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Systemic inflammatory response related to cardiopulmonary bypass and its modification by methyl prednisolone: high
1Department of Pediatric Cardiology, Baskent University Faculty of Medicine, Ankara, Turkey.
Insights
High-dose methylprednisolone (MP) did not significantly reduce the systemic inflammatory response (SIR) to cardiopulmonary bypass (CPB) in pediatric cardiac surgery patients compared to low-dose MP. No major complications arose from high-dose MP treatment.
Area of Science:
- Pediatric Cardiac Surgery
- Pharmacology
- Immunology
Background:
- Cardiopulmonary bypass (CPB) triggers a systemic inflammatory response (SIR).
- Methylprednisolone (MP) is used to mitigate SIR during cardiac surgery.
- The optimal dose of MP for pediatric patients undergoing CPB remains unclear.
Purpose of the Study:
- To investigate the safety and efficacy of high-dose MP versus low-dose MP in modulating SIR to CPB.
- To compare the effects of different MP doses on inflammatory markers and clinical outcomes in children with congenital heart disease.
Main Methods:
- Thirty pediatric patients undergoing cardiac surgery with CPB were randomized into two groups.
- Group 1 received high-dose MP (30 mg/kg), and Group 2 received low-dose MP (2 mg/kg) intravenously before CPB.
- Postoperative serum interleukin (IL)-6 and IL-8 levels, C-reactive protein (CRP), leukocyte counts, temperature, ventilation duration, ICU stay, oxygenation, and biochemistry were monitored.
Main Results:
- Both high-dose and low-dose MP groups showed elevated IL-6 and IL-8 levels post-CPB, with no significant difference between groups.
- No significant differences were observed in CRP levels, leukocyte counts, core temperature, mechanical ventilation duration, ICU stay, oxygenation indices, or biochemical parameters.
- High-dose MP was safe, with only one patient experiencing transiently elevated liver enzymes and renal parameters.
Conclusions:
- High-dose MP (30 mg/kg) is not superior to low-dose MP (2 mg/kg) in blunting the SIR to CPB in pediatric open-heart surgery.
- While CPB induces a SIR, high-dose MP did not demonstrate a significant clinical advantage in this pediatric cohort.
- Further research may explore alternative or adjunctive strategies for managing SIR in pediatric cardiac surgery.
Abstract:
The objective of our study was to investigate the safety and efficacy of high-dose methyl prednisolone (MP) in modifying the systemic inflammatory response (SIR) to cardiopulmonary bypass (CPB) and to compare its efficacy with low-dose MP in children undergoing cardiac surgery for congenital heart disease. Thirty children with congenital heart disease undergoing CPB were randomly assigned to two groups: group 1 (n = 15) received 30 mg/kg MP by an intravenous infusion for 30 minutes and group 2 (n = 15) received 2 mg/kg intravenously, before the onset of CPB. Postoperative clinical parameters were recorded, and serum interleukin (IL)-6 and 8 levels, acute phase reactants, and blood biochemistry were determined serially for both groups. In both groups plasma IL-6 and 8 levels were elevated above the preoperative levels at 2 and 24 hours after declamping. The peak levels were obtained at 2-hour samples. The difference between the two groups in terms of postoperative IL-6 and 8 levels was not statistically significant. C-reactive protein (CRP) levels and polymorphonuclear leukocyte counts, postoperative core temperature, duration of mechanical ventilation, period of stay in intensive care unit, oxygenation indices, and biochemical parameters of patients did not significantly differ in the two groups. Only 1 patient in group 1 had elevated liver enzymes, blood urea nitrogen, and creatinine in the postoperative period. No significant complications were observed due to treatment with high-dose MP. Although postoperative IL and CRP levels indicated a SIR in our patients, the clinical picture was apparently affected in only 1 patient and she was in the high-dose MP group. CPB initiates a SIR that is associated with an increase in neutrophil count, CRP, and IL-6 and 8 levels. High-dose (30 mg/kg) MP was not superior to low-dose (2 mg/kg) in blunting the SIR to CPB in pediatric patients undergoing open-heart surgery.