Lung Injury After Neonatal Congenital Cardiac Surgery Is Mild and Modifiable by Corticosteroids.

Autor: Kaskinen AK; Division of Pediatric Nephrology and Transplantation, Children's Hospital and Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: anu.kaskinen@helsinki.fi., Keski-Nisula J; Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Martelius L; Department of Radiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Moilanen E; The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland., Hämäläinen M; The Immunopharmacology Research Group, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland., Rautiainen P; Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Andersson S; Children's Hospital and Pediatric Research Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland., Pitkänen-Argillander OM; Division of Pediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2021 Jul; Vol. 35 (7), pp. 2100-2107. Date of Electronic Publication: 2021 Jan 16.
DOI: 10.1053/j.jvca.2021.01.017
Abstrakt: Objectives: The present study was performed to determine whether lung injury manifests as lung edema in neonates after congenital cardiac surgery and whether a stress-dose corticosteroid (SDC) regimen attenuates postoperative lung injury in neonates after congenital cardiac surgery.
Design: A supplementary report of a randomized, double-blinded, placebo-controlled clinical trial.
Setting: A pediatric tertiary university hospital.
Participants: Forty neonates (age ≤28 days) undergoing congenital cardiac surgery with cardiopulmonary bypass.
Interventions: After anesthesia induction, patients were assigned randomly to receive intravenously either 2 mg/kg methylprednisolone or placebo b, which was followed by hydrocortisone or placebo bolus six hours after weaning from CPB for five days as follows: 0.2 mg/kg/h for 48 hours, 0.1 mg/kg/h for the next 48 hours, and 0.05 mg/kg/h for the following 24 hours.
Measurements and Main Results: The chest radiography lung edema score was lower in the SDC than in the placebo group on the first postoperative day (POD one) (p = 0.03) and on PODs two and three (p = 0.03). Furthermore, a modest increase in the edema score of 0.9 was noted in the placebo group, whereas the edema score remained at the preoperative level in the SDC group. Postoperative dynamic respiratory system compliance was higher in the SDC group until POD three (p < 0.01). However, postoperative oxygenation; length of mechanical ventilation; and tracheal aspirate biomarkers of inflammation and oxidative stress, namely interleukin-6, interleukin-8, resistin, and 8-isoprostane, showed no differences between the groups.
Conclusions: The SDC regimen reduced the development of mild and likely clinically insignificant radiographic lung edema and improved postoperative dynamic respiratory system compliance without adverse events, but it failed to improve postoperative oxygenation and length of mechanical ventilation.
Competing Interests: Conflict of Interest The authors have no conflict of interest.
(Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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