Affiliation:
1. From the Divisions of Cardiology (V.A.S., S.M.S., D.P.N.), Cardiothoracic Surgery (J.M.P., P.B.M.), Molecular Cardiovascular Biology (S.M.S., D.P.N.), and Critical Care Medicine (T.P.S.), Cincinnati Children’s Hospital, Cincinnati, Ohio.
Abstract
Background—
Steroid administration during cardiopulmonary bypass is thought to improve cardiopulmonary function by modulating bypass-related inflammation. This study was designed to compare preoperative and intraoperative methylprednisolone (MP) to intraoperative MP alone with respect to postbypass inflammation and clinical outcome.
Methods and Results—
Twenty-nine pediatric patients undergoing bypass procedures were randomly assigned to receive preoperative and intraoperative MP (30 mg/kg 4 hours before bypass and in bypass prime, n=14) or intraoperative MP only (30 mg/kg, n=15). Myocardial inflammatory mediator mRNA expression was determined in paired atrial biopsies (before and after bypass) by ribonuclease protection. Before and after bypass, serum IL-6 and IL-10 were measured by ELISA. Postoperative outcome was assessed by intubation time, CICU length of stay, fluid balance, arterio-venous O
2
difference (ΔA−V
o
2
), and inotrope requirements. Compared with intraoperative MP alone, combined preoperative and intraoperative MP was associated with reduced myocardial mRNA expression for IL-6, MCP-1, and ICAM-1 both before and after bypass (
P
<0.05). Patients who received combined steroids had lower serum IL-6 and increased IL-10 at end-bypass (
P
<0.05), although differences were negligible by 24 hours. Combined MP treatment was associated with reduced fluid requirements, lower body temperature, and lower ΔA−V
o
2
for the first 24 hours after surgery (
P
<0.05), along with trends toward improvement in other clinical outcomes.
Conclusions—
Compared with intraoperative steroid treatment, combined preoperative and intraoperative steroid administration attenuates inflammatory mediator expression more effectively and is associated with improved indexes of O
2
delivery in the first 24 hours after congenital heart surgery. These findings need to be confirmed in a larger multicenter trial.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Cited by
135 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献