Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures?

Tassani, Peter; Richter, José A.; Barankay, A; Braun, S; Haehnel, Christoph; Spaeth, Paul; Schad, H.; Meisner, H

doi:10.1016/s1053-0770(99)90081-2

Cited by 97 publications

(50 citation statements)

References 45 publications

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“…Mechanistic studies within the literature also lend credence to the results. Decreased vasodilation and less metabolic derangement (as in the current study) as well as decreased myocardial and pulmonary injury have all been verified [11,18,20,40,45]. The results are also generalizable.…”

Section: Discussionsupporting

confidence: 83%

Pulse Low Dose Steroids Attenuate Post-Cardiopulmonary Bypass SIRS; SIRS I

Whitlock

Young

Noora

et al. 2006

Journal of Surgical Research

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Section: Discussionsupporting

confidence: 83%

Pulse Low Dose Steroids Attenuate Post-Cardiopulmonary Bypass SIRS; SIRS I

Whitlock

Young

Noora

et al. 2006

Journal of Surgical Research

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“…Langer et al 16 also measured IL-6 and IL-10 in 14 patients who underwent a PTE, and they found a similar peak of IL-6 and IL-10 levels immediately following surgery, with a return toward baseline at 24 h. Similar to other studies, we found that methylprednisolone did reduce the rise in the proinfl ammatory cytokines IL-6 and IL-8 and increased the rise in the antiinfl ammatory cytokine IL-10. However, as in other studies, 4,5,7,17 no signifi cant clinical benefi t was associated with the administration of methylprednisolone in PTE surgery. Blunting the rise in proinfl ammatory cytokines IL-6 and IL-8 and increasing the levels of antiinfl ammatory cytokine IL-10 with methylprednisolone does not appear suffi cient to prevent acute lung injury following PTE.…”

Section: Discussionmentioning

confidence: 48%

“…This therapeutic intervention was based on the observation that perioperative corticosteroids can reduce complement activation and the release of infl ammatory cytokines associated with cardiopulmonary bypass (CPB). [4][5][6][7][8] However, the clinical benefi t of this intervention is uncertain. Studies assessing the use of corticosteroids in patients who undergo CPB are limited by a small number of patients or an absence of physiologic or clinical correlates.…”

mentioning

confidence: 99%

Efficacy of Methylprednisolone in Preventing Lung Injury Following Pulmonary Thromboendarterectomy

Kerr

Auger

Marsh

et al. 2012

Chest

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Background:We sought to determine the effi cacy 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 5 47) or methylprednisolone (n 5 51) (30 mg/kg in the cardiopulmonary bypass prime, 500 mg IV bolus following the fi nal 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 defi ned criteria. The secondary end points included ventilator-free, ICU-free, and hospitalfree days and selected levels of cytokines in the blood and in BAL fl uid. Results: The incidence of lung injury was similar in both treatment groups (45% placebo, 41% steroid; P 5 .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 signifi cant reduction in plasma IL-6 and IL-8, a signifi cant increase in plasma IL-10, and a signifi cant reduction in postoperative IL-1ra and IL-6, but not IL-8 in BAL fl uid obtained 1 day after surgery. Conclusions: Perioperative methylprednisolone does not reduce the incidence of lung injury following pulmonary thromboendarterectomy surgery despite having an antiinfl ammatory effect on plasma and lavage cytokine levels.CHEST 2012; 141(1):27-35Abbreviations: CPB 5 cardiopulmonary bypass; mPAP 5 mean pulmonary artery pressure; NYHA 5 New York Heart Association; PTE 5 pulmonary thromboendarterectomy; PVR 5 pulmonary vascular resistance

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“…These cytokine alterations were anticipated, since perioperative steroids in adults are known to alter circulating cytokine levels. 4,8,12,16 The novel observation, however, is that combined steroid treatment reduces inflammatory mediator expression in the heart directly. Furthermore, steroid pretreatment reduces myocardial inflammatory mediator expression before bypass, thus indicating that antiinflammatory effects of preoperative steroid treatment precedes both myocardial ischemia and activation of blood elements by the extracorporeal circuit.…”

Section: Discussionmentioning

confidence: 99%

“…15 In adults, perioperative steroid administration reduces circulating proinflammatory cytokines (eg, TNF-␣, C5a, IL-6, IL-8), 8,12 increases serum antiinflammatory cytokines (eg, IL-10, IL-4), 4,16 and improves myocardial perfusion and function, 10,12,14 but data on intubation time and ICU length of stay are discordant. 9,10,12 The only study of steroid treatment for congenital heart surgery found that children receiving a single dose of dexamethasone 1 hour before bypass had reduced fluid requirements, lower body temperature, shorter intubation time, and lower troponin, IL-6, and TNF-␣ levels. 15 Previous clinical studies have chiefly compared placebo with steroid administration during or immediately preceding bypass.…”

mentioning

confidence: 99%

Combined Steroid Treatment for Congenital Heart Surgery Improves Oxygen Delivery and Reduces Postbypass Inflammatory Mediator Expression

et al. 2003

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Background-Steroid administration during cardiopulmonary bypass is thought to improve cardiopulmonary function by modulating bypass-related inflammation. This study was designed to compare preoperative and intraoperative methylprednisolone (MP) to intraoperative MP alone with respect to postbypass inflammation and clinical outcome. Methods and Results-Twenty-nine pediatric patients undergoing bypass procedures were randomly assigned to receive preoperative and intraoperative MP (30 mg/kg 4 hours before bypass and in bypass prime, nϭ14) or intraoperative MP only (30 mg/kg, nϭ15). Myocardial inflammatory mediator mRNA expression was determined in paired atrial biopsies (before and after bypass) by ribonuclease protection. Before and after bypass, serum IL-6 and IL-10 were measured by ELISA. Postoperative outcome was assessed by intubation time, CICU length of stay, fluid balance, arterio-venous O 2 difference (⌬AϪVO 2 ), and inotrope requirements. Compared with intraoperative MP alone, combined preoperative and intraoperative MP was associated with reduced myocardial mRNA expression for IL-6, MCP-1, and ICAM-1 both before and after bypass (PϽ0.05). Patients who received combined steroids had lower serum IL-6 and increased IL-10 at end-bypass (PϽ0.05), although differences were negligible by 24 hours. Combined MP treatment was associated with reduced fluid requirements, lower body temperature, and lower ⌬AϪVO 2 for the first 24 hours after surgery (PϽ0.05), along with trends toward improvement in other clinical outcomes. Conclusions-Compared with intraoperative steroid treatment, combined preoperative and intraoperative steroid administration attenuates inflammatory mediator expression more effectively and is associated with improved indexes of O 2 delivery in the first 24 hours after congenital heart surgery. These findings need to be confirmed in a larger multicenter trial. (Circulation. 2003;107:2823-2828.)

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Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures?

Cited by 97 publications

References 45 publications

Pulse Low Dose Steroids Attenuate Post-Cardiopulmonary Bypass SIRS; SIRS I

Pulse Low Dose Steroids Attenuate Post-Cardiopulmonary Bypass SIRS; SIRS I

Efficacy of Methylprednisolone in Preventing Lung Injury Following Pulmonary Thromboendarterectomy

Combined Steroid Treatment for Congenital Heart Surgery Improves Oxygen Delivery and Reduces Postbypass Inflammatory Mediator Expression

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