Single dose corticosteroid therapy after surgical repair of fallot’s tetralogy; A randomized controlled clinical trial

Dalili, Mohammad; Vesal, Ahmad; Tabib, Avisa; Khani-Tafti, Leila; Hosseini, Seyed Javad; Totonchi, Ziae

doi:10.5812/cardiovascmed.25500

Cited by 11 publications

(3 citation statements)

References 15 publications

(15 reference statements)

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“…Dexamethasone injection before cardiopulmonary bypass reduces the postbypass inflammatory response in children, as measured by cytokine levels and clinical outcome [41]. Another study found that a single dosage of methylprednisolone (corticosteroid) has no effect on the clinical outcome after tetralogy of fallot repair [38]. Similarly, intraoperative methylprednisolone failed to show a meaningful reduction in the composite primary study endpoint's incidence.…”

Section: Discussionmentioning

confidence: 99%

Cardiac surgery-associated acute kidney injury in newborns: A meta-analysis

et al. 2023

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Introduction: Acute kidney injury is a common complication following pediatric heart surgery, and it has been linked to an increased risk of morbidity and fatality. Methods: The PubMed and Medline databases were combed for relevant research until May 2022. The terms [Cardiac surgery] AND [acute renal injury] AND [newborns OR children OR neonates] AND [randomized control studies OR randomized control trials] were used as search criteria. The studies that met the inclusion criteria were considered qualified using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Results: A total of 2,941 newborns or children were enrolled in 14 studies, with 931 developing acute renal damage. 2,095 of the enrolled infants and children received steroid, aminophylline, dexmedetomidine, and acetaminophen therapies. In seven studies, the odds ratio for steroids was not significantly different from control. In contrast, two studies comparing aminophylline to a control group found no statistically significant change. Two studies found no significant difference in dexmedetomidine therapy compared to control. Three trials, however, found a significant difference between the acetaminophen treatment and control groups. Conclusion: Acetaminophen was linked to a decreased risk of postoperative acute renal injury, while steroids had no benefit and aminophylline treatment could be justified.

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Section: Discussionmentioning

confidence: 99%

Cardiac surgery-associated acute kidney injury in newborns: A meta-analysis

et al. 2023

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“…Out of the 267 records retrieved by the systematic search in PubMed and EMBASE, 10 studies met the inclusion criteria and included a total of 604 children (Table 8). [139][140][141][142][143][144][145][146][147][148] All studies were single centre. There were six retrospective cohort studies and four prospective, randomised, double-blind, placebo-controlled studies.…”

Section: Steroidsmentioning

confidence: 99%

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

et al. 2021

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Background: Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass. Methods: We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass. Results: We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety. Conclusion: In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.

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“…However, some potential adverse effects may be associated with corticosteroids, for example, hyperglycemia, poor wound healing, infections, and poor neurodevelopmental outcomes (6)(7)(8). Several small, randomized, controlled studies in pediatric patients have investigated the effect of perioperative corticosteroids on the inflammatory biomarkers, clinical outcomes, and adverse events after congenital heart surgeries (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Nevertheless, the results were conflicted, resulting in the controversy over perioperative corticosteroids.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Corticosteroid Therapy in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Luo

et al. 2020

Front. Pediatr.

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Background: The benefit-risk profile of perioperative corticosteroids in pediatric patients undergoing cardiac surgery remains controversial. Objective: To investigate the influence of perioperative corticosteroids on the postoperative mortality and clinical outcomes in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: We conducted a systematic search using MEDLINE, EMBASE, and Cochrane Database through August 31, 2019. We included randomized controlled trials comparing perioperative corticosteroids with other clinical interventions, placebo, or no treatment in children between 0 and 18 years of age undergoing cardiac surgery. The primary outcome of interest was all-cause in-hospital mortality. The secondary outcomes were length of intensive care unit stay (LOIS), duration of mechanical ventilation (DMV), postoperative insulin therapy, postoperative low cardiac output syndrome (LCOS), postoperative infection, maximal temperature (T max) in the first 24 h postoperatively, urine output (UO) in the first 24 h postoperatively, serum lactate at postoperative day (POD) 1, blood glucose at POD 1, vasoactive inotrope score (VIS) at POD 1, and postoperative acute kidney injury (AKI). Study quality was assessed using the Cochrane Risk of Bias Assessment Tool. Results: Our analysis included 17 studies and 848 pediatric patients. The data demonstrated that children receiving corticosteroids showed no significant difference on the all-cause in-hospital mortality with a fixed-effect model (RR = 0.59, 95% CI = 0.28-1.25, P = 0.55) compared with controls. For the secondary outcomes, corticosteroids had a statistically significant reduction on the VIS at POD1 (MD = −2.04, 95% CI = −3.96 −0.12, P = 0.04), while it might be significantly associated with an increased blood glucose at POD1 (MD = 1.38, 95% CI = 0.68-2.09, P = 0.0001) and a 2.69-fold higher risk of postoperative insulin therapy (RR = 2.69, 95% CI = 1.37-5.27, P = 0.004). No statistical significance was shown in other secondary outcomes. Conclusion: Perioperative corticosteroids might not significantly improve clinical outcomes identified as mortality, LOIS, DMV, AKI, and LCOS other than VIS at Li et al. Corticosteroids in Pediatric Cardiac Surgery POD1. However, it might increase the blood glucose and episodes of insulin therapy. Perioperative corticosteroids to attenuate the inflammatory response are not supported by available evidence from our study. Further results from ongoing randomized controlled trials with a larger sample size are required.

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Single dose corticosteroid therapy after surgical repair of fallot’s tetralogy; A randomized controlled clinical trial

Cited by 11 publications

References 15 publications

Cardiac surgery-associated acute kidney injury in newborns: A meta-analysis

Cardiac surgery-associated acute kidney injury in newborns: A meta-analysis

A systematic review of the evidence supporting post-operative medication use in congenital heart disease

Perioperative Corticosteroid Therapy in Children Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

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