Evolução funcional de crianças com cardiopatia congênita submetidas à cirurgia cardíaca

Abstract

Introduction: Congenital malformations represent the second leading cause of mortality in children under one year of age. However, with the advancement of technology, life expectancy reaches 85% of cases after surgery. With increased survival, critically ill patients remain longer in the Pediatric Intensive Care Unit (PICU), bringing motor, cognitive and pulmonary repercussions. There is a scarcity of studies evaluating the functional evolution of children undergoing cardiac surgery from hospital admission to discharge and its relationship with clinical outcomes. Objective: To verify the evolution of the functionality of children with congenital heart disease (CHD) undergoing cardiac surgery. Methodology: This is a prospective cohort study. We evaluated children with CHD in the preoperative period admitted to a public referral hospital for pediatric cardiology in Salvador. Children with CHD of both sexes, aged between 0 and 18 years old, at admission to the ward or at the PICU were included. The assessment of the functional outcome was evaluated at hospital admission (within 48 hours), at Intensive Care Unit (ICU) discharge, at hospital discharge using the Functional Status Scale (FSS). Results: The sample consisted of 112 children, with a median age of 12 (6-57) months, 53.6% of whom were male. The most frequent type of heart disease was acyanogenic with 61.6%. Greater functional impairment was found at ICU discharge when compared to hospital admission and discharge. A moderate positive correlation was observed between time on mechanical ventilation (MV) and functionality at ICU discharge. Children with moderate to very severe dysfunction were younger, underweight, with longer cardiopulmonary bypass times, anoxia, MV time, and ICU time. Patients who were readmitted to the ICU had worse FSS scores at ICU discharge. Conclusion: Differences were observed between adequate function/mild dysfunction and moderate/very severe dysfunction in the three evaluation moments.