The Utility of Steroids in Pediatric Cardiac Operations*

Graham, Eric M.

doi:10.1097/pcc.0000000000000139

Cited by 9 publications

(9 citation statements)

References 15 publications

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“…Similar to other studies, this work demonstrates that preoperative steroids reduce the inflammatory response following cardiac surgery yet the evidence to support an association with improved clinical outcomes remains unclear (9–13). As such, the intriguing question regarding the role steroids may play to attenuate the potentially deleterious inflammatory effects of cardiopulmonary bypass remains unanswered.…”

supporting

confidence: 79%

Predicting Acute Kidney Injury After Pediatric Cardiac Surgery

Buckley

Graham²

2016

Pediatric Critical Care Medicine

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supporting

confidence: 79%

Predicting Acute Kidney Injury After Pediatric Cardiac Surgery

Buckley

Graham²

2016

Pediatric Critical Care Medicine

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“…Studies to evaluate this practice in patients with congenital heart disease have been further limited by small sample sizes and/or heterogeneous patient populations (16,21). This is especially true of neonates, in whom the systemic inflammatory response may be exacerbated by morbidity factors such as smaller patient size, greater hemodilution, hypothermia, and longer bypass times.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Steroid Use and Outcomes Following the Norwood Procedure

Elhoff

Chowdhury²,

Zyblewski³

et al. 2016

Pediatric Critical Care Medicine

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Objective Data supporting the use of perioperative steroids during cardiac surgery are conflicting and most pediatric studies have been limited by small sample sizes and/or diverse cardiac diagnoses. The objective of this study was to determine if intraoperative steroid administration improved outcomes following the Norwood procedure. Design A retrospective analysis was performed on the 549 neonates who underwent a Norwood procedure in the publicly available datasets from the Pediatric Heart Network’s Single Ventricle Reconstruction (SVR) trial. Groups were compared to determine if outcomes differed between intraoperative steroid recipients (n=498, 91%) and non-recipients (n=51, 9%). Results Baseline characteristics and intraoperative variables were similar between groups with the exception of a shorter duration of cross clamp and cardiopulmonary bypass time in the group that received steroids. Subjects who did not receive intraoperative steroids had improved hospital survival (94% vs 83%, p=0.03), but longer intensive care unit stays (16 days (IQR 12–33) vs 14 days (IQR 9–28), p=0.04) and hospital stays (29 days (IQR 21–50) vs 23 days (IQR 15–40, p=0.01) than steroid recipients. In multivariate analysis lengths of stay associations were no longer significant but hospital survival trended towards favoring the non-steroids group with an odds ratio of 3.52 (95% confidence interval 0.98–12.64, p=0.054). Conclusions In the large multi-centered SVR trial there was widespread use of intraoperative steroids. Intraoperative steroid administration was not associated with an improvement in outcomes and may be associated with a reduction in hospital survival in neonates undergoing the Norwood procedure. This study highlights the need for a randomized control trial.

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“…I strongly believe that given the limited evidence for benefit for corticosteroid administration in pediatric cardiac surgery and the suggestion of potential harms, equipoise should definitely exist on this issue (3–8). However, the evidence from reported clinical practices suggests that it does not (5–8). …”

mentioning

confidence: 99%