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.

Figure 1.

Chart shows the flow of the study. PTE = pulmonary thromboendarterectomy.

Figure 2.

BAL cytokine levels in patients treated with methylprednisolone (gray bars) or placebo (white bars). Time points represented are before surgery (1) and 24 h after surgery (2). Median values are shown. Error bars represent the 25th and 75th percentiles. *P < 0.05 compared with placebo.

Figure 3.

Plasma cytokine levels in patients treated with methylprednisolone (gray bars) or placebo (white bars). Time points represented are before surgery (1), 60 min after circulatory arrest (2), 2 h after discontinuation of cardiopulmonary bypass (CPB) (3), 24 h after surgery (4), and 48 h after surgery (5). Median values are shown. Error bars represent the 25th and 75th percentiles. *P < 0.05 compared with placebo.

Figure 4.

BAL cytokine levels in patients who developed lung injury (gray bars) or had no lung injury (white bars). Time points represented are before surgery (1) and 24 h after surgery (2). Median values are shown. Error bars represent the 25th and 75th percentiles.

Figure 5.

Plasma cytokine levels in patients who developed lung injury (gray bars) or had no lung injury (white bars). Time points represented are before surgery (1), 60 min after circulatory arrest (2), 2 h after discontinuation of CPB (3), 24 h after surgery (4), and 48 h after surgery (5). Median values are shown. Error bars represent the 25th and 75th percentiles. *P < 0.05 compared with no injury. See Figure 3 legend for expansion of the abbreviation.