Significance of peritoneal fluid drainage in management after repair of complex heart defects in infancy: cytokine dynamics in vivo.
BACKGROUND
In vivo redundancy of pro-inflammatory cytokines results in a vicious cycle of systemic inflammatory response syndrome and low cardiac output syndrome (LOS). The purpose of this study was to elucidate the influence of peritoneal fluid (PF) drainage on cytokine dynamics in vivo and the significance of early induction for infants with LOS.


RESULTS
Seven infants, who underwent early PF drainage to manage LOS after repair of complex heart defects under cardiopulmonary bypass, were enrolled. The serum and PF levels of the pro- and antiinflammatory cytokines, interleukin (IL)-6, -8, -10 and tumor necrosis factor (TNF)-alpha, were measured during the perioperative period. Clinical outcomes were observed simultaneously. There were no cases of early or late death, or infectious complications. Drainage volume of PF peaked just after operation, and decreased completely. The amount of proinflammatory cytokines in the PF increased for 3 days after operation. Of the proinflammatory cytokines in the PF IL-6 increased the earliest and cleared the fastest. The amount of cleared IL-8 and TNF-alpha peaked on the 3rd postoperative day and resembled the course of C-reactive protein (CRP). Serum levels of CRP and proinflammatory cytokines in patients with PF drainage decreased significantly more than those without PF drainage.


CONCLUSIONS
Early initiation of PF drainage is useful in the postoperative critical care of infants with LOS by improving cytokine dynamics in vivo, although there are differences between the severity of patients undergoing PF drainage and those who do not.
Kurobe
Hirotsugu
H
Department of Cardiovascular Surgery, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima 770-8503, Japan.
Kitaichi
Takashi
T
Shimahara
Yusuke
Y
Kanemura
Takeyuki
T
Kanbara
Tamotsu
T
Kurushima
Atsushi
A
Kano
Masashi
M
Hori
Takaki
T
Yoshida
Homare
H
Urata
Masahiro
M
Kitagawa
Tetsuya
T
D001202:Ascitic Fluid / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D002303:Cardiac Output, Low / Q000378:metabolism / Q000628:therapy; D002315:Cardiopulmonary Bypass; D016207:Cytokines / Q000378:metabolism*; D004322:Drainage; D005260:Female; D006330:Heart Defects, Congenital / Q000378:metabolism* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D011182:Postoperative Care; D011184:Postoperative Period
D016207:Cytokines; D002097:C-Reactive Protein