NEW YORK (Reuters Health) – Despite having a favorable effect on cytokine levels, perioperative methylprednisolone does not reduce the incidence of lung injury after pulmonary thromboendarterectomy (PTE), according to a report in the August 11th online issue of Chest.

“This is a small study, but it suggests that there is no role for corticosteroids in the prevention of acute lung injury in patients at risk for developing lung injury,” Dr. Kim Kerr from University of California San Diego, California told Reuters Health by email. “However, the study was not designed to assess the effects of corticosteroids on other organ function (such as the brain or kidneys) in this patient population.”

Based on earlier observations that perioperative corticosteroids could reduce complement activation and the release of inflammatory cytokines associated with cardiopulmonary bypass, Dr. Kerr and colleagues sought to determine whether perioperative methylprednisolone would reduce the incidence and/or severity of lung injury following PTE in 98 evaluable patients.

The incidence of lung injury did not differ significantly between the methylprednisolone group (41%) and the placebo group (45%)(p=0.727). Moreover, there were no significant differences between the groups in ventilator-free days, ICU-free days, hospital-free days, hypoxemia severity, and lung injury scores.

Adverse events were similar in the treatment groups, with 2 deaths in the methylprednisolone group and 3 deaths in the placebo group.

Compared with placebo, methylprednisolone mitigated the rise in proinflammatory cytokines IL-6 and IL-8 and enhanced the rise in the anti-inflammatory cytokine IL-10.

“This study suggests that while corticosteroids suppress inflammatory cytokine levels, they do not prevent the development of acute lung injury,” Dr. Kerr concluded.

There were 2 other notable findings unrelated to methylprednisolone treatment. There was an unexpected lack of difference in postoperative bronchoalveolar lavage results between those with and without lung injury. “However, 7 of the patients with the most severe form of lung injury were not included in the analysis because they were too ill to undergo bronchoscopy – this may have affected results as well,” Dr. Kerr noted.

“Another notable finding of this study,” the researchers write, “is the statistical association between the severity of preoperative pulmonary hypertension…and degree of residual postoperative pulmonary hypertension…with the development of postoperative lung injury, suggesting that hemodynamic and/or mechanical factors may play a role in the development of lung injury following pulmonary thromboendarterectomy.”

Lung injury is a common complication of PTE, the authors note, but treatment currently is limited to supportive measures.

Reference:
Efficacy of Methylprednisolone in Preventing Lung Injury Following Pulmonary Thromboendarterectomy

Chest 11 August 2011.