Administration of steroids in pediatric cardiac surgery: impact on clinical outcome and systemic inflammatory response.
Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response. Pre-bypass steroid administration may modulate the inflammatory response, resulting in improved postoperative recovery. We performed a prospective study in the departments of cardiovascular surgery and pediatric intensive care medicine of two university hospitals that included 50 infants who underwent heart surgery. Patients received either prednisolone (30 mg/kg) added to the priming solution of the cardiopulmonary bypass circuit (steroid group) or no steroids (nonsteroid group). Clinical outcome parameters include therapy with inotropic drugs, oxygenation, blood lactate, glucose, and creatinine, and laboratory parameters of inflammation include leukocytes, C-reactive protein, and interleukin-8. Postoperative recovery (e.g., the number, dosage, and duration of inotropic drugs as well as oxygenation) was similar in patients treated with or without steroids when corrected for the type of cardiac surgery performed. After CPB, there was an inflammatory reaction, especially in patients with a long CPB time. Postoperative plasma levels of interleukin-8 were correlated with the duration of CPB time (r = 0.62, p < 0.001). Administration of steroids had no significant impact on the laboratory parameters of inflammation. Administration of prednisolone into the priming solution of the CPB circuit had no measurable influence on postoperative recovery and did not suppress the inflammatory response.
Gessler
P
P
University Children's Hospital, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland. peter.gessler@kispi.unizh.ch
Hohl
V
V
Carrel
T
T
Pfenninger
J
J
Schmid
E R
ER
Baenziger
O
O
Prètre
R
R
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006801:Humans; D007223:Infant; D016209:Interleukin-8 / Q000097:blood; D007958:Leukocyte Count; D009504:Neutrophils / Q000187:drug effects / Q000378:metabolism; D011239:Prednisolone / Q000008:administration & dosage*; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D016209:Interleukin-8; D002097:C-Reactive Protein; D011239:Prednisolone; D003404:Creatinine