Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures?
OBJECTIVE
To discover the possible effects of methylprednisolone on the systemic inflammatory response during aprotinin treatment.


METHODS
Randomized, double-blinded study.


METHODS
University-affiliated heart center.


METHODS
Fifty-two patients scheduled for elective coronary artery bypass grafting.


METHODS
In the methylprednisolone group (n = 26), 1 g of methylprednisolone was administered 30 minutes before cardiopulmonary bypass (CPB). The 26 control patients received a placebo instead. High-dose aprotinin was administered to all participants.


RESULTS
After CPB, the concentration of the proinflammatory cytokines, interleukin-6 and interleukin-8, was significantly less in the methylprednisolone group. The anti-inflammatory interleukin-10 concentration was, in contrast, greater. After CPB, PaO2 was greater in the methylprednisolone group (245+/-17 v 195+/-16 mmHg). Dynamic pulmonary compliance was also greater, whereas the alveolar-arterial oxygen difference was less (376+/-17 v 428+/-16 mmHg). On arrival in the intensive care unit, the oxygen delivery index was greater in the methylprednisolone group (62+/-2.7 v 54+/-2.3 mL/min/m2) and the oxygen extraction rate was less (25%+/-0.02% v 30%+/-0.02%). After CPB, the cardiac index was significantly greater in the methylprednisolone group (4.1+/-0.2 v 3.6+/-0.2 L/min/m2). These patients had less blood loss postoperatively (616+/-52 v 833+/-71 mL; p = 0.017) and a greater urine output (8,015+/-542 v 6,417+/-423 mL/24 h; p = 0.024).


CONCLUSIONS
The use of methylprednisolone attenuates the systemic inflammatory response during aprotinin treatment and improves clinical outcome parameters.
Tassani
P
P
Institute of Anesthesiology, Department of Cardiac Surgery, German Heart Center Munich at the Technical University, München.
Richter
J A
JA
Barankay
A
A
Braun
S L
SL
Haehnel
C
C
Spaeth
P
P
Schad
H
H
Meisner
H
H
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007611:Aprotinin / Q000008:administration & dosage / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D002302:Cardiac Output / Q000187:drug effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis; D016753:Interleukin-10 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D008170:Lung Compliance / Q000187:drug effects; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000187:drug effects; D010919:Placebos; D011292:Premedication; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D018746:Systemic Inflammatory Response Syndrome / Q000517:prevention & control*; D016896:Treatment Outcome; D014556:Urine
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D006490:Hemostatics; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D010919:Placebos; D016753:Interleukin-10; D007611:Aprotinin; D010100:Oxygen; D008775:Methylprednisolone