A neutrophil elastase inhibitor, sivelestat, improved respiratory and cardiac function in pediatric cardiovascular surgery with cardiopulmonary bypass

• DOI: 10.1007/s00540-008-0645-z
• Publication Date: 2008-11-14T12:48:40Z
• Authors: Satoshi Toyama; Fumimaro Hatori; Ayako Shimizu; Toshio Takagi
• Keywords: Heart Septal Defects, Ventricular; Male; Sulfonamides; Cardiopulmonary Bypass; Hypertension, Pulmonary; Glycine; Proteinase Inhibitory Proteins, Secretory; Infant; Heart; Intensive Care Units, Pediatric; Respiration, Artificial; 3. Good health; Oxygen; Leukocyte Count; 03 medical and health sciences; 0302 clinical medicine; Hematocrit; Respiratory Mechanics; Humans; Female; Anesthesia, Inhalation; Vascular Surgical Procedures; Retrospective Studies

Several reports indicate that a neutrophil elastase inhibitor, sivelestat, may have prophylactic efficacy against a systemic inflammatory response after cardiovascular surgery with cardiopulmonary bypass (CPB). We evaluated the clinical pulmonary and cardiac effects of sivelestat.We performed a retrospective study of 25 pediatric patients who underwent elective cardiovascular surgery with CPB for ventricular septal defect with pulmonary hypertension. Ten patients received 0.2 mg x kg(-1) x h(-1) sivelestat; the other is patients were the control group. There were no significant differences in demographic characteristics between the two groups. The P(a)O(2)/fractional inspired oxygen (F(I)O(2); P/F) ratio, the respiratory index (RI), and the fractional area change (FAC) of the left ventricle (LV) in the postoperative course were measured.The P/F ratio was higher in the sivelestat group compared with the control group and there were significant differences between the two groups immediately after weaning form CPB, and at 12 h after weaning from CPB (P < 0.05). The RI was lower in the sivelestat group compared with the control group and there were significant differences between the two groups at immediately after weaning from CPB, and at 6 h and 12 h after CPB (P < 0.05). The FAC of the LV was significantly better in the sivelestat group and there was a significant difference between the two groups on postoperative day (POD) 3 (P < 0.05).We have shown that pediatric patients who underwent cardiovascular surgery with CPB who received sivelestat had a higher P/F ratio, a lower RI, and better FAC of the LV in the postoperative course.