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Metilprednisolona en pacientes sometidos a bypass cardiopulmonar (SIRS): ensayo aleatorizado, doble ciego y

Richard P Whitlock¹, P J Devereaux², Kevin H Teoh³

¹Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.

Lancet (London, England)

|October 14, 2015

Resumen

La metilprednisolona no redujo significativamente la mortalidad a los 30 días ni la morbilidad mayor en pacientes de alto riesgo sometidos a bypass cardiopulmonar. El ensayo Steroids In Cardiac Surgery (SIRS) concluyó que el uso rutinario no está respaldado.

Área de la Ciencia:

Cardiología
Farmacología
Medicina de cuidados intensivos

Sus antecedentes:

El bypass cardiopulmonar desencadena una respuesta inflamatoria sistémica, aumentando la morbilidad y la mortalidad postoperatorias.
Los esteroides pueden mitigar estos efectos inflamatorios en pacientes quirúrgicos de alto riesgo.

Objetivo del estudio:

Evaluar la eficacia de la metilprednisolona en la reducción de la mortalidad y la morbilidad mayor en pacientes de alto riesgo sometidos a bypass cardiopulmonar.

Principales métodos:

Un ensayo controlado aleatorizado doble ciego en el que participaron 7507 pacientes en 80 centros.
Los pacientes recibieron metilprednisolona o placebo durante la cirugía cardíaca con derivación cardiopulmonar.
Los resultados primarios incluyeron la mortalidad a los 30 días y un compuesto de muerte o morbilidad mayor.

Principales resultados:

La metilprednisolona no disminuyó significativamente la mortalidad a los 30 días (4% frente a 5%) ni el resultado compuesto de muerte/ morbilidad mayor (24% frente a 24%).
No se observaron diferencias significativas en los riesgos de lesión miocárdica, accidente cerebrovascular, insuficiencia renal o respiratoria.
Los resultados de seguridad comunes incluyeron infección y delirio en ambos grupos.

Conclusiones:

La metilprednisolona no mostró ningún beneficio significativo en la reducción de la mortalidad o la morbilidad mayor después del bypass cardiopulmonar.
El ensayo de esteroides en cirugía cardíaca (SIRS) no apoya la administración rutinaria de metilprednisolona en estos pacientes.

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