Dexamethasone reduces the inflammatory response to cardiopulmonary bypass in children

Background. A randomized, prospective, double-blind study of 29 children wa s performed to evaluate the hypothesis that dexamethasone administration pr ior to cardiopulmonary bypass would decrease the inflammatory mediator rele ase and improve the postoperative clinical course. Methods. Fifteen children received dexamethasone (1 mg/kg intravenously) an d 14 (controls) received saline solution 1 hour prior to CPB. Serial blood analyses for interleukin-6, tumor necrosis factor-cu, complement component C3a, and absolute neutrophil count were performed. Postoperative variables evaluated included temperature, supplemental fluids, alveolar-arterial oxyg en 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-cy levels a fter CPB (p < 0.05). Complement component C3a and absolute neutrophil count were not affected by dexamethasone. The mean rectal temperature for the fi rst 24 hours postoperatively was significantly lower in the group given dex amethasone than in the controls (37.2 degrees +/- 0.4 degrees C versus 37.7 degrees +/- 4 degrees C; p = 0.007). Dexamethasone-treated patients requir ed less supplemental fluid during the first 48 hours (22 +/- 28 mL/kg versu s 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 cytokin e levels and clinical course. (C) 2000 by The Society of Thoracic Surgeons.