EFFECT OF METHYLPREDNISOLONE ON THE OXIDATIVE BURST ACTIVITY, ADHESION MOLECULES AND CLINICAL OUTCOME FOLLOWING OPEN-HEART-SURGERY

Following cardiac surgery with cardiopulmonary bypass (CPB), activated granulocytes may be involved with ischaemia/reperfusion injury. The p urpose of this study was to investigate whether steroids could reduce the oxidative burst activity of granulocytes, the expression of adhesi on molecules on granulocytes and improve clinical outcome. Sixteen pat ients undergoing open heart surgery participated in the study. Eight w ere randomized to receive methylprednisolone (30 mg/kg intravenously) at the start of anaesthesia while eight patients served as a control g roup. The oxidative burst was measured flow cytometrically using 123-d ihydrorhodamine. A panel of adhesion molecules was measured using mono clonal antibodies. Following CPB the oxidative burst activity and the expression of the adhesion molecule L-selectin more than doubled compa red to initial values. There was no difference between the steroid gro up and the control group regarding the expression of adhesion molecule s or the oxidative burst activity. In the steroid group the fluid gain during extracorporeal circulation (ECC) was 683 mi (median) compared to 1488 mi in the control group. Steroids prevented hyperthermia in th e postoperative period but did not improve the weaning from the ventil ator or reduce the stay in the intensive-care unit. In conclusion, tre atment with steroids prevented hyperthermia following open heart surge ry with CPB and reduced capillary leak during ECC. Methylprednisolone, however, did not reduce the oxidative burst activity or the expressio n of adhesion molecules on granulocytes following CPB.