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Original Research: PULMONARY VASCULAR DISEASE |

Efficacy of Methylprednisolone in Preventing Lung Injury Following Pulmonary ThromboendarterectomyCorticosteroids and Postoperative Lung Injury

Kim M. Kerr, MD, FCCP; William R. Auger, MD; James J. Marsh, PhD; Gehan Devendra, MD; Roger G. Spragg, MD; Nick H. Kim, MD; Richard N. Channick, MD, FCCP; Stuart W. Jamieson, MB; Michael M. Madani, MD; Gerard R. Manecke, MD; David M. Roth, MD, PhD; Gordon P. Shragg, MA; Peter F. Fedullo, MD, FCCP
Author and Funding Information

From theDivision of Pulmonary and Critical Care Medicine (Drs Kerr, Auger, Marsh, Spragg, Kim, and Fedullo), the Division of Cardiothoracic Surgery (Drs Jamieson and Madani), the Department of Anesthesiology (Drs Manecke and Roth), and the General Clinical Research Center (Mr Shragg), University of California, San Diego, CA; Kaiser Permanente (Dr Devendra), Sacramento, CA; and Massachusetts General Hospital (Dr Channick), Boston, MA.

Correspondence to: Kim M. Kerr, MD, FCCP, Pulmonary and Critical Care Medicine Division, Univeristy of California San Diego Medical Center, 9300 Campus Point Dr, M/C 7381, La Jolla, CA 92037; e-mail: kmkerr@ucsd.edu


Funding/Support: This study was supported by the National Institutes of Health [Grants NHLBI HL23584 and MO1-RR0827 from the National Center for Research Resources for the University of California, San Diego, General Clinical Research Center].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(1):27-35. doi:10.1378/chest.10-2639
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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.

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