaa, K. Alterations in cardiac contractility and gene expression during low-T3 syndrome: prevention with T3. Am J Physiol 1997; 273: E951–E956.Google ScholarPubMed
45.Portman, MA, Fearneyhough, C, Ning, XH, Duncan, BW, Rosenthal, GL, Lupinetti, FM. Triiodothyronine repletion in infants during cardiopulmonary bypass for congenital heart disease. J Thorac Cardiovasc Surg 2000; 120: 604–608.CrossRefGoogle ScholarPubMed
46.Faber, J, Kirkegaard, C, Rasmussen, B, Westh, H, Busch-Sorensen, M, Jensen, IW. Pituitary-thyroid axis in critical illness. J Clin Endocrinol Metab 1987; 65: 315–320.CrossRefGoogle ScholarPubMed
47.Bettendorf, M, Schmidt, KG, Tiefenbacher, U, Grulich-Henn, J, Heinrich, UE, Schonberg, DK. Transient secondary hypothyroidism in children after cardiac surgery. Pediatr Res 1997; 41: 375–379.CrossRefGoogle ScholarPubMed
48.Bennett-Guerrero, E, Jimenez, JL, White, WD, D’Amico, EB, Baldwin, BI, Schwinn, DA. Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery. A randomized, double-blind, placebo-controlled trial. Duke T3 study group. JAMA 1996; 275: 687–692.CrossRefGoogle ScholarPubMed
49.Bettendorf, M, Schmidt, KG, Grulich-Henn, J, Ulmer, HE, Heinrich, UE. Tri-iodothyronine treatment in children after cardiac surgery: a double-blind, randomised, placebo-controlled study. Lancet 2000; 356: 529–534.CrossRefGoogle ScholarPubMed
50.Kennedy, DJ, Butterworth, JF 4th. Endocrine function during and after cardiopulmonary bypass: recent observations. J Clin Endocrinol Metab 1994; 78: 997–1002.Google ScholarPubMed
51.Mackie, AS, Booth, KL, Newburger, JW, et al. A randomized, double-blind, placebo-controlled pilot trial of triiodothyronine in neonatal heart surgery. J Thorac Cardiovasc Surg 2005; 130: 810–816.CrossRefGoogle ScholarPubMed
52.Mainwaring, RD, Healy, RM, Meier, FA, Nelson, JC, Norwood, WI. Reduction in levels of triiodothyronine following the first stage of the Norwood reconstruction for hypoplastic left heart syndrome. Cardiol Young 2001; 11: 295–300.CrossRefGoogle ScholarPubMed
53.Murzi, B, Iervasi, G, Masini, S, et al. Thyroid hormones homeostasis in paediatric patients during and after cardiopulmonary bypass. Ann Thorac Surg 1995; 59: 481–485.CrossRefGoogle ScholarPubMed
54.Mainwaring, RD, Capparelli, E, Schell, K, Acosta, M, Nelson, JC. Pharmacokinetic evaluation of triiodothyronine supplementation in children after modified Fontan procedure. Circulation 2000; 101: 1423–1429.CrossRefGoogle ScholarPubMed
55.Dagan, O, Vidne, B, Josefsberg, Z, Phillip, M, Strich, D, Erez, E. Relationship between changes in thyroid hormone level and severity of the postoperative course in neonates undergoing open-heart surgery. Paediatr Anaesth 2006; 16: 538–542.CrossRefGoogle ScholarPubMed
56.Chowdhury, D, Ojamaa, K, Parnell, VA, McMahon, C, Sison, CP, Klein, I. A prospective randomized clinical study of thyroid hormone treatment after operations for complex congenital heart disease. J Thorac Cardiovasc Surg 2001; 122: 1023–1025.CrossRefGoogle ScholarPubMed
57.Chowdhury, D, Parnell, VA, Ojamaa, K, Boxer, R, Cooper, R, Klein, I. Usefulness of triiodothyronine (T3) treatment after surgery for complex congenital heart disease in infants and children. Am J Cardiol 1999; 84: 1107–1109, A1110.CrossRefGoogle ScholarPubMed
58.Kinnala, A, Rikalainen, H, Lapinleimu, H, Parkkola, R, Kormano, M, Kero, P. Cerebral magnetic resonance imaging and ultrasonography findings after neonatal hypoglycemia. Pediatrics 1999; 103: 724–729.CrossRefGoogle ScholarPubMed
59.Rassias, AJ. Intraoperative management of hyperglycemia in the cardiac surgical patient. Semin Thorac Cardiovasc Surg 2006; 18: 330–338.CrossRefGoogle ScholarPubMed
60.Dandona, P, Chaudhuri, A, Ghanim, H, Mohanty, P. Anti-inflammatory effects of insulin and the pro-inflammatory effects of glucose. Semin Thorac Cardiovasc Surg 2006; 18: 293–301.CrossRefGoogle ScholarPubMed
61.Van den Berghe, G, Wilmer, A, Hermans, G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006; 354: 449–461.CrossRefGoogle ScholarPubMed
