Methylprednisolone in Neonatal Cardiac Surgery: Reduced Inflammation Without Improved Clinical Outcome

Keski‐Nisula, Juho; Pesonen, Eero; Olkkola, Klaus T.; Peltola, Kaija; Neuvonen, Pertti J.; Tuominen, Netta; Sairanen, Heikki; Andersson, Sture; Suominen, Pertti

doi:10.1016/j.athoracsur.2013.02.013

Cited by 70 publications

(85 citation statements)

References 24 publications

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“…Their results are conflictive with some trials reporting benefit [8,11,19,21] while others reporting no effect on clinical outcomes [7,9,13,20]. The results of an ongoing trial on 190 neonates are still awaited and hopefully will give us more information [22].…”

Section: Less Inflammation Better Clinical Outcomes?mentioning

confidence: 88%

“…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%

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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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Section: Less Inflammation Better Clinical Outcomes?mentioning

confidence: 88%

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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“…One study has suggested that giving a single dose of MP (15 mg/kg) before a cardiopulmonary bypass surgery resulted in an improved myocardial function (32). In the neonatal period, a 30 mg/kg single dose of MP prior to open heart surgery reduced systemic infl ammatory responses and was shown to be cardioprotective (33). In our study, after an application with a high-dose of MP in the early period after BCT it was continued with low-dose steroid therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Steroids are known to prevent apoptosis subsequent to myocardial ischemia by increasing the expression of Bcl (6). Steroids act as anti-infl ammatory agents through the reduction of early infl ammatory processes and have also been shown to be cardioprotective in myocardial injury associated with ischemia and cardiac surgery (32,33). One study has suggested that giving a single dose of MP (15 mg/kg) before a cardiopulmonary bypass surgery resulted in an improved myocardial function (32).…”

Section: Discussionmentioning

confidence: 99%

Cardioprotective effect of aminoguanidine in combination with steroid therapy after blunt chest trauma

L¹,

Güzel²,

Hu³

et al. 2014

BLL

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Abstract:Background: Cardiac contusion is an important cause of mortality after blunt chest trauma (BCT). The aim of this study was to investigate the therapeutic effi cacy of the usage of aminoguanidine (AG), in myocardial damage occurring after BCT, alone and in combination with methylprednisolone (MP). Methods: Thirty-fi ve female Wistar albino rats were randomly assigned to fi ve groups (n = 7) including: sham controls (S); only cardiac contusion (CONT); cardiac contusion treated with methylprednisolone (CONT+MP); cardiac contusion treated with aminoguanidine (CONT+AG); and cardiac contusion treated with methylprednisolone and aminoguanidine (CONT+MP+AG). Seven days following the treatments, heart and serum specimens were evaluated histopathologically, immunohistochemically, and biochemically in all groups. Results: Serum AOPP and Tn-I levels increased signifi cantly after cardiac contusions. Haemorrhage, tissue degeneration, and necrosis development was evident following contusions. Increased iNOS expression in myocardial tissue was signifi cantly decreased in the CONT+AG+MP group compared to CONT+AG and CONT+MP groups (p = 0.001 and p = 0.011, respectively). The combined treatment of AG and MP increased Bcl-2 expression signifi cantly after contusions compared to the other treatment groups. Conclusions: Combined usage of AG, a selective iNOS inhibitor, with MP, in cardiac contusions, showed a more powerful cardioprotective effect by increasing Bcl-2 expression and reducing iNOS expression (Tab. 3, Fig. 4, Ref. 33). Text in PDF www.elis.sk.

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“…3 Corticosteroid prophylaxis in heart surgery has been studied for several years, however its role remains controversial. [4][5][6][7][8] Several mechanisms of corticosteroid's benefit on patient who required cardiopulmonary bypass have been shown on prior studies. They may include reduction in the expression of endothelial molecule, improvement in myocardial and pulmonary cell integrity, cytokine release, and complement activation.…”

Section: Introductionmentioning

confidence: 99%

The effect of hemofilter, preoperative and intraoperative methylprednisolone on complications after open heart surgery

et al. 2017

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Complications after open heart surgery may threaten patient's survival rate. The intraoperative methylprednisolone administration alone shows controversial results on open heart surgery complications. Similarly, the intraoperative and preoperative methylprednisolone administration as well as the use of hemofilter in open heart surgery is still controversial. This study aimed to evaluate the effect of hemofilter, preoperative and intraoperative methylprednisolone administration on complications following open heart surgery. This was a Prospective Randomized Open-Blinded Evaluation (PROBE) experimental study. Ninety-five patients who had open heart surgery in Dr. Sardjito General Hospital, Yogyakarta, and Integrated Cardiac Care of Dr. Cipto Mangunkusumo General Hospital, Jakarta within the period of December 2011 to May 2012 were involved in this study. The patients were divided into two groups i.e. group A, 48 patients received methylprednisolone 15mg/kg intraoperatively, methylprednisolone 5mg/kg preoperatively, and hemofilter, while group B, 47 patients received methylprednisolone 15mg/kg intraoperatively alone. From the total 95 patients, we found 26 (27.4%) patients experienced complications i.e. 19 in group B (40.4%) and 7 in group A (14.6%). The differences of the complications were statistically significant (p<0.05; OR=3.97; 95%CI=1.476-10.71). Complications risk decreased by 63.9% in the group A compared to the group B with the hazard ratio of 3.2. In conclusion, the application of hemofilter, preoperative and intraoperative methylprednisolone might decrease the risk of complications after open heart surgery. ABSTRAKKomplikasi paska bedah jantung terbuka dapat mempengaruhi angka harapan hidup pasien. Pemberian intraoperatif metilpredinsolon saja untuk mencegah komplikasi paska bedah jantung terbuka masih menunjukkan hasil yang kontroversial. Pemberian metilprednisolon preoperatif dan intraoperatif serta penggunaan hemofilter masih kontroversial. Penelitian ini bertujuan untuk mempelajari efek hemofilter, pemberian preoperatif dan intraoperatif metilprednisolon terhadap komplikasi paska bedah jantung terbuka. Penelitian ini merupakan studi eksperimental dengan desain Prospective Randomized Open-Blinded Evaluation (PROBE). Didapatkan 95 pasien yang menjalani bedah jantung terbuka di Rumah Sakit

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Methylprednisolone in Neonatal Cardiac Surgery: Reduced Inflammation Without Improved Clinical Outcome

Cited by 70 publications

References 24 publications

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

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

Cardioprotective effect of aminoguanidine in combination with steroid therapy after blunt chest trauma

The effect of hemofilter, preoperative and intraoperative methylprednisolone on complications after open heart surgery

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