Methylprednisolone does not benefit patients undergoing coronary artery bypass grafting and early tracheal extubation

Chaney, Mark A.; Durazo‐Arvizu, Ramón; Nikolov, Mihail P.; Blakeman, Bradford; Bakhos, Mamdouh

doi:10.1067/mtc.2001.112343

Cited by 86 publications

(43 citation statements)

References 32 publications

(45 reference statements)

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“…Moreover, two recent clinical investigations of steroid administration in adults demonstrated no benefit or even an adverse outcome after steroid administration [4,9,24]. However, in children, Schroeder et al [23] demonstrated improved oxygen delivery in the first 24 hours after congenital heart surgery with combined pre-and intraoperative steroid administration, but no significant difference was shown between the length of mechanical ventilation and the inotropic support.…”

Section: Discussionmentioning

confidence: 99%

Administration of Steroids in Pediatric Cardiac Surgery: Impact on Clinical Outcome and Systemic Inflammatory Response

Gessler¹,

Hohl²,

Carrel

et al. 2005

Pediatr Cardiol

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Abstract. Cardiopulmonary bypass (CPB) is associated with a systemic inflammatory response. Pre-bypass steroid administration may modulate the inflammatory response, resulting in improved postoperative recovery. We performed a prospective study in the departments of cardiovascular surgery and pediatric intensive care medicine of two university hospitals that included 50 infants who underwent heart surgery. Patients received either prednisolone (30 mg/ kg) added to the priming solution of the cardiopulmonary bypass circuit (steroid group) or no steroids (nonsteroid group). Clinical outcome parameters include therapy with inotropic drugs, oxygenation, blood lactate, glucose, and creatinine, and laboratory parameters of inflammation include leukocytes, C-reactive protein, and interleukin-8. Postoperative recovery (e.g., the number, dosage, and duration of inotropic drugs as well as oxygenation) was similar in patients treated with or without steroids when corrected for the type of cardiac surgery performed. After CPB, there was an inflammatory reaction, especially in patients with a long CPB time. Postoperative plasma levels of interleukin-8 were correlated with the duration of CPB time (r = 0.62, p < 0.001). Administration of steroids had no significant impact on the laboratory parameters of inflammation. Administration of prednisolone into the priming solution of the CPB circuit had no measurable influence on postoperative recovery and did not suppress the inflammatory response.

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Section: Discussionmentioning

confidence: 99%

Administration of Steroids in Pediatric Cardiac Surgery: Impact on Clinical Outcome and Systemic Inflammatory Response

Gessler¹,

Hohl²,

Carrel

et al. 2005

Pediatr Cardiol

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“…In patients who are undergoing cardiac surgery, acute administration of methylprednisolone reduces postoperative interleukin-6 secretion but offers no clinical benefits. [18][19][20] However, in the peripheral vasculature, normalization of elevated hsCRP concentrations over time is associated with a normalization of endothelium-mediated flow after 3 months in patients with coronary artery disease. 45 Thus, in the present study dxinduced anti-inflammatory period for 2 days might be too short to improve coronary vascular resistance in obese subjects.…”

Section: Discussionmentioning

confidence: 99%

“…15 Furthermore, reduced coronary vasoreactivity can be improved by medical interventions. 16,17 Clucocorticoids suppress secretion of inflammatory cytokines [18][19][20] and some animal studies have demonstrated beneficial effects of glucocorticoids during myocardial ischemia. 21,22 Still, clucocorticoids appear not to benefit patients undergoing coronary artery bypass grafting.…”

Section: Introductionmentioning

confidence: 99%

“…21,22 Still, clucocorticoids appear not to benefit patients undergoing coronary artery bypass grafting. 19 However, since clucocorticoids have been found to increase shunt flow, 19 these antiinflammatory agents might have acute cardiovascular effects. In the present PET study, we examined the short-term anti-inflammatory effect of dexamethasone (dx) on hsCRP concentrations and coronary vascular resistance values in obese subjects.…”

Section: Introductionmentioning

confidence: 99%

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Short-term changes in inflammatory response protein (hsCRP) do not parallel with changes in coronary vasoreactivity in obese men

et al. 2005

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Aim: Obese subjects are characterized by increased high-sensitivity C-reactive protein (hsCRP) and coronary vascular resistance. Clucocorticoids suppress inflammation, a possible cardioprotective effect. We tested the short-term anti-inflammatory effect of dexamethasone (dx) on these parameters in obese subjects. Methods: Coronary vascular resistance was quantitated basally and during adenosine infusion with or without simultaneous euglycemic hyperinsulinemic clamp (insulin infusion rate of 1 mU/kg/min) in 11 obese and 19 age-matched nonobese males using positron emission tomography and 15 O-water. Each subject was studied both with and without previous dx treatment for 2 days (2 mg/day). Results: Before dx treatment, hsCRP concentration was significantly higher in obese than in nonobese subjects (1.5571.73 vs 0.3270.32 mg/l, P ¼ 0.005). In addition, coronary vascular resistances were higher (Po0.05) in obese than in nonobese subjects at baseline (139736 vs 117722) and during adenosine infusion without (3277 vs 2677) or with simultaneous clamp (2678 vs 2175 mmHg min g/ ml). Dx treatment decreased significantly hsCRP concentration in obese but not in nonobese subjects, leading to similar hsCRP concentrations between the groups (0.4570.43 vs 0.2670.42 mg/l, respectively, P ¼ 0.3). Dx had no effect on coronary vascular resistances (NS). Conclusions: Obese subjects are characterized by high hsCRP, which can be normalized by dx. However, despite this, coronary vascular resistances did not decrease in obese subjects. Short-term changes in inflammatory response protein appear not to parallel with changes in coronary vasoreactivity in obese men.

