| Trotter et al.(4040. Trotter A, Mück K, Grill HJ, Schirmer U, Hannekum A, Lang D. Gender-related plasma levels of progesterone, interleukin-8 and interleukin-10 during and after cardiopulmonary bypass in infants and children. Crit Care. 2001;5(6):343–8.) (Germany) |
To investigate the plasma levels of progesterone, IL-8, and IL-10 during and after CPB in infants/children according to gender and PO cardiac morbidities |
n = 18 (10M;8F)/19 months (2 months to 15 years) |
Progesterone, IL-8, and IL-10 |
Immediately before surgery; after anesthesia induction and heparin administration; ten minutes after the beginning of CPB; after disconnecting the protamine administration circuit; six hours, one day, three days, and seven days after surgery |
CPB time; aortic clamp; mechanical ventilation; days in the PICU; and MOD
|
After CPB, all the patients showed an increase in the levels of progesterone, IL-8, and IL-10, with the IL-10 level being considerably higher in girls (p < 0.05). Six out of ten boys and no girl showed MOD (p = 0.01) |
| ElBarbary et al.(4141. el-Barbary M, Khabar KS. Soluble tumor necrosis factor receptor p55 predicts cytokinemia and systemic inflammatory response after cardiopulmonary bypass. Crit Care Med. 2002;30(8):1712–6.) (Saudi Arabia) |
To examine the behavior of the TNF-α p55 receptor before and after CPB and its relationship with the development of cytokinemia and clinical complications such as SIRS and MOD
|
n = 20 (12M;8F)/ 4.4 years |
IL-1β, TNF-α p55 and p75 receptors, TNF-α, IL-6, and IL-8 |
Immediately before CPB; two hours and one day after the beginning of CPB |
Hypotension; coagulopathy; liver dysfunction; kidney dysfunction; respiratory dysfunction; and capillary leak |
The levels of the TNF p55 receptor increased considerably two hours after CPB and remained stable up to one day after the procedure, showing a positive correlation with the presence of SIRS (r = 0.74, p = 0.0001) and MOD (r = 0.84, p = 0.0007). The preoperative levels of the TNF p55 receptor were predictors of hypotension, respiratory dysfunction, and coagulopathy in the patients (p < 0.005) |
| Madhok et al.(4242. Madhok AB, Ojamaa K, Haridas V, Parnell VA, Pahwa S, Chowdhury D. Cytokine response in children undergoing surgery for congenital heart disease. Pediatr Cardiol. 2006;27(4):408–13.) (United States) |
To measure cytokine levels in the PO period of surgeries to treat congenital heart disease and correlate them with intraoperative variables and PO outcomes |
n = 20 (11M;9F) 15 months (0.1 to 180) |
TNF-α, IL-1β, IL-12, IL-6, IL-8, and IL-10 |
Preoperative (after anesthesia induction); one to three days in the PO period |
Diagnosis; CPB time; aortic clamp; days in the PICU; mechanical ventilation; days in the hospital; inotropic score; venous oxygen saturation; and lactate |
The levels of IL-6, IL-8, and IL-10 increased considerably in the first PO period (p < 0.01), and the IL-8 level showed a positive correlation with the need for inotropic support (r = 0.470, p = 0.057) and an inverse correlation with the IL-6 (r = -0.575; p = 0.016) and IL-8 (r = -0.614, p = 0.009) level and with the venous oxygen saturation |
| Allen et al.(4343. Allen ML, Hoschtitzky JA, Peters MJ, Elliott M, Goldman A, James I, et al. Interleukin-10 and its role in clinical immunoparalysis following pediatric cardiac surgery. Crit Care Med. 2006;34(10):2658–65.) (United Kingdom) |
To determine the relationship between IL-10 observed levels, the genetic polymorphism that influences these levels, and the occurrence of severe hyperresponsiveness to endotoxin in children submitted to heart surgery with the use of CPB |
n = 36 (21M;15F) 6.5 months (9 days to 24 months) |
IL-10, IL-1 receptor antagonist, IL-6, IL-8, and TNF-α |
After anesthesia induction and insertion of the arterial catheter; during the aortic clamp release; at the end of CPB; after ultrafiltration; when arriving at the PICU; and 2, 4, 8, 14,18, 24, and 48 hours after admission to the PICU |
Duration of mechanical ventilation; days in the PICU; presence of sepsis; immunoparalysis; SIRS; and death |
The response of blood IL-10 (p < 0.001), TNF-α (p < 0.001), and IL-6 (p < 0.05) to a lipopolysaccharide was reduced up to 50% in the first PO period in comparison with the response found in the preoperative period. Immunoparalysis was partially related to high circulating levels of IL-10 (p < 0.001), which exposed the patients to high risk of complications in the PO period. In addition, the IL-10 GCC genotype seemed to be a marker for risk of immunoparalysis (p < 0.01) |
| Allan et al.(2626. Allan CK, Newburger JW, McGrath E, Elder J, Psoinos C, Laussen PC, et al. The relationship between inflammatory activation and clinical outcome after infant cardiopulmonary bypass. Anesth Analg. 2010;111(5):1244–51.) (United States) |
