Key result
Hemofiltration is linked to reduced TNF-alpha during pediatric cardiac surgery, with no effect on other cytokines.
Why the study?
Pediatric cardiac surgery with CPB triggers an inflammatory cytokine response that may impact outcomes, and the effect of hemofiltration on cytokine levels is unclear.
Does hemofiltration reduce inflammatory cytokine levels in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass?
Observational (n=20)
Does hemofiltration reduce inflammatory cytokine levels in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass?
Hemofiltration during pediatric cardiac surgery effectively removes TNF-alpha temporarily but does not significantly control levels of IL-1, IL-6, sIL-6r, or IL-8.
Hemofiltration was associated with selective TNF-alpha reduction in this small pediatric cohort; hypothesis-generating and leaves open clinical relevance.
Cardiac surgery with cardiopulmonary bypass (CPB) elicits an inflammatory response and has a multitude of biological consequences, ranging from subclinical organ dysfunction to severe multiorgan failure. Pediatric patients are more prone to have a reaction that can jeopardize their outcome. Cytokines are supposed to be important mediators in this response: limiting their circulating levels is, therefore, appealing. We investigated the pattern of cytokine release during pediatric operation for congenital heart anomalies in 20 patients, and the effect of hemofiltration. Tumor necrosis factor alpha (TNF-alpha) was elevated after anesthesia induction and showed significant decrease during CPB. Hemofiltration reduced its concentration, but the effect disappeared on the following day. Interleukin-1 (IL-1) increased slowly at the end of CPB and hemofiltration had no effect. Interleukin-6 (IL-6) showed a tendency toward augmentation during rewarming and hemofiltration did not significantly affect the course. Soluble interleukin-6 receptor (sIL-6r) had a pattern similar to TNF-alpha, but hemofiltration had no effect. On the other hand, interleukin-8 (IL-8) behaved like IL-6. Our findings suggest that baseline clinical status, anesthetic drugs, and maneuvers before incision may elicit a cytokine response, whereas rewarming is a critical phase of CPB. Hemofiltration is effective in removal of TNF-alpha, but its role is debatable for the control of IL-1, IL-6, sIL-6r and IL-8 levels.
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Brancaccio et al. (2005) conducted an observational in Congenital heart anomalies (n=20). Hemofiltration was evaluated on Pattern of cytokine release (TNF-alpha, IL-1, IL-6, sIL-6r, IL-8). Hemofiltration reduced TNF-alpha concentrations in 20 pediatric patients undergoing cardiac surgery, but had no significant effect on IL-1, IL-6, sIL-6r, or IL-8 levels.
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