Hemofiltration but not steroids results in earlier tracheal extubation following cardiopulmonary bypass: a prospective, randomized double-blind trial.
BACKGROUND
Activation of the inflammatory cascade is thought to account for some of the respiratory dysfunction and prolonged mechanical ventilation associated with cardiopulmonary bypass. The objective of this investigation was to identify whether perioperative steroids or hemofiltration during cardiopulmonary bypass, by their attenuation of inflammation, would reduce duration of mechanical ventilation after cardiac surgery.


METHODS
After Institutional Review Board approval and informed consent, 192 patients scheduled to undergo elective primary coronary artery bypass grafting or valvular replacement or repair were randomized in a double-blind prospective study into three groups. One group (Control) received saline at induction and at 6-h intervals for four doses. Another group (Hemofil) received saline and hemofiltration to obtain 27 ml/kg of hemofiltrate. The final group (Steroid) received 1 g methylprednisolone before anesthesia induction and then 4 mg of dexamethasone at 6-h intervals for four doses. All patients underwent normothermic cardiopulmonary bypass and received propofol for postoperative sedation. Separate two-sample comparisons were performed to compare each experimental group versus the control group using the Wilcoxon rank sum test for continuous variables and Fisher exact test for categorical variables. In all cases, two-tailed P values </= 0.05 were considered statistically significant.


RESULTS
The median time until the patient reached an intermittent mandatory ventilation of 4/min (258.5 versus 385.0 min, respectively; P = 0.02) and tracheal extubation (352.0 versus 518.0 min; P = 0.03) was significantly reduced for group Hemofil but no different for Steroid compared to Control.


CONCLUSIONS
Hemofiltration and steroids are both previously reported to attenuate the inflammatory response but only hemofiltration reduced time to tracheal extubation for adults after cardiopulmonary bypass in this study.
Mayo Medical School, Rochester, Minnesota, USA. oliver.william@mayo.edu
William C
WC
Oliver
Gregory A
GA
Nuttall
Thomas A
TA
Orszulak
William R
WR
Bamlet
Martin D
MD
Abel
Mark H
MH
Ereth
Hartzell V
HV
Schaff
D000368:Aged; D000769:Anesthesia, Inhalation; D001785:Blood Gas Monitoring, Transcutaneous; D001794:Blood Pressure; D001831:Body Temperature; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D015926:Complement C3a / Q000032:analysis / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006440:Hemofiltration; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000502:physiology; D012121:Respiration, Artificial; D013256:Steroids / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning
D013256:Steroids; D015926:Complement C3a