1. In infants undergoing cardiopulmonary bypass surgery, prophylactic methylprednisolone usage did not importantly trim composite death, bosom transplantation, complications, and prolonged infirmary stay.
2. Prophylactic methylprednisolone usage was associated with an accrued hazard of postoperative hyperglycemia.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Perioperative glucocorticoids person been utilized for decades to attenuate cardiopulmonary bypass-mediated systemic inflammation, but specified usage remains controversial. Several meta-analyses person provided conflicting information. Some suggest that mortality is little with the usage of perioperative glucocorticoids, portion different meta-analyses showed nary quality successful mortality. Therefore, determination is simply a spread successful cognition arsenic to knowing the information and efficacy of perioperative methylprednisolone successful infants undergoing country for congenital bosom disease. Overall, this survey recovered that for infants younger than 1 twelvemonth of property undergoing cardiac surgery, prophylactic usage of methylprednisolone did not trim the likelihood of a ranked composite of death, bosom transplantation, large complications, and prolonged infirmary stay. It was associated with an accrued hazard of postoperative hyperglycemia. This survey was constricted arsenic enrolled patients were permitted to person postoperative glucocorticoids. Additionally, registry information is not arsenic close arsenic information collected and placed into a accepted proceedings database. Nevertheless, these study’s findings are significant, arsenic they show that prophylactic methylprednisolone for infants undergoing cardiac country provides nary important payment successful presumption of outcome.
Click to work the survey successful NEJM
Relevant Reading: Halothane–Morphine Compared with High-Dose Sufentanil for Anesthesia and Postoperative Analgesia successful Neonatal Cardiac Surgery
In-Depth [randomized controlled trial]: This double-blind, randomized, placebo-controlled proceedings progressive patients from 24 congenital bosom illness centers successful the United States. Patients who were undergoing elective cardiac country with cardiopulmonary bypass were eligible for inclusion if they were younger than 1 twelvemonth of age. Patients who had an adjusted gestational property of less than 37 weeks astatine the clip of surgery, had received immoderate glucocorticoids wrong 2 days earlier surgery, had an corruption contraindicating glucocorticoid use, oregon were receiving preoperative mechanical circulatory enactment were excluded from the study. The superior result measured was a composite of death, bosom transplantation during hospitalization, oregon the occurrence of immoderate of 13 idiosyncratic large complications. Outcomes successful the superior investigation were assessed via a proportional likelihood logistic regression model. Based connected the superior analysis, the composite result did not disagree importantly betwixt the methylprednisolone radical and the placebo radical (adjusted likelihood ratio, 0.86; 95% Confidence Interval [CI], 0.71 to 1.05). Secondary analyses showed an likelihood ratio for the composite result of 0.82 (95% CI, 0.67 to 1.00) and a triumph ratio of 1.15 (95% CI, 1.00 to 1.32) successful the methylprednisolone radical arsenic compared with the placebo group, findings suggestive of a payment with methylprednisolone. However, patients successful the methylprednisolone radical were much apt than those successful the placebo radical to necessitate postoperative insulin for hyperglycemia (19.0% vs. 6.7%). Overall, this survey demonstrates that prophylactic usage of methylprednisolone did not importantly trim the likelihood of a worse result and was associated with a higher hazard of processing postoperative hyperglycemia warranting insulin.
Image: PD
©2022 2 Minute Medicine, Inc. All rights reserved. No works whitethorn beryllium reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire astir licensing here. No nonfiction should beryllium construed arsenic aesculapian proposal and is not intended arsenic specified by the authors oregon by 2 Minute Medicine, Inc.
English (US)