Methylprednisolone does not benefit patients undergoing coronary artery bypass grafting and early tracheal extubation

Objective: We sought to determine whether methylprednisolone, when administ ered to patients undergoing cardiac surgery, is able to ward off the detrim ental hemodynamic and pulmonary alterations associated with cardiopulmonary bypass. Methods: After institutional review board approval and informed consent was obtained, 90 patients scheduled for elective cardiac surgery were randomiz ed to 1 of 3 groups. Group 30MP patients received 30 mg/kg intravenous meth ylprednisolone during sternotomy and 30 mg/kg during initiation of cardiopu lmonary bypass, group 15MP patients received 15 mg/kg methylprednisolone at the same 2 times, and group NS patients received similar volumes of isoton ic sodium chloride solution at the same 2 times. Perioperative care was sta ndardized, and all caregivers were blinded to treatment group. Various hemo dynamic and pulmonary measurements were obtained perioperatively, as well a s fluid balance, weight, peak postoperative blood glucose level, and trache al extubation time. Results: Demographic and clinical characteristics of patients and intraoper ative data were similar among the 3 groups. Patients receiving methylpredni solone (either dose) exhibited significantly increased cardiac index (P = . 0006), significantly decreased systemic vascular resistance (P = .0005), an d significantly increased shunt flow (P = .0020) during the immediate posto perative period. All 3 groups exhibited significant increases in alveolar-a rterial oxygen gradient (P < .0001), significant decreases in dynamic lung compliance (P < .0001), and significant decreases in static lung compliance (P < .0001) during the immediate postoperative period, with no differences between groups. Perioperative fluid balance and weights were similar betwe en groups. A statistically significant difference in peak postoperative blo od glucose level existed (P = .016) among group NS (234 <plus/minus> 96 mg/ dL), group 15MP (292 +/- 93 mg/dL), and group 30MP (311 +/- 90 mg/dL). In p atients extubated within 12 hours of intensive care unit arrival, a statist ically significant difference in extubation times existed (P = .025) betwee n group NS (5.7 +/- 2.3 hours), group 15MP (5.9 +/- 2.2 hours), and group 3 0MP (7.5 +/- 2.7 hours). Conclusions: Methylprednisolone, as used in this investigation, offers no c linical benefits to patients undergoing elective coronary artery bypass gra fting with cardiopulmonary bypass and may in fact be detrimental by initiat ing postoperative hyperglycemia and possibly hindering early postoperative tracheal extubation for undetermined reasons.