T3 in cardiac surgery

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Definition: triiodothyronine levels decrease in infants and children after cardiopulmonary bypass. Lower T3 concentration is associated with a more complicated recovery in PICU after congenital heart surgery. T3 is safe and has proven clinical benefit in infants less than 5 months of age. Given prophylactically before and after cardiopulmonary bypass, T3 decreases ventilation time and inotrope requirement and improves cardiac function compared to placebo.


Patient selection:

Infants less than 5 months of age having congenital heart surgery with cardiopulmonary bypass.


T3 treatment regimen:

  • 0.4 mcg/kg immediately prior to going on to CPB
  • 0.4 mcg/kg on release of aortic cross clamp
  • 0.2 mcg/kg at 3 hrs after cross clamp removal
  • 0.2 mcg/kg at 6 hrs after cross clamp removal
  • 0.2 mcg/kg at 9 hrs after cross clamp removal

A single vial can be used for multiple doses for a single patient up to 24 hrs after opening, but must be kept in the fridge once open.


References:

[1] Bartkowski, R., et al., Thyroid hormones levels in infants during and after cardiopulmonary bypass with ultrafiltration. Eur J Cardiothorac Surg, 2002. 22(6): p. 879-84.

[2] Plumpton, K. et al, Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass. Intensive Care Med, 2005. 31(4): p. 581-7.

[3] Plumpton, K.R., B.J. Anderson, and J. Beca, Thyroid hormone and cortisol concentrations after congenital heart surgery in infants younger than 3 months of age. Intensive Care Med, 2009. 36(2): p. 321-8.

[4] Portman, M.A., et al., Triiodothyronine Supplementation in Infants and Children Undergoing Cardiopulmonary Bypass (TRICC): a multicenter placebo-controlled randomized trial: age analysis. Circulation, 2010. 122(11 Suppl): p. S224-33.


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Marc Anders is a paediatric intensivist.

Author: Marc Anders

Marc Anders is a paediatric intensivist.