Treatment of postoperative lung injury in patients with SIRS by methylprednisolone

Introduction

Intraperitoneal hyperthermic perfusion (IPHP) is performed clinically as one treatment for cancer patients with advanced gastrointestinal cancer. All patients are fallen the systemic inflammatory response syndrome (SIRS) by IPHP. In our previous work, we clarified the elevated TNF-α in the serum of IPHP patients [1]. Glucocorticoids are well known inhibitors of TNF-α [2]. We examined serum TNF-α levels before and after administration of methylprednisolone (MPS) and compaired the lung injury score in postoperative days between the group of MPS and control.

Methods

Seventeen patients with gastrointestinal cancer were undergone surgery combined with IPHP. Group 1 (10 patients): MPS was not adminstrated. Group 2 (7 patients): MPS was administered before and during IPHP. We measured serum TNF-α levels and evaluate the metabolism, hematorogy, hemodynamics and the post-operative lung injury.

Results

In group 1, serum TNF-α levels was increased to 46.0 ± 25.7 pg/ml (mean ± SD) at the end of IPHP and patients were SIRS with the postoperative lung injury. In group 2, TNF-α was not detected but postoperative lung injury were improved.

Conclusion

MPS inhibited the production of TNF-α which was able to improve postoperative lung injury. Pre-emptive MPS might be one of strategy for treatment of lung injury during SIRS.