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Ann Thorac Surg 2000;69:1490-1495
© 2000 The Society of Thoracic Surgeons

Original articles: Cardiovascular

Dexamethasone reduces the inflammatory response to cardiopulmonary bypass in children

Ronald A. Bronicki, MDa,b,c,d,e,f, Carl L. Backer, MDa,d, Harris P. Baden, MDa,b,c,d,e,f, Constantine Mavroudis, MDa,b,c,d,e,f, Susan E. Crawford, MDa,b,c,d,e,f, Thomas P. Green, MDa,b,c,d,e,f

a Departments of Department of Surgery, Northwestern University Medical School, Chicago, Illinois, USA
b Department of Pathology, Northwestern University Medical School, Chicago, Illinois, USA
c Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois, USA
d Division of Cardiovascular-Thoracic Surgery, Children’s Memorial Hospital, Chicago, Illinois, USA
e Division of Pediatric Critical Care Medicine, Children’s Memorial Hospital, Chicago, Illinois, USA
f Department of Pathology, Children’s Memorial Hospital, Chicago, Illinois, USA

Address reprint requests to Dr Backer, Children’s Memorial Hospital, 2300 Children’s Plaza, m/c 22, Chicago, IL 60614
e-mail: c-backer{at}nwu.edu

Background. A randomized, prospective, double-blind study of 29 children was performed to evaluate the hypothesis that dexamethasone administration prior to cardiopulmonary bypass would decrease the inflammatory mediator release and improve the postoperative clinical course.

Methods. Fifteen children received dexamethasone (1 mg/kg intravenously) and 14 (controls) received saline solution 1 hour prior to CPB. Serial blood analyses for interleukin-6, tumor necrosis factor-{alpha}, complement component C3a, and absolute neutrophil count were performed. Postoperative variables evaluated included temperature, supplemental fluids, alveolar-arterial oxygen gradient, and days of mechanical ventilation.

Results. Dexamethasone caused an eightfold decrease in interleukin-6 levels and a greater than threefold decrease in tumor necrosis factor-{alpha} levels after CPB (p < 0.05). Complement component C3a and absolute neutrophil count were not affected by dexamethasone. The mean rectal temperature for the first 24 hours postoperatively was significantly lower in the group given dexamethasone than in the controls (37.2° ± 0.4°C versus 37.7° ± 4°C; p = 0.007). Dexamethasone-treated patients required less supplemental fluid during the first 48 hours (22 ± 28 mL/kg versus 47 ± 34 mL/kg; p = 0.04). Compared with controls, dexamethasone-treated children had significantly lower alveolar-arterial oxygen gradients during the first 24 hours (144 ± 108 mm Hg versus 214 ± 118 mm Hg; p = 0.02) and required less mechanical ventilation (median duration, 3 days versus 5 days; p = 0.02).

Conclusions. Dexamethasone administration prior to CPB in children leads to a reduction in the postbypass inflammatory response as assessed by cytokine levels and clinical course.




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