Efficacy of methylprednisolone in preventing lung injury following pulmonary thromboendarterectomy.

Abstract

BACKGROUND:

We sought to determine the efficacy and safety of perioperative treatment with methylprednisolone on the development of lung injury after pulmonary thromboendarterectomy.

METHODS:

This was a randomized, prospective, double-blind, placebo-controlled study of 98 adult patients with chronic thromboembolic pulmonary hypertension who were undergoing pulmonary thromboendarterectomy at a single institution. The patients received either placebo (n = 47) or methylprednisolone (n = 51) (30 mg/kg in the cardiopulmonary bypass prime, 500 mg IV bolus following the final circulatory arrest, and 250 mg IV bolus 36 h after surgery). The primary end point was the presence of lung injury as determined by two independent, blinded physicians using prospectively defined criteria. The secondary end points included ventilator-free, ICU-free, and hospital-free days and selected levels of cytokines in the blood and in BAL fluid.

RESULTS:

The incidence of lung injury was similar in both treatment groups (45% placebo, 41% steroid; P = .72). There were no statistical differences in the secondary clinical end points between treatment groups. Treatment with methylprednisolone, compared with placebo, was associated with a statistically significant reduction in plasma IL-6 and IL-8, a significant increase in plasma IL-10, and a significant reduction in postoperative IL-1ra and IL-6, but not IL-8 in BAL fluid obtained 1 day after surgery.

CONCLUSIONS:

Perioperative methylprednisolone does not reduce the incidence of lung injury following pulmonary thromboendarterectomy surgery despite having an antiinflammatory effect on plasma and lavage cytokine levels.

• Authors: Kim M Kerr, William R Auger, James J Marsh, Gehan Devendra, Roger G Spragg, Nick H Kim, Richard N Channick, Stuart W Jamieson, Michael M Madani, Gerard R Manecke, David M Roth, Gordon P Shragg, Peter F Fedullo
• Journal: Chest (Chest) Vol. 141 Issue 1 Pg. 27-35 (Jan 2012) ISSN: 1931-3543 [Electronic] United States
• PMID: 21835900 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural)

Chemical References

• Glucocorticoids
• Interleukin-6
• Interleukin-8
• Interleukin-10
• Methylprednisolone

Topics

• Bronchoalveolar Lavage Fluid (chemistry)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Endarterectomy (adverse effects)
• Female
• Follow-Up Studies
• Glucocorticoids (administration & dosage)
• Humans
• Injections, Intravenous
• Interleukin-10 (metabolism)
• Interleukin-6 (metabolism)
• Interleukin-8 (metabolism)
• Lung Injury (etiology, metabolism, prevention & control)
• Male
• Methylprednisolone (administration & dosage)
• Middle Aged
• Preoperative Care (methods)
• Prospective Studies
• Pulmonary Embolism (surgery)
• Thrombectomy (adverse effects)
• Treatment Outcome