Comparison Between Preoperative Administration of Methylprednisolone With its Administration Before and During Congenital Heart Surgery on Serum Levels of IL-6 And IL-10

Tashnizi, Mohammad Abbasi; Soltani, Ghasem; Moeinipour, Aliasghar; Ayatollahi, Hossein; Tanha, Amir Saber; Jarahi, Lida; Shamloo, Alireza Sepehri; Zirak, Nahid

doi:10.5812/ircmj.8039

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…However, the infection episodes and maximal temperature in the first 24 h postoperatively were similar between groups as well as LOIS and mortality. We must admit that the studies included enrolled patients with different conditions, especially for the three (10,17,20) of them, in which only patients undergoing simple congenital heart surgeries were enrolled. These three studies played important roles on assessing the infection episodes and maximal temperature in the first 24 h postoperatively, which might be the reason for the high heterogeneity between studies in the assessment above.…”

Section: Discussionmentioning

confidence: 99%

“…However, as we all know, neonates were of great difference in physiology from elder children, which reduced the generalization of the results. Meanwhile, three studies (10,17,20) we included only enrolled patients undergoing simple congenital heart surgeries with shorter CPB duration, which might complicate the results. Third, the 30-mg/kg dose of methylprednisolone was too much for clinical practice in some institutions.…”

Section: Study Limitationsmentioning

confidence: 99%

“…However, some potential adverse effects may be associated with corticosteroids, for example, hyperglycemia, poor wound healing, infections, and poor neurodevelopmental outcomes (6)(7)(8). Several small, randomized, controlled studies in pediatric patients have investigated the effect of perioperative corticosteroids on the inflammatory biomarkers, clinical outcomes, and adverse events after congenital heart surgeries (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Nevertheless, the results were conflicted, resulting in the controversy over perioperative corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Corticosteroid Therapy in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Luo

et al. 2020

Front. Pediatr.

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Background: The benefit-risk profile of perioperative corticosteroids in pediatric patients undergoing cardiac surgery remains controversial. Objective: To investigate the influence of perioperative corticosteroids on the postoperative mortality and clinical outcomes in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: We conducted a systematic search using MEDLINE, EMBASE, and Cochrane Database through August 31, 2019. We included randomized controlled trials comparing perioperative corticosteroids with other clinical interventions, placebo, or no treatment in children between 0 and 18 years of age undergoing cardiac surgery. The primary outcome of interest was all-cause in-hospital mortality. The secondary outcomes were length of intensive care unit stay (LOIS), duration of mechanical ventilation (DMV), postoperative insulin therapy, postoperative low cardiac output syndrome (LCOS), postoperative infection, maximal temperature (T max) in the first 24 h postoperatively, urine output (UO) in the first 24 h postoperatively, serum lactate at postoperative day (POD) 1, blood glucose at POD 1, vasoactive inotrope score (VIS) at POD 1, and postoperative acute kidney injury (AKI). Study quality was assessed using the Cochrane Risk of Bias Assessment Tool. Results: Our analysis included 17 studies and 848 pediatric patients. The data demonstrated that children receiving corticosteroids showed no significant difference on the all-cause in-hospital mortality with a fixed-effect model (RR = 0.59, 95% CI = 0.28-1.25, P = 0.55) compared with controls. For the secondary outcomes, corticosteroids had a statistically significant reduction on the VIS at POD1 (MD = −2.04, 95% CI = −3.96 −0.12, P = 0.04), while it might be significantly associated with an increased blood glucose at POD1 (MD = 1.38, 95% CI = 0.68-2.09, P = 0.0001) and a 2.69-fold higher risk of postoperative insulin therapy (RR = 2.69, 95% CI = 1.37-5.27, P = 0.004). No statistical significance was shown in other secondary outcomes. Conclusion: Perioperative corticosteroids might not significantly improve clinical outcomes identified as mortality, LOIS, DMV, AKI, and LCOS other than VIS at Li et al. Corticosteroids in Pediatric Cardiac Surgery POD1. However, it might increase the blood glucose and episodes of insulin therapy. Perioperative corticosteroids to attenuate the inflammatory response are not supported by available evidence from our study. Further results from ongoing randomized controlled trials with a larger sample size are required.

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Section: Discussionmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perioperative Corticosteroid Therapy in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Luo

et al. 2020

Front. Pediatr.

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Prophylactic corticosteroids for paediatric heart surgery with cardiopulmonary bypass

Gibbison

Villalobos-Lizardi

Martínez

et al. 2020

Cochrane Database of Systematic Reviews

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This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of prophylactic corticosteroids in children between birth and 18 years of age undergoing cardiac surgery with cardiopulmonary bypass. B A C K G R O U N D Description of the condition Paediatric heart surgery outcomes have improved markedly over time as a result of marginal gains in training, technology and safety systems (Brown 2015; Hoashi 2015; Jacobs 2016; NICOR 2016). This improvement has been particularly notable in the last 20 years: the publication of heart surgery outcomes after the Kennedy Inquiry in the UK has been associated with a large increase in survival for risk-adjusted surgery (Kennedy 2001; Grant 2013). This has been mirrored worldwide (Brown 2015; Hoashi 2015; Jacobs 2016). One area where there is still controversy is corticosteroid use. Paediatric heart surgery with the use of cardiopulmonary bypass results in a systemic inflammatory response; corticosteroids have been widely used to mitigate the potential deleterious effects of this response. The surgical intervention for which corticosteroids are used includes a variety of surgeries performed on the heart and great vessels. In most cases this procedure aims to correct congenital heart diseases (i.e. heart malformations that the child is born with). In most cases (78% in the UK) (NICOR 2016), surgery will take place with the use Cardio-Pulmonary By-1 Prophylactic corticosteroids for paediatric heart surgery with cardiopulmonary bypass (Protocol)

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Inflammatory Response After Neonatal Cardiac Surgery and Its Relationship to Clinical Outcomes

Mahle

Matthews

Kanter

et al. 2014

The Annals of Thoracic Surgery

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Comparison Between Preoperative Administration of Methylprednisolone With its Administration Before and During Congenital Heart Surgery on Serum Levels of IL-6 And IL-10

Cited by 4 publications

References 15 publications

Perioperative Corticosteroid Therapy in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Perioperative Corticosteroid Therapy in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Prophylactic corticosteroids for paediatric heart surgery with cardiopulmonary bypass

Inflammatory Response After Neonatal Cardiac Surgery and Its Relationship to Clinical Outcomes

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