Pharmacokinetic Evaluation of Triiodothyronine Supplementation in Children After Modified Fontan Procedure

Mainwaring, Richard D.; Capparelli, Edmund V.; Schell, Kenneth H.; Acosta, Mark; Nelson, Jerald C.

doi:10.1161/01.cir.101.12.1423

Cited by 36 publications

(28 citation statements)

References 24 publications

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“…In this immature population, postoperative abnormalities in hemodynamic parameters are associated with depression of thyroid hormone levels 1,6. Accordingly, several investigators have conducted randomized clinical trials with relatively small subject numbers (between 28 and 42 total subjects per study) to explore the utility of thyroid hormone supplementation in children undergoing CPB7–9 or to evaluate pharmacokinetics 10. The authors of those studies acknowledged some clinical design issues, which hamper interpretation of the results.…”

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confidence: 99%

“…The authors of those studies acknowledged some clinical design issues, which hamper interpretation of the results. These include the use of surrogate end points and inadequate power 7–10. Furthermore, their published reports often lacked details regarding adverse events 7–10.…”

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confidence: 99%

“…These include the use of surrogate end points and inadequate power 7–10. Furthermore, their published reports often lacked details regarding adverse events 7–10. Bettendorf et al7 showed some elevation in the Therapeutic Interventional Scoring System score and cardiac index in patients receiving T3 infusion.…”

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confidence: 99%

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Triiodothyronine Supplementation in Infants and Children Undergoing Cardiopulmonary Bypass (TRICC)

Slee²,

et al. 2010

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Background-Triiodothyronine levels decrease in infants and children after cardiopulmonary bypass. We tested the primary hypothesis that triiodothyronine (T3) repletion is safe in this population and produces improvements in postoperative clinical outcome. Methods and Results-The TRICC study was a prospective, multicenter, double-blind, randomized, placebo-controlled trial in children younger than 2 years old undergoing heart surgery with cardiopulmonary bypass. Enrollment was stratified by surgical diagnosis. Time to extubation (TTE) was the primary outcome. Patients received intravenous T3 as Triostat (nϭ98) or placebo (nϭ95), and data were analyzed using Cox proportional hazards. Overall, TTE was similar between groups. There were no differences in adverse event rates, including arrhythmia. Prespecified analyses showed a significant interaction between age and treatment (Pϭ0.0012). For patients younger than 5 months, the hazard ratio (chance of extubation)

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Triiodothyronine Supplementation in Infants and Children Undergoing Cardiopulmonary Bypass (TRICC)

Slee²,

et al. 2010

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“…There are limited data on the use of T3 in infants. A few recent studies describe T3 use for infants and children following cardiac surgery (13,14). Literature in adults with advanced congestive heart failure demonstrates that low triiodothyronine levels are associated with impaired haemodynamics and poor survival rates (15).…”

Section: Discussionmentioning

confidence: 99%

Perioperative considerations in a hypothyroid infant with hepatic haemangioma

Mason

Koka

Eldredge

et al. 2001

Pediatric Anesthesia

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Hepatic haemangiomas in infants are rare. An infant with both a hepatic haemangioma and a severe hypothyroid condition, unresponsive to conventional thyroxine therapy, will be described. This case presented here is the perioperative management of a critically ill infant who had myocardial depression secondary to hypothyroidism and a hepatic haemangioma that required embolization. To our knowledge, this is the first published report describing intravenous triiodothyronine as a therapeutic modality to stabilize a hypothyroid infant prior to undergoing a general anaesthetic.

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“…33 Dosing guidelines are not available for pediatric donors, but a dose of 0.4 Á/ 0.8 mcg/kg has been shown to provide adequate serum levels. 34 At our institution, we give the donor 0.4 mcg/kg, to a maximum dose of 10 mcg. We also administer the same dose to the recipient during the implantation procedure.…”

Section: Hormonal Resuscitationmentioning

confidence: 99%

Cardiac organ donor management

et al. 2006

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There is a critical shortage of donor organs. According to the United Network for Organ Sharing (UNOS), 20% of organs are discarded after procurement. Many of these may be potentially salvageable. Brain death is particularly detrimental to cardiac function. The initial sympathetic storm can produce direct myocardial injury. The ensuing spinal shock reduces global oxygen delivery. There is a change to anaerobic metabolism due to global mitochondrial dysfunction. Diabetes insipidus worsens hypovolemia and thyroid deficiency impairs cardiac function. Inadequate replacement of blood loss from trauma and coagulopathy worsens anemia and oxygen delivery. In the mid-1990s, the Papworth Hospital group in the UK advocated early invasive hemodynamic monitoring and administration of a 'hormonal cocktail', consisting of triiodothyronine (T3), vasopressin, methylprednisolone and insulin. This has been widely accepted and is endorsed by UNOS. Ventricular function, volume status and adequacy of resuscitation should be guided by invasive monitoring and serial echocardiography. Dopamine or epinephrine is used for inotropic support. If hypotension persists, vasopressin should be added which may allow reduction of inotropes. Donor lung function and ventilation should be optimized. Recently, two large retrospective studies have shown that, with aggressive pharmacological and hormonal resuscitation, a significant increase in the number and quality of organs harvested can be achieved.

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Pharmacokinetic Evaluation of Triiodothyronine Supplementation in Children After Modified Fontan Procedure

Abstract: The half-life of intravenous T(3) in children is approximately one-third of that reported for adults. These results provide a framework for studying the efficacy of T(3) supplementation in children undergoing open-heart surgery.

Cited by 36 publications

References 24 publications

Triiodothyronine Supplementation in Infants and Children Undergoing Cardiopulmonary Bypass (TRICC)

Triiodothyronine Supplementation in Infants and Children Undergoing Cardiopulmonary Bypass (TRICC)

Perioperative considerations in a hypothyroid infant with hepatic haemangioma

Cardiac organ donor management

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