Efficacy of methylprednisolone in preventing lung injury following pulmonary thromboendarterectomy

Chest. 2012 Jan;141(1):27-35. doi: 10.1378/chest.10-2639. Epub 2011 Aug 11.


Background: We sought to determine the efficacy and safety of perioperative treatment with methylprednisolone on the development of lung injury after pulmonary thromboendarterectomy.

Methods: This was a randomized, prospective, double-blind, placebo-controlled study of 98 adult patients with chronic thromboembolic pulmonary hypertension who were undergoing pulmonary thromboendarterectomy at a single institution. The patients received either placebo (n = 47) or methylprednisolone (n = 51) (30 mg/kg in the cardiopulmonary bypass prime, 500 mg IV bolus following the final circulatory arrest, and 250 mg IV bolus 36 h after surgery). The primary end point was the presence of lung injury as determined by two independent, blinded physicians using prospectively defined criteria. The secondary end points included ventilator-free, ICU-free, and hospital-free days and selected levels of cytokines in the blood and in BAL fluid.

Results: The incidence of lung injury was similar in both treatment groups (45% placebo, 41% steroid; P = .72). There were no statistical differences in the secondary clinical end points between treatment groups. Treatment with methylprednisolone, compared with placebo, was associated with a statistically significant reduction in plasma IL-6 and IL-8, a significant increase in plasma IL-10, and a significant reduction in postoperative IL-1ra and IL-6, but not IL-8 in BAL fluid obtained 1 day after surgery.

Conclusions: Perioperative methylprednisolone does not reduce the incidence of lung injury following pulmonary thromboendarterectomy surgery despite having an antiinflammatory effect on plasma and lavage cytokine levels.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Bronchoalveolar Lavage Fluid / chemistry
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Endarterectomy / adverse effects*
  • Female
  • Follow-Up Studies
  • Glucocorticoids / administration & dosage
  • Humans
  • Injections, Intravenous
  • Interleukin-10 / metabolism
  • Interleukin-6 / metabolism
  • Interleukin-8 / metabolism
  • Lung Injury / etiology
  • Lung Injury / metabolism
  • Lung Injury / prevention & control*
  • Male
  • Methylprednisolone / administration & dosage*
  • Middle Aged
  • Preoperative Care / methods*
  • Prospective Studies
  • Pulmonary Embolism / surgery*
  • Thrombectomy / adverse effects*
  • Treatment Outcome


  • Glucocorticoids
  • Interleukin-6
  • Interleukin-8
  • Interleukin-10
  • Methylprednisolone