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A comparison of three dose timings of methylprednisolone in infant cardiopulmonary bypass
Although commonly used in pediatric cardiopulmonary bypass (CPB) optimal dose and timing of steroid administration is unclear. We hypothesized that early administration of a commonly used dose of methylprednisolone given the evening before surgery (ultra-early) would be more effective in decreasing...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer International Publishing
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161735/ https://www.ncbi.nlm.nih.gov/pubmed/25221738 http://dx.doi.org/10.1186/2193-1801-3-484 |
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author | Withington, Davinia E Fontela, Patricia S Harrington, Karen P Tchervenkov, Christo Lands, Larry C |
author_facet | Withington, Davinia E Fontela, Patricia S Harrington, Karen P Tchervenkov, Christo Lands, Larry C |
author_sort | Withington, Davinia E |
collection | PubMed |
description | Although commonly used in pediatric cardiopulmonary bypass (CPB) optimal dose and timing of steroid administration is unclear. We hypothesized that early administration of a commonly used dose of methylprednisolone given the evening before surgery (ultra-early) would be more effective in decreasing CPB-related inflammatory response than when given at induction of anesthesia (early) or in pump prime (standard). This was a triple-arm, parallel, active control, superiority RCT including 54 infants <2 years old who were randomised to receive 30 mg/kg methylprednisolone at one of the 3 time points. Outcomes included alveolar-arterial oxygen gradient (AaDO2) during, 24, 48 and 72 hours post-CPB, IL-6, IL-8 and reduced (GSH) to oxidized (GSSG) glutathione ratio (pre-ultrafiltration on CPB, end-CPB and 24 hours), PICU length of stay (LOS) and ventilator days. Data were analysed using descriptive statistics and a random effects regression model. The ultra-early group had higher Risk Adjusted Congenital Heart Surgery Score, lower age and longer CPB times than the other groups. No significant differences in AaDO2, IL-8, PICU LOS and ventilator days were observed between groups. Compared to the ultra-early group, the overall rise in IL-6 in the early and standard groups was lower, -27.8 pg/ml (95% CI -52.7,-2.9) and -35.3 pg/ml (95% CI -64.3,-6.34), respectively. GSH:GSSG was significantly lower in the standard group (-35.9; 95% CI -63.31,-8.5) at 24 hours post-CPB. Ultra-early administration of methylprednisolone does not improve AaDO2 post-CPB, nor diminish cytokine release. Lower GSH:GSSG in the standard group suggests less oxidative stress. However despite statistical adjustments conclusions are limited by the unbalanced randomisation of the groups. |
format | Online Article Text |
id | pubmed-4161735 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-41617352014-09-12 A comparison of three dose timings of methylprednisolone in infant cardiopulmonary bypass Withington, Davinia E Fontela, Patricia S Harrington, Karen P Tchervenkov, Christo Lands, Larry C Springerplus Research Although commonly used in pediatric cardiopulmonary bypass (CPB) optimal dose and timing of steroid administration is unclear. We hypothesized that early administration of a commonly used dose of methylprednisolone given the evening before surgery (ultra-early) would be more effective in decreasing CPB-related inflammatory response than when given at induction of anesthesia (early) or in pump prime (standard). This was a triple-arm, parallel, active control, superiority RCT including 54 infants <2 years old who were randomised to receive 30 mg/kg methylprednisolone at one of the 3 time points. Outcomes included alveolar-arterial oxygen gradient (AaDO2) during, 24, 48 and 72 hours post-CPB, IL-6, IL-8 and reduced (GSH) to oxidized (GSSG) glutathione ratio (pre-ultrafiltration on CPB, end-CPB and 24 hours), PICU length of stay (LOS) and ventilator days. Data were analysed using descriptive statistics and a random effects regression model. The ultra-early group had higher Risk Adjusted Congenital Heart Surgery Score, lower age and longer CPB times than the other groups. No significant differences in AaDO2, IL-8, PICU LOS and ventilator days were observed between groups. Compared to the ultra-early group, the overall rise in IL-6 in the early and standard groups was lower, -27.8 pg/ml (95% CI -52.7,-2.9) and -35.3 pg/ml (95% CI -64.3,-6.34), respectively. GSH:GSSG was significantly lower in the standard group (-35.9; 95% CI -63.31,-8.5) at 24 hours post-CPB. Ultra-early administration of methylprednisolone does not improve AaDO2 post-CPB, nor diminish cytokine release. Lower GSH:GSSG in the standard group suggests less oxidative stress. However despite statistical adjustments conclusions are limited by the unbalanced randomisation of the groups. Springer International Publishing 2014-08-29 /pmc/articles/PMC4161735/ /pubmed/25221738 http://dx.doi.org/10.1186/2193-1801-3-484 Text en © Withington et al.; licensee Springer. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. |
spellingShingle | Research Withington, Davinia E Fontela, Patricia S Harrington, Karen P Tchervenkov, Christo Lands, Larry C A comparison of three dose timings of methylprednisolone in infant cardiopulmonary bypass |
title | A comparison of three dose timings of methylprednisolone in infant cardiopulmonary bypass |
title_full | A comparison of three dose timings of methylprednisolone in infant cardiopulmonary bypass |
title_fullStr | A comparison of three dose timings of methylprednisolone in infant cardiopulmonary bypass |
title_full_unstemmed | A comparison of three dose timings of methylprednisolone in infant cardiopulmonary bypass |
title_short | A comparison of three dose timings of methylprednisolone in infant cardiopulmonary bypass |
title_sort | comparison of three dose timings of methylprednisolone in infant cardiopulmonary bypass |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161735/ https://www.ncbi.nlm.nih.gov/pubmed/25221738 http://dx.doi.org/10.1186/2193-1801-3-484 |
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