Fudulu Daniel P, Schadenberg Alvin, Gibbison Ben, Jenkins Ian, Lightman Stafford, Angelini Gianni D, Stoica Serban
1 Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom.
2 Henry Welcome Laboratories for Integrative Neuroscience and Metabolism, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom.
World J Pediatr Congenit Heart Surg. 2018 May;9(3):289-293. doi: 10.1177/2150135118762392.
The role of steroids to mitigate the deleterious effects of pediatric cardiopulmonary bypass (CPB) remains a matter of debate; therefore, we aimed to assess preferences in administering corticosteroids (CSs) and the use of other anti-inflammatory strategies in pediatric cardiac surgery.
A 19-question survey was distributed to consultants in pediatric cardiac anesthesia from 12 centers across the United Kingdom and Ireland.
Of the 37 respondents (37/60, 62%), 24 (65%) use CSs, while 13 (35%) do not use steroids at all. We found variability within 5 (41%) of the 12 centers. Seven consultants (7/24, 29%) administer CSs in every case, while 17 administer CSs in selected cases only (17/24, 71%). There was variability in the dose of steroid administration. Almost all consultants (23/24, 96%) administer a single dose at induction, and one administers a two-dose regimen (1/24, 4%). There was variability in CS indications. Most consultants (24/37, 66%) use modified ultrafiltration at the conclusion of CPB. Fifteen consultants (15/32, 47%) report the use of aprotinin, while only 3 use heparin-coated circuits (3/24, 9%).
We found wide variability in practice in the administration of CSs for pediatric cardiac surgery, both within and between units. While most anesthetists administer CSs in at least some cases, there is no consensus on the type of steroid, the dose, and at which patient groups this should be directed. Modified ultrafiltration is still used by most of the centers. Almost half of consultants use aprotinin, while heparin-coated circuits are infrequently used.
类固醇减轻小儿体外循环（CPB）有害影响的作用仍存在争议；因此，我们旨在评估小儿心脏手术中使用皮质类固醇（CSs）的偏好以及其他抗炎策略的应用情况。
向英国和爱尔兰12个中心的小儿心脏麻醉顾问发放了一份包含19个问题的调查问卷。
37名受访者（37/60，62%）使用CSs，而13名（35%）根本不使用类固醇。我们发现12个中心中有5个（41%）存在差异。7名顾问（7/24，29%）在每种情况下都使用CSs，而17名仅在特定情况下使用CSs（17/24，71%）。类固醇给药剂量存在差异。几乎所有顾问（23/24，96%）在诱导时给予单剂量，1名给予两剂方案（1/24，4%）。CS适应证存在差异。大多数顾问（24/37，66%）在CPB结束时使用改良超滤。15名顾问（15/32，47%）报告使用抑肽酶，而只有3名使用肝素涂层回路（3/24，9%）。
我们发现小儿心脏手术中CS给药在各单位内部和之间的实践中存在很大差异。虽然大多数麻醉师至少在某些情况下使用CSs，但在类固醇类型、剂量以及应针对哪些患者群体方面尚无共识。大多数中心仍使用改良超滤。几乎一半的顾问使用抑肽酶，而肝素涂层回路很少使用。
