Ineffectiveness of methylprednisolone in the treatment of pulmonary dysfunction after cardiopulmonary bypass.

ABSTRACT

Fifty consecutive adults undergoing elective cardiac surgery with cardiopulmonary bypass received a single dose of methylprednisolone (30 mg/kg) at the time of anesthesia. The results were compared with those in the immediately preceding fifty adult patients who underwent elective cardiac surgery and who did not receive corticosteroids. The age, sex, and weight of the patient, mortality, nature of the lesions treated surgically, bypass time, smoking history, physiologic evidence of preexisting lung disease, preoperative New York Heart Association class, preoperative left ventricular end diastolic pressure, incidence and duration of the postoperative low cardiac output syndrome, postoperative arrhythmias, operative and postoperative blood loss and postoperative hours of respiratory support, dynamic lung-thorax compliance, alveolar arterial oxygen gradient, fraction of wasted ventilation, and incidence of tracheostomy were tabulated and statistically contrasted. The two groups were comparable relative to all preoperative factors, except for a slightly higher end diastolic pressure in the patients who received steroids. Methylprednisolone given at the time of anesthesia was associated with a higher intraoperative blood loss, a higher incidence of low cardiac output syndrome, and an increased requirement for postoperative mechanical ventilation. As bypass time approached three hours, the proportion of patients requiring prolonged support in both groups became similar. It was concluded that pretreatment with methylprednisolone in massive doses had an overall adverse cardiopulmonary effect.