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Effect of the Neutrophil Elastase Inhibitor Sivelestat on Perioperative Inflammatory Response After Pediatric Heart Surgery With Cardiopulmonary Bypass: A Prospective Randomized Study
Author(s) -
Kohira Satoshi,
Oka Norihiko,
Inoue Nobuyuki,
Itatani Keiichi,
Hanayama Naoji,
Kitamura Tadashi,
Fujii Masami,
Takeda Akikazu,
Oshima Hiroyuki,
Tojo Keiichi,
Yoshitake Shigenori,
Miyaji Kagami
Publication year - 2013
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.12103
Subject(s) - cardiopulmonary bypass , medicine , neutrophil elastase , cardiac surgery , perioperative , inflammatory response , anesthesia , cardiology , surgery , inflammation
Cardiopulmonary bypass ( CPB ) elicits a systemic inflammatory response. The neutrophil elastase inhibitor sivelestat is known to suppress this systemic inflammatory response, which can eventually result in acute organ failure. The prophylactic effect of sivelestat on acute lung injury, especially in pediatric cardiac surgery, remains unclear. This prospective double‐blind, randomized study evaluated the perioperative prophylactic effect of sivelestat in patients undergoing elective pediatric open heart surgery with CPB . Thirty consecutive patients, weighing 5–10 kg and undergoing open heart surgery with CPB , were assigned to sivelestat ( n = 15) or control ( n = 15) groups. From CPB initiation to 24 h after surgery, patients in the sivelestat group received a continuous intravenous infusion of 0.2 mg/kg/h sivelestat, whereas patients in the control group received the same volume of 0.9% saline. Blood samples were collected, and levels of interleukin ( IL )‐6, IL ‐8, tumor necrosis factor alpha, polymorphonuclear elastase ( PMN ‐ E ), C ‐reactive protein ( CRP ), as well as the white blood cell ( WBC ) count, platelet count, and neutrophil count ( NC ) were measured. PMN ‐ E levels, IL ‐8 levels, WBC count, NC , and CRP levels were significantly lower, and platelet count was significantly higher in the sivelestat group, according to repeated two‐way analysis of variance. The activated coagulation time was significantly shorter in the sivelestat group, similarly, blood loss was significantly less in the sivelestat group. In conclusion, Sivelestat attenuates perioperative inflammatory response and clinical outcomes in patients undergoing pediatric heart surgery with CPB .