BACKGROUND:Cardiopulmonary bypass (CPB) initiates inflammation that contributes to multiorgan dysfunction (SIRS). Steroids have been demonstrated to attenuate this response; however, resistance to use steroids remains because of potential adverse effects of the high doses used. This study examines a lower dose steroid protocol for safety and attenuation of SIRS. METHODS:Sixty patients undergoing CPB were randomized to pulse low doses of methylprednisolone (250 mg given twice IV) or placebo in this RCT. Outcomes pertaining to hemodynamics, ventilator requirement, arrhythmia, and metabolic derangements were recorded. Post-operative glucose control and gastrointestinal prohylaxis was instituted in all patients. RESULTS:IL-6 concentrations were lower in the steroid group at 4 and 8 h post-operatively (P < 0.0001). The steroid group demonstrated more normothermia (37.2 degrees C versus 37.6 degrees C, P = 0.002), better hemodynamic stability with less requirement for inotropes or vasopressors (0% versus 27.6%, P = 0.005), higher SVRIs (1840 versus 1340 DSm2/cm5, P = 0.002), and higher mean arterial pressures (79 versus 74 mmHg, P = 0.03). The steroid group had a shorter duration of intubation (7.7 versus 10.7 h, P = 0.02), a shorter length of ICU stay (1.0 versus 2.0 days, P = 0.03), and less blood loss (505 versus 690 ml, P = 0.04) with no difference in post-operative blood glucose levels or complications. CONCLUSIONS:Patients undergoingcardiopulmonary bypass receiving low pulse dose steroids had better hemodynamics, shorter mechanical ventilation times, less blood loss, and required less time in the ICU compared to those receiving placebo. Therefore, this study demonstrates that prophylactic low dose steroids attenuate the SIRS response to CPB without resulting in any untoward side-effects.
RCT Entities:
BACKGROUND: Cardiopulmonary bypass (CPB) initiates inflammation that contributes to multiorgan dysfunction (SIRS). Steroids have been demonstrated to attenuate this response; however, resistance to use steroids remains because of potential adverse effects of the high doses used. This study examines a lower dose steroid protocol for safety and attenuation of SIRS. METHODS: Sixty patients undergoing CPB were randomized to pulse low doses of methylprednisolone (250 mg given twice IV) or placebo in this RCT. Outcomes pertaining to hemodynamics, ventilator requirement, arrhythmia, and metabolic derangements were recorded. Post-operative glucose control and gastrointestinal prohylaxis was instituted in all patients. RESULTS:IL-6 concentrations were lower in the steroid group at 4 and 8 h post-operatively (P < 0.0001). The steroid group demonstrated more normothermia (37.2 degrees C versus 37.6 degrees C, P = 0.002), better hemodynamic stability with less requirement for inotropes or vasopressors (0% versus 27.6%, P = 0.005), higher SVRIs (1840 versus 1340 DSm2/cm5, P = 0.002), and higher mean arterial pressures (79 versus 74 mmHg, P = 0.03). The steroid group had a shorter duration of intubation (7.7 versus 10.7 h, P = 0.02), a shorter length of ICU stay (1.0 versus 2.0 days, P = 0.03), and less blood loss (505 versus 690 ml, P = 0.04) with no difference in post-operative blood glucose levels or complications. CONCLUSIONS:Patients undergoing cardiopulmonary bypass receiving low pulse dose steroids had better hemodynamics, shorter mechanical ventilation times, less blood loss, and required less time in the ICU compared to those receiving placebo. Therefore, this study demonstrates that prophylactic low dose steroids attenuate the SIRS response to CPB without resulting in any untoward side-effects.
Authors: Amit X Garg; Matthew T V Chan; Meaghan S Cuerden; P J Devereaux; Seyed Hesameddin Abbasi; Ainslie Hildebrand; François Lamontagne; Andre Lamy; Nicolas Noiseux; Chirag R Parikh; Vlado Perkovic; Mackenzie Quantz; Antoine Rochon; Alistair Royse; Daniel I Sessler; Pallav J Shah; Jessica M Sontrop; Georgios I Tagarakis; Kevin H Teoh; Jessica Vincent; Michael Walsh; Jean-Pierre Yared; Salim Yusuf; Richard P Whitlock Journal: CMAJ Date: 2019-03-04 Impact factor: 8.262
Authors: Benjamin D Carr; Thomas J Johnson; Amalia Gomez-Rexrode; Azmath Mohammed; Megan Coughlin; John M Toomasian; Alvaro Rojas-Pena; Robert H Bartlett; Jonathan W Haft Journal: ASAIO J Date: 2020-01 Impact factor: 3.826
Authors: Ben Gibbison; José Carlos Villalobos Lizardi; Karla Isis Avilés Martínez; Daniel P Fudulu; Miguel Angel Medina Andrade; Giordano Pérez-Gaxiola; Alvin Wl Schadenberg; Serban C Stoica; Stafford L Lightman; Gianni D Angelini; Barnaby C Reeves Journal: Cochrane Database Syst Rev Date: 2020-10-12