To evaluate the acute inflammatory response and cardiac output in children after surgery for ventricular septal defect.Design and setting:
Prospective, observational study in a level III multidisciplinary neonatal and pediatric intensive care unit.Patients:
Ten children undergoing open-heart surgery for ventricular septal defect.Interventions:
All children received methylprednisolone (30 mg/kg) in cardiopulmonary bypass (CPB) prime.Measurements and results:
Before and after cardiopulmonary bypass, plasma interleukin-10 and tumor necrosis factor α were measured by enzyme-linked immunosorbent assay, and lymphocyte subsets in peripheral blood by flow cytometry. Relative values (post-/pre-CPB) of interleukin-10 and tumor necrosis factor α were calculated. The cardiac index (CI) was measured continuously beat-to-beat by a pulse contour analysis (PiCCO). Children above the cutoff value (median cardiac index value 3.0 l min- 1 m- 2) were designated as the normal CI group and those below this value as the low CI group. In the normal CI group the relative values of interleukin-10 remained almost seven times higher than pre-CPB values at 24 h while in the low CI group they decreased almost to pre-CPB values. Furthermore, the normal CI group, but not the low CI group, exhibited more than threefold decrease in T-lymphocytes (lymphocyte T-cells, T-helper cells, and cytotoxic T-cells) 24 h after CPB.Conclusions:
Children operated on for ventricular septal defect developed either a normal or low CI. The higher relative values of interleukin-10 and lower counts of lymphocyte T-cells, T-helper and cytotoxic T-cells differentiated the normal CI group from the low CI group at 24 h after cardiopulmonary bypass.