Xiuhua Chen, Shu-Ting Huang, J Y Lin, Yi-Rong Zheng
OBJECTIVES: We have investigated postoperative dynamic changes in endothelial glycocalyx (EG) degradation markers in infants who have undergone cardiopulmonary bypass (CPB) for congenital heart disease (CHD) surgery, and related the observations to the development of pediatric acute respiratory distress syndrome (PARDS). DESIGN: Single-center prospective, case-control study, June to December 2024. SETTING: Twenty-bed to a pediatric cardiac ICU (CICU) in a tertiary hospital in China. PATIENTS: Overall, 45 infants (age range 121-351 d) undergoing nonemergency CPB for CHD were recruited; 15 with PARDS and 30 matched non-PARDS cases. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: PARDS patients in comparison with non-PARDS patients had higher glycocalyx degradation markers at CICU admission (T 1 ): syndecan-1, 199.2 ± 22.1 vs. 118.6 ± 6.2 ng/mL ( p < 0.05); heparan sulfate (HS), 105.7 ± 11.9 vs. 79.1 ± 6.8 ng/mL ( p < 0.05); and hyaluronic acid (HA), 53.6 ± 10.5 vs. 40.4 ± 4.7 ng/mL ( p < 0.05). Biomarkers were highest at T 1 , fell at postoperative day 1 (T 2 ), and returned to baseline by day 5 (T 3 ) in both groups, with levels consistency higher in PARDS infants. The PARDS group also had longer median duration of mechanical ventilation (48 vs. 24 hr, p < 0.001), CICU stay (7.0 vs. 4.0 d), and hospital stay (18.5 vs. 12.0 d), with T 1 biomarker levels correlated with duration of mechanical ventilation (r = 0.52-0.68) and CICU length of stay (r = 0.61-0.71; all p < 0.05). CONCLUSIONS: In CHD infants admitted to the CICU after surgery involving CPB, PARDS cases exhibit an associated EG injury. Monitoring of the peak levels of degradation markers (syndecan-1, HS, and HA) at admission to the CICU may help identify those at most risk of PARDS.