Corticoids during Hypothermic Open-Heart Operations in Children

Kučera, V.; Hampl, R; Stárka, L

doi:10.1055/s-2007-1012378

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…Several studies have attempted to characterize dynamic HPA axis physiology during surgery or critical illness in children (Table 4 ). Kucera et al measured plasma cortisol at six time points in 24 children of various ages (ranging from 2 months to 15 years): the day before surgery, at the end of surface cooling, at the lowest temperature during CPB, 10 min after rewarming, at the end of CPB and on the 8th day, postoperatively [ 67 ]. They found the cortisol levels to be in the range of the normal laboratory values with a trend toward increase during rewarming.…”

Section: Resultsmentioning

confidence: 99%

Corticosteroids in Pediatric Heart Surgery: Myth or Reality

et al. 2018

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Background: Corticosteroids have been administered prophylactically for more than 60 years in pediatric heart surgery, however, their use remains a matter of debate. There are three main indications for corticosteroid use in pediatric heart surgery with the use of cardiopulmonary bypass (CPB): (1) to blunt the systemic inflammatory response (SIRS) induced by the extracorporeal circuit; (2) to provide perioperative supplementation for presumed relative adrenal insufficiency; (3) for the presumed neuroprotective effect during deep hypothermic circulatory arrest operations. This review discusses the current evidence behind the use of corticosteroids in these three overlapping areas.Materials and Methods: We conducted a structured research of the literature using PubMed and MEDLINE databases to November 2017 and additional articles were identified by cross-referencing.Results: The evidence suggests that there is no correlation between the effect of corticosteroids on inflammation and their effect on clinical outcome. Due to the limitations of the available evidence, it remains unclear if corticosteroids have an impact on early post-operative outcomes or if there are any long-term effects. There is a limited understanding of the hypothalamic-pituitary-adrenal axis function during cardiac surgery in children. The neuroprotective effect of corticosteroids during deep hypothermic circulatory arrest surgery is controversial.Conclusions: The utility of steroid administration for pediatric heart surgery with the use of CPB remains a matter of debate. The effect on early and late outcomes requires clarification with a large multicenter randomized trial. More research into the understanding of the adrenal response to surgery in children and the effect of corticosteroids on brain injury is warranted.

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Section: Resultsmentioning

confidence: 99%

Corticosteroids in Pediatric Heart Surgery: Myth or Reality

et al. 2018

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“…Therefore, such frequent variations in the cortisol concentration make the ACTH tests inaccurate because they rely on a just few time-point measurements that can be taken either at the peak or trough of the pulse [40]. Several studies tried to assess the HPA axis during surgery [41][42][43][44][45][46][47][48][49][50][51]. Some used a few time cortisol measurements or just ACTH stimulation tests and tried to correlate their findings with clinical outcomes.…”

Section: Steroids and The Hypothalamic-pituitary-adrenal Axismentioning

confidence: 99%

Steroids in paediatric heart surgery: eminence or evidence-based practice?

Fudulu

Lightman

Caputo

et al. 2018

Indian J Thorac Cardiovasc Surg

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Steroids in paediatric heart surgery are given prophylactically to blunt the systemic inflammatory response induced by the extracorporeal circuit and to improve clinical outcomes. However, there is an ongoing controversy about the impact of steroids on clinical outcomes after paediatric heart surgery. The hypothalamic-pituitary-adrenal axis is the primary neuroendocrine system activated during the stress of surgery. Relative adrenal insufficiency can accompany paediatric heart surgery; therefore, perioperative steroid supplementation is still administered by some centres. The studies that investigate the hypothalamic-pituitaryadrenal axis physiology during surgery have many limitations, and it is unclear how to define what is adrenal insufficiency. In this review, we focus on discussing the available evidence for steroid use in paediatric cardiac surgery.

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Corticoids during Hypothermic Open-Heart Operations in Children

Cited by 2 publications

References 2 publications

Corticosteroids in Pediatric Heart Surgery: Myth or Reality

Corticosteroids in Pediatric Heart Surgery: Myth or Reality

Steroids in paediatric heart surgery: eminence or evidence-based practice?

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