Does high-dose methylprednisolone in aprotinin-treated patients attenuate the systemic inflammatory response during coronary artery bypass grafting procedures?

Abstract

Objective: To discover the possible effects of methylprednisolone on the systemic inflammatory response during aprotinin treatment. Design: Randomized, double-blinded study. Setting: University-affiliated heart center. Participants: Fifty-two patients scheduled for elective coronary artery bypass grafting. Interventions: 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. Measurements and Main 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, PaO 2 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/m 2) 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/m 2). 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). Conclusion: The use of methylprednisolone attenuates the systemic inflammatory response during aprotinin treatment and improves clinical outcome parameters.