A neutrophil elastase inhibitor, sivelestat, improved respiratory and cardiac function in pediatric cardiovascular surgery with cardiopulmonary bypass.
OBJECTIVE
Several reports indicate that a neutrophil elastase inhibitor, sivelestat, may have prophylactic efficacy against a systemic inflammatory response after cardiovascular surgery with cardiopulmonary bypass (CPB). We evaluated the clinical pulmonary and cardiac effects of sivelestat.


METHODS
We performed a retrospective study of 25 pediatric patients who underwent elective cardiovascular surgery with CPB for ventricular septal defect with pulmonary hypertension. Ten patients received 0.2 mg x kg(-1) x h(-1) sivelestat; the other is patients were the control group. There were no significant differences in demographic characteristics between the two groups. The P(a)O(2)/fractional inspired oxygen (F(I)O(2); P/F) ratio, the respiratory index (RI), and the fractional area change (FAC) of the left ventricle (LV) in the postoperative course were measured.


RESULTS
The P/F ratio was higher in the sivelestat group compared with the control group and there were significant differences between the two groups immediately after weaning form CPB, and at 12 h after weaning from CPB (P < 0.05). The RI was lower in the sivelestat group compared with the control group and there were significant differences between the two groups at immediately after weaning from CPB, and at 6 h and 12 h after CPB (P < 0.05). The FAC of the LV was significantly better in the sivelestat group and there was a significant difference between the two groups on postoperative day (POD) 3 (P < 0.05).


CONCLUSIONS
We have shown that pediatric patients who underwent cardiovascular surgery with CPB who received sivelestat had a higher P/F ratio, a lower RI, and better FAC of the LV in the postoperative course.
Toyama
Satoshi
S
Department of Anesthesia, Chiba Children's Hospital, 579-1 Heta-cho, Midori-ku, Chiba, 266-0077, Japan.
Hatori
Fumimaro
F
Shimizu
Ayako
A
Takagi
Toshio
T
D000769:Anesthesia, Inhalation; D002315:Cardiopulmonary Bypass; D005260:Female; D005998:Glycine / Q000031:analogs & derivatives* / Q000494:pharmacology; D006321:Heart / Q000187:drug effects*; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery; D006400:Hematocrit; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007958:Leukocyte Count; D008297:Male; D010100:Oxygen / Q000097:blood; D053491:Proteinase Inhibitory Proteins, Secretory / Q000494:pharmacology*; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000187:drug effects*; D012189:Retrospective Studies; D013449:Sulfonamides / Q000494:pharmacology*; D014656:Vascular Surgical Procedures; D016277:Ventricular Function, Left / Q000187:drug effects
D053491:Proteinase Inhibitory Proteins, Secretory; D013449:Sulfonamides; C069195:sivelestat; D010100:Oxygen; D005998:Glycine