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Comparative effectiveness of methylprednisolone and zero-balance ultrafiltration on inflammatory response after
Jinping Liu1, Bingyang Ji, Cun Long
1Department of Cardiopulmonary Bypass, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Insights
Zero-balance ultrafiltration (ZBUF) is more effective than methylprednisolone (MP) in reducing inflammatory mediators like TNF-alpha, IL-6, and IL-8 following pediatric cardiopulmonary bypass (CPB). This leads to shorter mechanical ventilation times in infants undergoing cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiopulmonary Bypass (CPB)
- Inflammatory Response Syndrome (SIRS)
Background:
- Systemic inflammatory response syndrome (SIRS) is a significant cause of organ injury during pediatric cardiac surgery using cardiopulmonary bypass (CPB).
- Effective management of SIRS is crucial for improving outcomes in pediatric cardiac surgery patients.
Purpose of the Study:
- To compare the efficacy of methylprednisolone (MP) and zero-balance ultrafiltration (ZBUF) in mitigating SIRS during pediatric CPB.
- To evaluate the impact of MP and ZBUF on inflammatory mediator levels and clinical outcomes.
Main Methods:
- Thirty infants undergoing open-heart surgery were randomized into two groups: MP administration (n=15) or ZBUF (n=15).
- Plasma levels of TNF-alpha, IL-6, IL-8, and IL-10 were measured at multiple time points.
- Duration of postoperative mechanical ventilation was recorded.
Main Results:
- ZBUF group showed significantly lower plasma concentrations of TNF-alpha at T4 and T5 compared to the MP group.
- The ZBUF group had significantly lower IL-6 levels at T4 and IL-8 levels at T5 than the MP group.
- Postoperative mechanical ventilation duration was significantly shorter in the ZBUF group (7.8 h) versus the MP group (9.6 h).
Conclusions:
- Zero-balance ultrafiltration (ZBUF) demonstrates superior effectiveness in reducing key inflammatory mediators (TNF-alpha, IL-6, IL-8) post-pediatric CPB compared to methylprednisolone (MP).
- ZBUF application is associated with improved clinical outcomes, specifically a reduced need for prolonged mechanical ventilation.
Abstract:
Studies have demonstrated that systemic inflammatory response syndrome (SIRS) remains one of the major causes of cardiopulmonary bypass (CPB)-associated organ injury during pediatric cardiac surgery. The purpose of this investigation was to compare the effectiveness of methylprednisolone (MP) and zero-balance ultrafiltration (ZBUF) on SIRS during pediatric CPB. Thirty infants undergoing open-heart surgeries were randomized to receive either MP in the priming solution (group M, n = 15) or ZBUF during CPB (group Z, n = 15). All the patients survived. Plasma levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-10 (IL-10) were measured before CPB (T1), 5 min after the start of CPB (T2), at the termination of CPB (T3), the fourth hour (T4), and the eighth hour (T5) postoperatively. The results showed that the plasma concentrations of TNF-alpha in the Z group were significantly less than those in the M group at T4 and T5 (P < 0.05), and the plasma concentrations of IL-6 were significantly less than those in the M group at T4 (P < 0.05); the plasma concentrations of IL-8 in the Z group were significantly less than those in the M group at T5 (P < 0.05). There was no difference between two groups on the plasma concentrations of IL-10. The duration of postoperative mechanical ventilation was (9.6 +/- 0.8 h) in the M group and (7.8 +/- 0.4 h) in the Z group (P < 0.05). This study showed that application of ZBUF is more effective to decrease the level of inflammatory mediators including TNF-alpha, IL-6, and IL-8 than administration of MP after pediatric CPB.
