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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...

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Autores principales: Withington, Davinia E, Fontela, Patricia S, Harrington, Karen P, Tchervenkov, Christo, Lands, Larry C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2014
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.
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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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