To evaluate the relationship between inflammatory status and clinical outcomes in infants submitted to CPB |
n = 93 (61M;32F) 37 days (2 to 264) |
CRP, IL-6, IL-8, IL-10, TNF-α, and IL-1β |
Before CPB; immediately after CPB; and 6, 12, and 24 hours after CPB |
Preoperative: use of inotropes and mechanical ventilation, for example; intraoperative: CPB, aortic clamp, administered hemoderivatives; PO: duration of intubation, days in the PICU and the hospital, and lactate concentration |
The pre-CPB IL-6 and CRP levels were higher in young infants (p < 0.001). The levels of IL-6, IL-8, and IL-10 increased in the PO period, but only IL-6 (r = 0.29, p = 0.006) and IL-8 (r = 0.30, p = 0.004) showed a correlation with a longer PICU stay and the need for hemoderivatives administration. There was a positive correlation between IL-8 and lactate concentration 24 hours after surgery (r = 0.44, p < 0.001) |
| Wald et al.(77. Wald EL, Preze E, Eickhoff JC, Backer CL. The effect of cardiopulmonary bypass on the hypothalamic-pituitary-adrenal axis in children. Pediatr Crit Care Med. 2011;12(2):190–6.) (United States) |
To examine the effect of CPB on the HPA axis, specifically on the adrenal responsiveness, of infants/children with congenital heart disease submitted to surgeries to treat the problem |
n = 52 (25M;27F) 1.6 years (0.4 to 6.5) |
Total cortisol, globulin-bound cortisol, free serum cortisol, and albumin |
Preoperative (immediately after the central catheter incision); PO: 30 minutes after surgery and 60 minutes after administration of cosyntropin |
Inotropic score; hemodynamic indexes and use of supplementary corticoids; heart surgery adjusted score risk; duration of mechanical ventilation; days in the PICU |
Decreased levels of globulin-bound cortisol were associated with a considerable increase in free cortisol levels. After stimulation with CPB, they were associated with worse clinical outcomes, such as a longer PICU stay (p = 0.02), higher inotropic scores (p = 0.05), greater requirement for isotonic solutions (p = 0.007), and a longer period on mechanical ventilation (p = 0.013) |
| Crow et al.(4444. Crow SS, Oliver WC Jr, Kiefer JA, Snyder MR, Dearani JA, Li Z, et al. Dexamethasone levels predict cortisol response after infant cardiopulmonary bypass. J Thorac Cardiovasc Surg. 2014;147(1):475–81.) (United States) |
To evaluate whether there was variability in blood dexamethasone levels after the administration of a dosage of 1 mg/kg before CPB in infants |
n = 32 (13M;19F) 199±114 days (group with a low dexa level) and 225±363 days (group with a high dexa level) |
Dexamethasone, cortisol, ACTH, IL-6, IL-8, and IL-10 |
After anesthesia induction; after ultrafiltration; at the admission to the PICU; 4, 8, 12, and 24 hours after surgery |
Congenital heart disease surgery adjusted score risk; time of CPB; aortic clamp; inotropic score; duration of mechanical ventilation; days in the PICU |
The administration of 1 mg/kg of dexamethasone before CPB originated different levels of the drugs in the infants at the arrival at the PICU, which were highly correlated with the magnitude of the response to stress/cortisol in the PO period (p < 0.05). Patients with high dexamethasone levels had lower cortisol levels in the PO period in comparison with the baseline levels (pre-CPB) (p = 0.018) |
| Correia et al.(44. Correia GD, Wooi Ng K, Wijeyesekera A, Gala-Peralta S, Williams R, MacCarthy-Morrogh S, et al. Metabolic profiling of children undergoing surgery for congenital heart disease. Crit Care Med. 2015;43(7):1467–76.) (United Kingdom) |
To evaluate the change in key metabolite levels after the surgery and examine the potential of a metabolic profile in the stratification of patients regarding expected clinical outcomes |
n = 28 (15M;13F) 6.6 months (4.4 to 15.5) |
IL-1 receptor antagonist, IL-6, IL-8, IL-10, and main metabolites |
Preoperative (during anesthesia induction); PO: at the admission to the PICU (zero hour), 6, 24, and 28 hours after surgery |
Congenital heart disease surgery adjusted score risk; pediatric organs dysfunction score at the admission to the PICU; inotropic score; lactate; arteriovenous oxygen saturation; days outside the PICU |
A rigorous glycemic control did not change the response profile of the patients in the PO period considerably. Eight metabolites were associated with the disease severity and the surgery severity (3-d-hydroxibutirate, acetone, acetoacetate, citrate, lactate, creatine, creatinine, and alanine). The concentration of IL-6 (r = -0.73, p = 0.026) and IL-8 (r = -0.76, p = 0.017) showed an inverse correlation with the number of days outside the PICU, and the IL-6/IL-10 ratio showed a positive correlation with the plasma lactate level (p < 0.05) |
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