62.Vanhorebeek, I, Ingels, C, Van den Berghe, G. Intensive insulin therapy in high-risk cardiac surgery patients: evidence from the Leuven randomized study. Semin Thorac Cardiovasc Surg 2006; 18: 309–316.CrossRefGoogle ScholarPubMed
63.Branco, RG, Tasker, RC. Glycemic level in mechanically ventilated children with bronchiolitis. Pediatr Crit Care Med 2007; 8: 546–550.CrossRefGoogle ScholarPubMed
64.de Ferranti, S, Gauvreau, K, Hickey, PR, et al. Intraoperative hyperglycemia during infant cardiac surgery is not associated with adverse neurodevelopmental outcomes at 1, 4, and 8 years. Anesthesiology 2004; 100: 1345–1352.CrossRefGoogle ScholarPubMed
65.Yates, AR, Dyke, PC 2nd, Taeed, R, et al. Hyperglycemia is a marker for poor outcome in the postoperative paediatric cardiac patient. Pediatr Crit Care Med 2006; 7: 351–355.CrossRefGoogle ScholarPubMed
66.Rossano, JW, Taylor, MD, Smith, O, et al. Glycemic profile in infants who have undergone the arterial switch operation: hyperglycemia is not associated with adverse events. J Thorac Cardiovasc Surg 2008; 135: 739–745.CrossRefGoogle Scholar
67.Parker, MM, Hazelzet, JA, Carcillo, JA. Pediatric considerations. Crit Care Med 2004; 32: S591–S594.CrossRefGoogle ScholarPubMed
68.Ariyan, CE, Sosa, JA. Assessment and management of patients with abnormal calcium. Crit Care Med 2004; 32: S146–S154.CrossRefGoogle ScholarPubMed
69.Zaloga, GP. Hypocalcemia in critically ill patients. Crit Care Med 1992; 20: 251–262.CrossRefGoogle ScholarPubMed
70.Burchard, KW, Gann, DS, Colliton, J, Forster, J. Ionized calcium, parathormone, and mortality in critically ill surgical patients. Ann Surg 1990; 212: 543–549; discussion 549–550.CrossRefGoogle ScholarPubMed
71.Carcillo, JA, Fields, AI. Clinical practice parameters for hemodynamic support of paediatric and neonatal patients in septic shock. Crit Care Med 2002; 30: 1365–1378.CrossRefGoogle Scholar
72.Dyke, PC 2nd, Yates, AR, Cua, CL, et al. Increased calcium supplementation is associated with morbidity and mortality in the infant postoperative cardiac patient. Pediatr Crit Care Med 2007; 8: 254–257.CrossRefGoogle ScholarPubMed
73.LeJemtel, TH, Serrano, C. Vasopressin dysregulation: hyponatremia, fluid retention and congestive heart failure. Int J Cardiol 2007; 120: 1–9.CrossRefGoogle ScholarPubMed
74.Treschan, TA, Peters, J. The vasopressin system: physiology and clinical strategies. Anesthesiology 2006; 105: 599–612; quiz 639–540.CrossRefGoogle ScholarPubMed
75.Holmes, CL, Landry, DW, Granton, JT. Science review: Vasopressin and the cardiovascular system part 1 – receptor physiology. Crit Care 2003; 7: 427–434.CrossRefGoogle ScholarPubMed
76.Ali, F, Guglin, M, Vaitkevicius, P, Ghali, JK. Therapeutic potential of vasopressin receptor antagonists. Drugs 2007; 67: 847–858.CrossRefGoogle ScholarPubMed
77.Tanoue, A, Ito, S, Honda, K, et al. The vasopressin V1b receptor critically regulates hypothalamic-pituitary-adrenal axis activity under both stress and resting conditions. J Clin Invest 2004; 113: 302–309.CrossRefGoogle ScholarPubMed
78.Aguilera, G, Rabadan-Diehl, C. Vasopressinergic regulation of the hypothalamic-pituitary-adrenal axis: implications for stress adaptation. Regul Pept 2000; 96: 23–29.CrossRefGoogle ScholarPubMed
79.Sharshar, T, Blanchard, A, Paillard, M, Raphael, JC, Gajdos, P, Annane, D. Circulating vasopressin levels in septic shock. Crit Care Med 2003; 31: 1752–1758.CrossRefGoogle ScholarPubMed
80.Lechner, E, Dickerson, HA, Fraser, CD Jr, Chang, AC. Vasodilatory shock after surgery for aortic valve endocarditis: use of low-dose vasopressin. Pediatr Cardiol 2004; 25: 558–561.CrossRefGoogle ScholarPubMed
81.Lechner, E, Hofer, A, Mair, R, Moosbauer, W, Sames-Dolzer, E, Tulzer, G. Arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass. Eur J Pediatr 2007; 166: 1221–1227.CrossRefGoogle ScholarPubMed
82.Rosenzweig, EB, Starc, TJ, Chen, JM, et al. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 1999; 100: II182–II186.CrossRefGoogle ScholarPubMed