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Intraoperative solumedrol helps prevent postpneumonectomy pulmonary edema
Robert J Cerfolio1, Ayesha S Bryant, John S Thurber
1Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. robert.cerfolio@ccc.uab.edu
The Annals of Thoracic Surgery
|October 8, 2003
Summary
Intraoperative steroids significantly reduced postpneumonectomy pulmonary edema and major complications. This prophylactic measure also shortened hospital stays and prevented bronchopleural fistulas in pneumonectomy patients.
Area of Science:
- Thoracic Surgery
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Postpneumonectomy pulmonary edema and pneumonia are severe, often unavoidable complications.
- A prophylactic intraoperative dose of intravenous steroids was investigated to mitigate pulmonary injury.
Purpose of the Study:
- To evaluate the efficacy of intraoperative methylprednisolone sodium succinate in preventing postpneumonectomy pulmonary edema and other complications.
Main Methods:
- A prospective study of 72 pneumonectomy patients, divided into steroid (S group, n=35) and non-steroid (non-S group, n=37) groups.
- The S group received 250 mg of methylprednisolone sodium succinate before pulmonary artery ligation.
- Groups were matched for preoperative, intraoperative, and postoperative risk factors.
Main Results:
- The incidence of postpneumonectomy pulmonary edema/ARDS was 0% in the S group versus 13.5% in the non-S group (p=0.049).
- Major complication rates were lower in the S group (20% vs. 43%, p=0.04), with a significantly shorter hospital stay (6.1 vs. 11.9 days, p=0.02).
- No bronchopleural fistulas occurred in the S group, compared to two in the non-S group.
Conclusions:
- Intraoperative methylprednisolone sodium succinate may reduce postpneumonectomy pulmonary edema, ARDS, and other major complications.
- Steroid administration appears to shorten hospital stays without increasing bronchopleural fistula incidence.
- Further randomized trials are recommended to confirm these findings.