Minor Infection Encouraged by Steroid Administration during Cardiac Surgery

Abstract

The aim of this study was to investigate whether steroid administration would increase the risk of postoperative infection. Sixty adults who underwent elective cardiac surgery under cardiopulmonary bypass were prospectively randomized into two groups. Thirty-one patients received hydrocortisone (50 mg x kg(-1)) before and after cardiopulmonary bypass, the other 29 served as controls. Various hemodynamic and pulmonary measurements were obtained perioperatively, and the white blood cell counts and levels of C-reactive protein were checked up to the 14(th) postoperative day. Steroid administration did not have any favorable effects during the perioperative period. Re-administration of antibiotics was needed in 7 patients (22.6%) after the 7(th) postoperative day in the steroid group, and in 3 (10.3%) in the control group. The peak white cell counts and C-reactive protein levels after the 7(th) postoperative day were significantly higher in the steroid group. Steroid administration offered no clinical benefit to patients undergoing cardiac surgery with cardiopulmonary bypass, and it may encourage minor infections in the late postoperative period.

The Efficacy of Glucocorticoids for the Prevention of Atrial Fibrillation, or Length of Intensive Care Unite or Hospital Stay After Cardiac Surgery: A Meta‐Analysis

“…A total of 42 randomized controlled trails involving 7621 participants were identified and included in the meta‐analysis (Figure ) . All studies were published in English.…”

Steroids in cardiac surgery: a systematic review and meta-analysis

“…Two large recent RCTs contributed the majority of the included participants (74.9%) (SIRSe7507 patients and DECSe4494 patients). 6,7 Thirtyfive trials focused on patients undergoing isolated CABG, 14,16,19,20,22,24e26,28,31e33,35e36,39e40,42e44,46e49,51e54,57e62,64,67 three on patients requiring isolated valve repair or replacement, 15,42,43 eight on patients undergoing either or both interventions, 21,23,29,30,34,55,65,66 one on patients undergoing pulmonary thromboendarterectomy only, 51 and nine included all CPB patients. 6,7,17,18,37,41,50,56,63 There were variations between trials in terms of treatment protocols and follow-up duration.…”

“…The effect of steroids on incidence of new onset atrial fibrillation did not differ based on steroid type (interaction P¼0.16) (Supplementary Material I); however, steroid dose (interaction P¼0.01) and surgery type (interaction P¼0.003) impacted the treatment effect. Trials of low dose steroids (13 studies, 13 248 patients) were associated with a smaller clinical benefit RR¼0.92; 95% CI, 0.87e0.98 whereas trials of high dose steroids (nine studies, 700 patients) were associated with a greater clinical benefit RR¼0.70; 95% CI, 0.57e0.87 33 68 CABG Methylprednisolone Biochemical Double-blind 5 High Rumalla and colleagues 48 13 CABG Methylprednisolone Biochemical Open label 1 Low Sano and colleagues 34 60 CABG or valve Hydrocortisone Clinical Open label 1 Low Schurr and colleagues 35 50 CABG Methylprednisolone Biochemical Open label 1 Low Sobieski and colleagues 36 28 CABG Dexamethasone Biochemical Double-blind 2 Low Tassani and colleagues 54 52 CABG Methylprednisolone Biochemical Double-blind 3 High Toft and colleagues 37 16…”

Effects of Dexamethasone on Pulmonary and Renal Functions in Patients Undergoing CABG With Cardiopulmonary Bypass

“…With regard to the side effects of corticosteroid, Sano et al 16 concluded that steroid administration offered no clinical benefit to patients undergoing cardiac surgery with CPB and that it may encourage minor infections in the late postoperative period.…”