Steroid Supplementation: A Legitimate Pharmacotherapy After Neonatal Open Heart Surgery

Ando, Motomi; Park, In-Sam; Wada, Naoki; Takahashi, Yukihiro

doi:10.1016/j.athoracsur.2005.04.035

Cited by 96 publications

(87 citation statements)

References 20 publications

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“…Recently, the hypothesis that the utilization of corticosteroids in the postoperative period would minimize the inflammatory process and that their reposition would diminish hemodynamic dysfunction, which is common in this period, have been considered, since adrenal failure is very common in severely sick patients 32,33 .…”

Section: Discussionmentioning

confidence: 99%

Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

Soares¹,

Ribas²,

Spring³

et al. 2010

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

Soares¹,

Ribas²,

Spring³

et al. 2010

Arq. Bras. Cardiol.

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“…Two recent randomized controlled trials in adults on the use of steroids in suspected adrenal insufficiency showed conflicting results (12,13), further adding to the controversy. We identified only a few small observational studies (ranging from 13-72 patients; see Table E1 in the online supplement) examining adrenal insufficiency in pediatric critical illness (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). These pediatric studies used multiple different definitions for the diagnosis of adrenal insufficiency, focused almost exclusively on patients with septic shock (17,19,20,22,23), did not conduct corticotropin stimulation tests on all patients (only obtained random cortisol levels) (15,16,24), and used different doses for the corticotropin tests.…”

Section: Abstract Adrenal Gland; Adrenal Function; Adrenocorticotropimentioning

confidence: 99%

“…We identified only a few small observational studies (ranging from 13-72 patients; see Table E1 in the online supplement) examining adrenal insufficiency in pediatric critical illness (14-24). These pediatric studies used multiple different definitions for the diagnosis of adrenal insufficiency, focused almost exclusively on patients with septic shock (17,19,20,22,23), did not conduct corticotropin stimulation tests on all patients (only obtained random cortisol levels) (15,16,24), and used different doses for the corticotropin tests. As a result, the reported prevalence of adrenal insufficiency varies from 10 (16) to 100% (15).…”

Section: Abstract Adrenal Gland; Adrenal Function; Adrenocorticotropimentioning

confidence: 99%

“…These pediatric studies used multiple different definitions for the diagnosis of adrenal insufficiency, focused almost exclusively on patients with septic shock (17,19,20,22,23), did not conduct corticotropin stimulation tests on all patients (only obtained random cortisol levels) (15,16,24), and used different doses for the corticotropin tests. As a result, the reported prevalence of adrenal insufficiency varies from 10 (16) to 100% (15). None of the studies identified risk factors for the development of adrenal insufficiency, were adequately powered to assess associations with outcomes, or studied both the high-and low-dose corticotropin tests.…”

Section: Abstract Adrenal Gland; Adrenal Function; Adrenocorticotropimentioning

confidence: 99%

See 1 more Smart Citation

A Prospective Multicenter Study of Adrenal Function in Critically Ill Children

Menon

Ward²,

Lawson³

et al. 2010

Am J Respir Crit Care Med

101

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Rationale-Adrenal insufficiency is a clinical condition associated with fluid-and catecholamine-resistant hypotension.Objectives-The objectives of this study were to determine the prevalence of adrenal insufficiency, risk factors and potential mechanisms for its development, and its association with clinically important outcomes in critically ill children.Correspondence and requests for reprints should be addressed to Kusum Menon, M.Sc., Pediatric Intensive Care Unit, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1S 3H2 Canada. menon@cheo.on.ca. * Canadian Critical Care Trials AIP Study Group: Institutions, site investigators, research coordinators, and research assistants (numbers of enrolled patients are shown in parentheses): British Columbia Children's and Women's Hospital, Vancouver, BC, Canada Conflict of Interest Statement:None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.The CIHR and CHEORI had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data, or in the preparation of the manuscript. Assistance in the design of the study was provided by the Canadian Critical Care Trials Group. This article has an online supplement, which is accessible from this issue's CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptMethods-A prospective, cohort study was conducted from 2005 to 2008 in seven tertiary-care, pediatric intensive care units in Canada on patients up to 17 years of age with existing vascular access. Adrenocorticotropic hormone stimulation tests (1 μg) were performed and adrenocorticotropic hormone levels measured in all participants. Measurements and MainResults-A total of 381 patients had adrenal testing on admission. The prevalence of adrenal insufficiency was 30.2% (95% confidence interval, 25.9-35.1). Patients with adrenal insufficiency had higher baseline cortisol levels (28.6 μg/dl vs. 16.7 μg/dl, P < 0.001) and were significantly older (11.5 yr vs. 2.3 yr, P < 0.001) than those without adrenal insufficiency. Adrenal insufficiency was associated with an increased need for catecholamines (P <0.001) and more fluid boluses (P = 0.026). The sensitivity and specificity of the low-dose adrenocorticotropic hormone stimulation test were 100% and 84%, respectively.Conclusions-Adrenal insufficiency occurs in many disease conditions in critically ill children and is associated with an increased use of catecholamines and fluid boluses. It is likely multifactorial in etiology and is associated with high baseline cortisol levels. Further research is necessary to determine which of these critically ill children are truly cortisol deficient before any treatment recommendations can be made. Keywords adrenal gland; adrenal function; adrenocorticotropic hormoneAdrenal insufficiency is a clinical condition associated with hypotension that can be resistant to fluid and catecholamine therapy and, if untreated, can result in increased morta...

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“…There are several small size, randomised trials of steroids versus placebo conducted on children of various ages or just neonates [8][9][10][19][20][21]. 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].…”

Section: Less Inflammation Better Clinical Outcomes?mentioning

confidence: 97%

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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Steroid Supplementation: A Legitimate Pharmacotherapy After Neonatal Open Heart Surgery

Cited by 96 publications

References 20 publications

Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

A Prospective Multicenter Study of Adrenal Function in Critically Ill Children

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

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