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Perioperative steroids administration in pediatric cardiac surgery: a meta-analysis of randomized controlled trials*
Giuseppe Scrascia1, Crescenzia Rotunno, Pietro Guida
11Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari "Aldo Moro," Bari, Italy. 2Pediatric Cardiac Anesthesia/Intensive Care Unit Department of Medical and Surgical Pediatric Cardiology, "Bambino Gesù" Children's Hospital, Rome, Italy. 3Department of Anesthesia, Intensive and Palliative Care, Foundation-I.R.C.C.S. "National Institute of cancer," Milan, Italy.
Insights
Prophylactic perioperative corticosteroids in pediatric cardiac surgery showed a trend toward reduced mortality and significantly decreased renal dysfunction. Further research is needed to confirm these potential clinical benefits.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Pharmacology
Background:
- Pediatric cardiac surgery often involves cardiopulmonary bypass (CPB), which can trigger an inflammatory response.
- Corticosteroids are known to modulate inflammatory processes, but their role in pediatric cardiac surgery outcomes is not fully established.
Purpose of the Study:
- To evaluate the impact of prophylactic perioperative corticosteroid administration versus placebo on postoperative mortality and key clinical outcomes in pediatric patients undergoing cardiac surgery with CPB.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) identified through MEDLINE and Cochrane Library up to August 2013.
- Included RCTs focused on pediatric populations undergoing cardiac surgery with CPB, reporting on mortality, renal dysfunction, mechanical ventilation duration, and ICU length of stay.
Main Results:
- A trend towards reduced mortality was observed in the corticosteroid group (OR 0.41, p=0.089), though not statistically significant.
- Corticosteroid administration significantly reduced the prevalence of renal dysfunction (OR 0.07, p=0.002).
- No significant effects were found on mechanical ventilation duration or ICU length of stay.
Conclusions:
- Perioperative corticosteroid administration may offer clinical advantages in pediatric cardiac surgery, including a potential reduction in mortality and a significant decrease in renal dysfunction.
- While steroids attenuate the CPB-induced inflammatory response, larger prospective studies are required to definitively confirm these benefits.
Objective:
To evaluate the effects of prophylactic perioperative corticosteroid administration, compared with placebo, on postoperative mortality and clinical outcomes (renal dysfunction, duration of mechanical ventilation, and ICU length of stay) in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.
Data Sources:
MEDLINE and Cochrane Library were screened through August 2013 for randomized controlled trials in which perioperative steroid treatment was adopted.
Study Selection:
Included were randomized controlled trials conducted on pediatric population that reported clinical outcomes about mortality and morbidity.
Data Extraction:
Eighty citations (PubMed, 48 citations; Cochrane, 32 citations) were identified, of which 14 articles were analyzed in depth and six articles fulfilled eligibility criteria and reported mortality data (232 patients), two studies reported ICU length of stay and mechanical ventilation duration (60 patients), and two studies reported renal dysfunction (49 patients).
Data Synthesis:
A nonsignificant trend of reduced mortality was observed in steroid-treated patients (11 [4.7%] vs 4 [1.7%] patients; odds ratio, 0.41; 95% CI, 0.14-1.15; p = 0.089). Steroids had no effects on mechanical ventilation time (117.4 ± 95.9 hr vs 137.3 ± 102.4 hr; p = 0.43) and ICU length of stay (9.6 ± 4.6 d vs 9.9 ± 5.9 d; p = 0.8). Perioperative steroid administration reduced the prevalence of renal dysfunction (13 [54.2%] vs 2 [8%] patients; odds ratio, 0.07; 95% CI, 0.01-0.38; p = 0.002).
Conclusion:
Despite a demonstrated attenuation of cardiopulmonary bypass-induced inflammatory response by steroid administration, a systematic review of randomized controlled trials performed so far reveals that steroid administration has potential clinical advantages (lower mortality and significant reduction of renal function deterioration). A larger prospective randomized study is needed to verify clearly the effects of steroid prophylaxis in pediatric patients.
