Title |
A comparison of three dose timings of methylprednisolone in infant cardiopulmonary bypass
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Published in |
SpringerPlus, August 2014
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DOI | 10.1186/2193-1801-3-484 |
Pubmed ID | |
Authors |
Davinia E Withington, Patricia S Fontela, Karen P Harrington, Christo Tchervenkov, Larry C Lands |
Abstract |
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. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 17 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Student > Doctoral Student | 2 | 12% |
Student > Ph. D. Student | 2 | 12% |
Student > Postgraduate | 2 | 12% |
Other | 1 | 6% |
Student > Master | 1 | 6% |
Other | 3 | 18% |
Unknown | 6 | 35% |
Readers by discipline | Count | As % |
---|---|---|
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Agricultural and Biological Sciences | 2 | 12% |
Biochemistry, Genetics and Molecular Biology | 1 | 6% |
Social Sciences | 1 | 6% |
Chemistry | 1 | 6% |
Other | 0 | 0% |
Unknown | 8 | 47% |