PENTOXIFYLLINE DECREASES THE INCIDENCE OF MULTIPLE ORGAN FAILURE IN PATIENTS AFTER MAJOR CARDIOTHORACIC SURGERY

We assessed the safety and efficacy of intravenous pentoxifylline [3,7 -dimethyl-1-(5-oxohexyl)-xanthine] in patients at risk for developing multiple organ failure after major cardio-thoracic surgery in a single -center, randomized, placebo-controlled study. Of 816 consecutive pati ents who underwent major cardio-thoracic surgery, 40 who had Acute Phy siology and Chronic Health Evaluation II score values greater than or equal to 19 at the first postoperative day after the surgery were incl uded. Patients were randomized to receive either placebo (control; n = 25) or intravenous pentoxifylline treatment (pentoxifylline; n = 15) at a dosage of 1.5 mg/kg/h as an adjunct to standard supportive therap y. Main outcome measurements were duration of required ventilator supp ort, intensive care unit stay, and incidence of renal failure. Thirty- seven patients were eligible for evaluation. No significant adverse ev ents related to pentoxifylline treatment were observed. The duration o f mechanical ventilation was significantly greater for control patient s (8.3 +/- 3.1 days) compared with pentoxifylline-treated patients (3. 1 +/- .9 days; p <.05). Patients treated with pentoxifylline experienc ed fewer days on hemofiltration (1.2 +/- .8 vs. 6.8 +/- 3.3; p <.05) a nd a shorter intensive care unit stay (5.2 +/- 1.1 vs. 11.4 +/- 3.1 da ys). There were no intergroup differences in mortality. Mortality was 33% in the pentoxifylline group and 36% among control group patients. In conclusion, supplemental pentoxifylline treatment may decrease the incidence of multiple organ failure in patients at risk of systemic in flammatory response syndrome after cardiac surgery. Additional studies are required to determine the validity of the observed effects.