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Acute-phase responses to cardiopulmonary bypass in children weighing less than 10 kilograms
J Butler1, V L Pathi, R D Paton
1Department of Cardiothoracic Surgery, Royal Hospital for Sick Children, Glasgow, United Kingdom.
Insights
Intraoperative steroid administration effectively reduced the inflammatory response, including interleukin-6 and C-reactive protein levels, in pediatric patients undergoing cardiopulmonary bypass. This intervention mitigated the acute-phase response following cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Immunology
- Pharmacology
Background:
- Cardiopulmonary bypass (CPB) triggers a significant systemic inflammatory response in pediatric patients.
- The acute-phase response involves elevated cytokines and inflammatory markers.
- The role of intraoperative steroids in modulating this response requires further investigation.
Purpose of the Study:
- To investigate cytokine-induced inflammatory responses in pediatric patients undergoing cardiac operations.
- To evaluate the efficacy of intraoperative methylprednisolone in mitigating the acute-phase response during CPB.
Main Methods:
- A perioperative study involving 24 pediatric patients (<10 kg) undergoing cardiac surgery.
- Randomization into three groups: no steroid CPB (Group I), methylprednisolone CPB (Group II), and non-CPB controls (Group III).
- Measurement of interleukin-6 (IL-6), C-reactive protein (CRP), and core temperature as markers of the acute-phase response.
Main Results:
- Interleukin-6 (IL-6) and C-reactive protein (CRP) levels were elevated postoperatively in all groups, with higher levels in the no-steroid CPB group (Group I).
- Methylprednisolone administration (Group II) significantly reduced peak IL-6 and CRP levels compared to Group I.
- Group I exhibited a greater acute-phase response compared to both Group II and the non-CPB controls (Group III).
Conclusions:
- Intraoperative steroid administration effectively abrogates the heightened acute-phase response associated with cardiopulmonary bypass in pediatric patients.
- Interleukin-6 plays a crucial role in inducing acute-phase proteins like CRP after CPB.
- While IL-6 is linked to CRP, other factors likely contribute to postoperative fever (pyrexia).
Background:
Cardiopulmonary bypass induces a systemic inflammatory response. This study investigated, in a pediatric population, cytokine-induced responses and their potential modification by intraoperative steroid administration.
Methods:
Markers of the acute-phase response were measured perioperatively in 24 children weighing less than 10 kg undergoing cardiac operations. Those having operations with cardiopulmonary bypass were randomized to receive either no steroid (group I, n = 8) or 10 mg/kg methylprednisolone in the pump prime (group II, n = 10); patients undergoing nonbypass procedures were controls (group III, n = 6).
Results:
In all groups, plasma interleukin-6 level was elevated (p < 0.01) above baseline throughout the post-operative period, peaking earlier in group I. Levels of C-reactive protein peaked at 48 hours, and postoperative core temperature was raised in all groups. Levels of interleukin-6 from 2 to 6 hours and C-reactive protein at 24 hours postoperatively were greater (p < 0.05) in group I than in group II. Maximum interleukin-6 level, C-reactive protein level, and temperature were all significantly greater in group I than in group III. Maximum interleukin-6 level correlated with maximum C-reactive protein level in group I only (rs = 0.76; p < 0.05) and showed no association with temperature. Duration of bypass did not correlate with levels of interleukin-6.
Conclusions:
This study demonstrated a marked acute-phase response to operation; the greater response to procedures with cardiopulmonary bypass was abrogated by intraoperative steroid administration. The importance of interleukin-6 as an inducer of acute phase proteins after bypass is supported by its association with C-reactive protein levels, but other factors must be important in the induction of pyrexia.