Systemic Inflammatory Response Related to Cardiopulmonary Bypass and Its Modification by Methyl Prednisolone: High Dose Versus Low Dose

Abstract

The objective of our study was to investigate the safety and efficacy of high-dose methyl prednisolone (MP) in modifying the systemic inflammatory response (SIR) to cardiopulmonary bypass (CPB) and to compare its efficacy with low-dose MP in children undergoing cardiac surgery for congenital heart disease. Thirty children with congenital heart disease undergoing CPB were randomly assigned to two groups: group 1 (n = 15) received 30 mg/kg MP by an intravenous infusion for 30 minutes and group 2 (n = 15) received 2 mg/kg intravenously, before the onset of CPB. Postoperative clinical parameters were recorded, and serum interleukin (IL)-6 and 8 levels, acute phase reactants, and blood biochemistry were determined serially for both groups. In both groups plasma IL-6 and 8 levels were elevated above the preoperative levels at 2 and 24 hours after declamping. The peak levels were obtained at 2-hour samples. The difference between the two groups in terms of postoperative IL-6 and 8 levels was not statistically significant. C-reactive protein (CRP) levels and polymorphonuclear leukocyte counts, postoperative core temperature, duration of mechanical ventilation, period of stay in intensive care unit, oxygenation indices, and biochemical parameters of patients did not significantly differ in the two groups. Only 1 patient in group 1 had elevated liver enzymes, blood urea nitrogen, and creatinine in the postoperative period. No significant complications were observed due to treatment with high-dose MP. Although postoperative IL and CRP levels indicated a SIR in our patients, the clinical picture was apparently affected in only 1 patient and she was in the high-dose MP group. CPB initiates a SIR that is associated with an increase in neutrophil count, CRP, and IL-6 and 8 levels. High-dose (30 mg/kg) MP was not superior to low-dose (2 mg/kg) in blunting the SIR to CPB in pediatric patients undergoing open-heart surgery.

Extracorporeal perfusion of isolated organs of large animals – Bridging the gap between in vitro and in vivo studies

“…Glucocorticoids are commonly used during CPB (Varan et al, 2002) to suppress complement activation and cytokine production (Butler et al, 1993;Mold and Morris, 2001) following ischemia, which eventually leads to vascular leakage and hence to edema formation. The glucocorticoid methylprednisolone is commonly used in perfusion experiments with an interest in organ preservation (Domingo-Pech et al, 1991;Constantinescu et al, 2011) for this purpose.…”

The effects of modified ultrafiltration on clinical outcomes of adult and pediatric cardiac surgery

“…These proinflammatory cytokines play important roles in the pathogenesis of SIRS or post-pump syndrome [21][22][23]. Several risk factors have implicated in the accumulation of excess water such as children, long CPB duration, hypothermia and hemodilution; however, they have not been thoroughly investigated.…”

“…Several risk factors have implicated in the accumulation of excess water such as children, long CPB duration, hypothermia and hemodilution; however, they have not been thoroughly investigated. Effects of MUF on clinical outcomes in pediatric cardiac surgery have been reported by several randomized, nonrandomized studies and meta-analysis although the results were inconclusive [1,12,14,18,[21][22][23][24][25][26][27][28][29][30][31].…”

Immediate post-operative care following cardiac surgery

“…As alterações são maiores quanto maior o tempo de CEC; -síndrome da resposta inflamatória sistêmica: ocorre aumento da permeabilidade vascular, com perda transendotelial de líquidos, proteínas e aumento do líquido intersticial. Pela exposição do sangue nas superfícies não endotelizadas, há ativação de macrófagos, neutró-filos e plaquetas e liberação de citocinas como fator de necrose tumoral e interleucinas, provocando lesão endotelial 9,10 ; -retenção hídrica: em 30 a 60% da volemia. É decorrente do aumento da permeabilidade vascular, diminuição da pressão coloidosmótica do plasma e do aumento da renina e do hormônio antidiurético.…”