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“…System inflammatory response syndrome (SIRS) is the main cause of pulmonary dysfunction after CPB [2]. Although many strategies to attenuate SIRS have been developed [3], it has not been completely prevented and remains a significant contributor to pulmonary dysfunction after surgery [2,4,5].SIRS is mainly caused by the contact of blood with the non-endothelialised surface of CPB circuits activating multiple plasma protein cascades and blood cells, resulting in increased production of inflammatory mediators and activation of vascular endothelium [3,4]. Activated polymorphonucleocytes (PMNs) sequestered in the lung in response to chemotactic factor interleukin-8 (IL-8) may result in widespread pulmonary inflammatory response and injury through the release of harmful oxygen free radicals and specific enzymes [6,7].…”

mentioning

confidence: 99%

Effects of propofol on pulmonary inflammatory response and dysfunction induced by cardiopulmonary bypass*

An¹,

Shu²,

Huang

et al. 2008

Anaesthesia

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SummaryThe pulmonary inflammatory response and pulmonary dysfunction after cardiopulmonary bypass is a major problem in patients undergoing cardiac surgery. Propofol has anti-inflammatory and immunomodulatory properties which may attenuate this response. Thirty patients undergoing cardiopulmonary bypass were randomly assigned to receive saline (control group) or propofol (propofol group). Pulmonary thoracic compliance, respiratory index, malondialdehyde and interleukin-8 concentrations and intrapulmonary polymorphonucleocyte sequestration were measured at pre-bypass and 5, 30, 60, 90 and 120 min after unclamping the aorta. Plasma levels of interleukin-8, malondialdehyde and the respiratory index increased and reached peaks 30 min after unclamping in both groups. However, in the propofol group the increases were less than in the control group (p < 0.01). Intrapulmonary polymorphonucleocytes sequestration in the propofol group was less than in the control group 5 min after unclamping (p < 0.0001). Pulmonary thoracic compliance decreased significantly after unclamping in both groups, but the reduction was less in the propofol group (p < 0.01). These findings suggest that propofol administered during bypass could reduce the severity of pulmonary dysfunction. Pulmonary dysfunction is common after cardiopulmonary bypass (CPB). The clinical manifestations range from subclinical functional changes to full-blown adult respiratory distress syndrome (ARDS) seen in 2% of cases and which carries a 50% mortality rate [1]. System inflammatory response syndrome (SIRS) is the main cause of pulmonary dysfunction after CPB [2]. Although many strategies to attenuate SIRS have been developed [3], it has not been completely prevented and remains a significant contributor to pulmonary dysfunction after surgery [2,4,5].SIRS is mainly caused by the contact of blood with the non-endothelialised surface of CPB circuits activating multiple plasma protein cascades and blood cells, resulting in increased production of inflammatory mediators and activation of vascular endothelium [3,4]. Activated polymorphonucleocytes (PMNs) sequestered in the lung in response to chemotactic factor interleukin-8 (IL-8) may result in widespread pulmonary inflammatory response and injury through the release of harmful oxygen free radicals and specific enzymes [6,7]. Thus, inhibition of IL-8 release and PMNs sequestration in the lung is a key strategy to control the pulmonary inflammatory response.Propofol is structurally similar to endogenous antioxidant a-tocoferol (vitamin E) and possesses multiple anti-inflammatory [8][9][10] and immunomodulatory properties [11]. Experimental evidence suggests that propofol is a valuable pharmacological tool to treat pulmonary dysfunction related to CPB [12]. However, these studies are in vitro and may not be relevant to the clinical scenario. Hence, we undertook a prospective,

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Methylprednisolone does not benefit patients undergoing coronary artery bypass grafting and early tracheal extubation

Cited by 86 publications

References 32 publications

Administration of Steroids in Pediatric Cardiac Surgery: Impact on Clinical Outcome and Systemic Inflammatory Response

Administration of Steroids in Pediatric Cardiac Surgery: Impact on Clinical Outcome and Systemic Inflammatory Response

Short-term changes in inflammatory response protein (hsCRP) do not parallel with changes in coronary vasoreactivity in obese men

Effects of propofol on pulmonary inflammatory response and dysfunction induced by cardiopulmonary bypass*

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