The survival rate for children with
congenital heart disease (CHD) has increased significantly coincident with improved techniques in cardiothoracic surgery,
cardiopulmonary bypass and myocardial protection, and
perioperative care.
Cardiopulmonary bypass, likely in combination with
ischemia-reperfusion injury,
hypothermia, and surgical
trauma, elicits a complex, systemic inflammatory response that is characterized by activation of the
complement cascade, release of
endotoxin, activation of leukocytes and the vascular endothelium, and release of proinflammatory
cytokines. This complex inflammatory state causes a transient immunosuppressed state, which may increase the risk of hospital-acquired
infection in these children. Postoperative
sepsis occurs in nearly 3% of children undergoing cardiac surgery and has been associated with longer
length of stay and mortality risks in the pediatric cardiac intensive care unit. Herein, we review the epidemiology, pathobiology, and management of
sepsis in the pediatric cardiac intensive care unit.