Naguib Aymen N, Bozych Marc, McNally Kelly, Galantowicz Mark, Tobias Joseph
Departments of Anesthesiology and Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
The Heart Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
Cardiol Res. 2025 Jun;16(3):178-188. doi: 10.14740/cr2029. Epub 2025 Apr 22.
This study aimed to investigate the impact of early extubation on stress response and neurodevelopmental outcomes after pediatric cardiac surgery utilizing cardiopulmonary bypass (CPB).
In this single-center prospective pilot study, we attempted to study the impact of using dexmedetomidine as an adjunct to facilitate early extubation after pediatric cardiac surgery requiring CPB during the first year of life. The study was conducted between May 2014 and January 2020. Perioperative data and stress hormone levels were collected at different points during the perioperative period. In addition, neurodevelopmental outcome measures including cognitive composite score, language (expressive and receptive) and motor (fine and gross) composites were evaluated at five time points including prior to surgery and up to 1 year after the procedure. Two-sample -tests and Kruskal-Wallis tests were used to compare continuous parametric and non-parametric outcomes, respectively. Fisher's exact or Chi-squared tests were used to compare categorical outcomes.
A total of 30 subjects were included in the final cohort of patients. Of the 30 subjects, 14 patients were randomized to the dexmedetomidine group (dexmedetomidine plus fentanyl) (DEX group) and 16 patients were randomized to the no dexmedetomidine group (fentanyl only) (no DEX group). With few exceptions, both groups demonstrated appropriate blunting of the stress response. There was a significant increase in the ratio of the pro-inflammatory interleukin-10 (IL-10) to the anti-inflammatory interleukin-6 (IL-6) for the no DEX group at the end of the procedure when compared to the DEX group (10 ± 9 vs. 5 ± 4, P = 0.04). When looking at the Bayley cognitive composite score, the DEX group scored better than the no DEX group during the second visit (102 ± 11 vs. 88 ± 17, P = 0.023). By the fifth visit, the two groups scored similarly (94 ± 12 vs. 94 ± 12, P = 0.9 for the no DEX and DEX groups, respectively).
When looking at the neurodevelopmental outcome, both groups had no significant changes in their Bayley scores from baseline with blunting of most stress markers. This study offers possible evidence of the safety of early extubation after pediatric cardiac surgery while maintaining the goal of neuroprotection.
本研究旨在探讨早期拔管对小儿心脏手术体外循环（CPB）后应激反应和神经发育结局的影响。
在这项单中心前瞻性试点研究中，我们试图研究在生命的第一年，使用右美托咪定作为辅助手段以促进小儿心脏手术CPB后早期拔管的影响。该研究于2014年5月至2020年1月进行。围手术期不同时间点收集围手术期数据和应激激素水平。此外，在包括手术前和手术后长达1年的五个时间点，评估神经发育结局指标，包括认知综合评分、语言（表达性和接受性）和运动（精细和粗大）综合评分。分别使用两样本t检验和Kruskal-Wallis检验比较连续参数和非参数结局。使用Fisher精确检验或卡方检验比较分类结局。
最终队列共纳入30名受试者。在这30名受试者中，14例患者被随机分配至右美托咪定组（右美托咪定加芬太尼）（DEX组），16例患者被随机分配至无右美托咪定组（仅芬太尼）（无DEX组）。除少数例外，两组均表现出对应激反应的适当抑制。与DEX组相比，无DEX组在手术结束时促炎白细胞介素-10（IL-10）与抗炎白细胞介素-6（IL-6）的比值显著升高（10±9对5±4，P = 0.04）。在第二次访视时，DEX组的贝利认知综合评分高于无DEX组（102±11对88±17，P = 0.023）。到第五次访视时，两组评分相似（无DEX组和DEX组分别为94±12对94±12，P = 0.9）。
从神经发育结局来看，两组的贝利评分与基线相比均无显著变化，且大多数应激指标得到抑制。本研究为小儿心脏手术后早期拔管的安全性提供了可能的证据，同时维持了神经保护的目标。
