Effects of dexamethasone on clinical course, C-reactive protein, S100B protein and von Willebrand factor antigen after paediatric cardiac surgery

Lindberg, Lars; Forsell, C.; Jögi, Peeter; Olsson, Anders

doi:10.1093/bja/aeg125

Cited by 68 publications

(45 citation statements)

References 20 publications

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“…Several studies have shown that, whereas corticosteroids can reduce levels of certain inflammatory markers, this effect is not universal, and other markers of inflammation may not be impacted. 2,19 In addition, consistent with our previous analysis of a larger cohort of patients, we found that methylprednisolone was associated with increased postoperative infection. 6 This effect was seen only in the lower-risk surgical group.…”

Section: Discussionsupporting

confidence: 91%

“…1 Although previous studies have shown that corticosteroids are effective at reducing levels of various inflammatory markers in this setting, clinical outcomes associated with corticosteroids are less clear. 2,3 Some analyses have suggested that corticosteroids are associated with improved outcomes, however other recent analyses have called this into question. [4][5][6] Many studies have been limited by small sample size and the grouping of various steroid regimens together in analysis.…”

mentioning

confidence: 99%

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Perioperative Methylprednisolone and Outcome in Neonates Undergoing Heart Surgery

2012

PEDIATRICS

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Perioperative Methylprednisolone and Outcome in Neonates Undergoing Heart Surgery

2012

PEDIATRICS

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“…However, results obtained in double-blind trials with children (36,37) and in adult cohorts (43) could not demonstrate obvious clinical benefits regarding postoperative clinical course, intubation time, stay on ICU, duration of hospitalization, as well as complications including pleural -or pericardial effusions or drainage volume. Anti-inflammatory effects of MP may be clinically beneficial in more complex lesions with longer CPB runs and exaggerated systemic inflammatory response as shown for adults (46).…”

Section: Influence Of Mp On Postoperative Clinical Coursementioning

confidence: 93%

Modulation of the cellular and humoral immune response to pediatric open heart surgery by methylprednisolone

Bocsi

Hänzka

Osmančík

et al. 2011

Cytometry Part B Clinical

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Background: With the intention to reduce overshooting immune response, glucocorticoids are frequently administered perioperatively in children undergoing open heart surgery. In a retrospective study we investigated extensively the modulation of the humoral and cellular immune response by methylprednisolone (MP).Methods: This study was carried out on blood samples from two groups of children who had undergone surgical correction of atrial or ventricular septal defects, either without (MP 2 , n 5 10), or with MP administration (MP 1 , n 5 23, dose median 11 (IQR 10-16) mg kg 21 body weight) before cardiopulmonary bypass (CPB, duration median 42 (IQR 36-65) min). EDTA blood was obtained 24 h preoperatively, after anesthesia, at CPB begin and end, 4, 24, and 48 h after surgery, at discharge and at out-patient follow-up (median 8.2 (IQR 3.3-12.2) months after surgery). Complex blood analysis including clinical chemistry and flow cytometry were performed to monitor humoral immune response, differential blood count, lymphocyte subsets, and the degree of activation of various leukocyte subpopulations.Results: The patients' postoperative courses and follow-up were uneventful. Release of IL-6 and IL8 was reduced and that of the anti-inflammatory cytokine IL-10 upregulated by MP. Significant increase of circulating neutrophils and monocytes as inflammatory reaction to surgery and CPB contact was detected in both groups. However, invasion of monocytes to the periphery was delayed with MP. CD41 and CD81 T-lymphocyte counts were lower with MP treatment. B-lymphocyte count increased significantly after surgery in MP 1 but remained constant in MP 2 group. Conclusions: MP treatment partially decreased the pro-inflammatory effect of CPB surgery and induced anti-inflammatory effect on the cellular and humoral level.

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“…Some studies found that steroids can blunt inflammation [7][8][9][10][11][12][13][14] while others found the opposite [15]. Most importantly, it is unclear to what degree this presumed Banti-inflammatoryê ffect also translates into better clinical outcomes [7,10,13]. Firstly, it is very difficult to characterise the multifaceted nature of the SIRS response whereby a variety of cytokines are activated and interact in a rather complex, unpredictable manner [16].…”

Section: Less Inflammation Better Clinical Outcomes?mentioning

confidence: 99%

Steroids in paediatric heart surgery: eminence or evidence-based practice?

Fudulu

Lightman

Caputo

et al. 2018

Indian J Thorac Cardiovasc Surg

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Steroids in paediatric heart surgery are given prophylactically to blunt the systemic inflammatory response induced by the extracorporeal circuit and to improve clinical outcomes. However, there is an ongoing controversy about the impact of steroids on clinical outcomes after paediatric heart surgery. The hypothalamic-pituitary-adrenal axis is the primary neuroendocrine system activated during the stress of surgery. Relative adrenal insufficiency can accompany paediatric heart surgery; therefore, perioperative steroid supplementation is still administered by some centres. The studies that investigate the hypothalamic-pituitaryadrenal axis physiology during surgery have many limitations, and it is unclear how to define what is adrenal insufficiency. In this review, we focus on discussing the available evidence for steroid use in paediatric cardiac surgery.

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Effects of dexamethasone on clinical course, C-reactive protein, S100B protein and von Willebrand factor antigen after paediatric cardiac surgery

Abstract: Administration of dexamethasone before cardiopulmonary bypass for paediatric cardiac surgery decreased the inflammatory response, but did not affect the immediate features after surgery or changes in vWf:Ag or S100B.

Cited by 68 publications

References 20 publications

Perioperative Methylprednisolone and Outcome in Neonates Undergoing Heart Surgery

Perioperative Methylprednisolone and Outcome in Neonates Undergoing Heart Surgery

Modulation of the cellular and humoral immune response to pediatric open heart surgery by methylprednisolone

Steroids in paediatric heart surgery: eminence or evidence-based practice?

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