PULMONARY EFFECTS OF METHYLPREDNISOLONE IN PATIENTS UNDERGOING CORONARY-ARTERY BYPASS-GRAFTING AND EARLY TRACHEAL EXTUBATION

Numerous clinical studies suggest that methylprednisolone may facilita te early tracheal extubation after cardiac surgery, yet no investigati on has rigorously examined the use of the drug in this setting. In thi s prospective, randomized, double-blind, placebo-controlled study, we examined the pulmonary effects of methylprednisolone in patients under going coronary artery bypass grafting (CABG) and early tracheal extuba tion. Sixty patients undergoing elective CABG and early tracheal extub ation were randomized into two groups. Group MP patients received TV m ethylprednisolone (30 mg/kg during sternotomy and 30 mg/kg during init iation of cardiopulmonary bypass) and Group NS patients received IV pl acebo at the same two times. Perioperative management was standardized . Alveolar-arterial (A-a) oxygen gradient, lung compliance, shunt, and dead space were determined four times perioperatively. Postoperative tracheal extubation was accomplished at the earliest appropriate time. Both groups exhibited significant postoperative increases in A-a oxyg en gradient and shunt (P < 0.000001 for each group) and significant po stoperative decreases in dynamic lung compliance (P < 0.000001 for eac h group). Patients in Group MP exhibited significantly larger increase s in postoperative A-a oxygen gradient (P = 0.001) and shunt (P = 0.00 1) compared with patients in Group NS. Postoperative alterations in dy namic lung compliance, static lung compliance, and dead space were not statistically significant between the groups. The time to postoperati ve tracheal extubation was prolonged in Group MP patients compared wit h Group NS patients (769 +/- 294 vs 604 +/- 315 min, respectively; P = 0.05). Methylprednisolone was associated with larger increases in pos toperative A-a oxygen gradient and shunt, was unable to prevent postop erative decreases in lung compliance, and prolonged extubation time, w hich indicate that use of the drug may hinder early tracheal extubatio n in patients after cardiac surgery. Implications: Traditionally, meth ylprednisolone has been administered to patients undergoing cardiac su rgery to decrease postoperative pulmonary dysfunction. This study reve aled that the drug is associated with larger increases in postoperativ e alveolar-arterial oxygen gradient and shunt and prolonged tracheal e xtubation time in patients undergoing coronary artery bypass grafting, which indicate that use of the drug may hinder early tracheal extubat ion.