title: Efficacy of methylprednisolone in preventing lung injury following pulmonary thromboendarterectomy.
abstract: BACKGROUND
  We sought to determine the efficacy 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 = 47) or methylprednisolone (n = 51) (30 mg/kg in the cardiopulmonary bypass prime, 500 mg IV bolus following the final 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 defined criteria. The secondary end points included ventilator-free, ICU-free, and hospital-free days and selected levels of cytokines in the blood and in BAL fluid.
  
  
  RESULTS
  The incidence of lung injury was similar in both treatment groups (45% placebo, 41% steroid; P = .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 significant reduction in plasma IL-6 and IL-8, a significant increase in plasma IL-10, and a significant reduction in postoperative IL-1ra and IL-6, but not IL-8 in BAL fluid obtained 1 day after surgery.
  
  
  CONCLUSIONS
  Perioperative methylprednisolone does not reduce the incidence of lung injury following pulmonary thromboendarterectomy surgery despite having an antiinflammatory effect on plasma and lavage cytokine levels.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA. Electronic address: kmkerr@ucsd.edu.
authors.forename: Kim M
authors.initials: KM
authors.lastname: Kerr
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA.
authors.forename: William R
authors.initials: WR
authors.lastname: Auger
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA.
authors.forename: James J
authors.initials: JJ
authors.lastname: Marsh
authors.affiliation: Kaiser Permanente, Sacramento, CA.
authors.forename: Gehan
authors.initials: G
authors.lastname: Devendra
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Spragg
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA.
authors.forename: Nick H
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Channick
authors.affiliation: Division of Cardiothoracic Surgery, University of California, San Diego, CA.
authors.forename: Stuart W
authors.initials: SW
authors.lastname: Jamieson
authors.affiliation: Division of Cardiothoracic Surgery, University of California, San Diego, CA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Madani
authors.affiliation: Department of Anesthesiology, University of California, San Diego, CA.
authors.forename: Gerard R
authors.initials: GR
authors.lastname: Manecke
authors.affiliation: Department of Anesthesiology, University of California, San Diego, CA.
authors.forename: David M
authors.initials: DM
authors.lastname: Roth
authors.affiliation: General Clinical Research Center, University of California, San Diego, CA.
authors.forename: Gordon P
authors.initials: GP
authors.lastname: Shragg
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of California, San Diego, CA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Fedullo
mesh_terms: D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004691:Endarterectomy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D016753:Interleukin-10 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D055370:Lung Injury / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D015850:Interleukin-6; D016209:Interleukin-8; D016753:Interleukin-10; D008775:Methylprednisolone