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Volume 5 Supplement 7

3rd International Symposium on the Pathophysiology of Cardiopulmonary Bypass. Myocardial cell damage and myocardial protection

Effects of high-dose methylprednisolone on neonatal pulmonary function after cardiopulmonary bypass and deep hypothermic circulatory arrest

Introduction

Methylprednisolone has been widely used during neonatal cardiac surgery with cardiopulmonary bypass (CPB), in order to limit the inflammatory response and postperfusion syndrome. However, the influence of high-dose methylprednisolone pretreatment on postoperative respiratory function and pulmonary haemodynamics in the neonate is controversial. The aim of this investigation was to determine whether methyl-prednisolone improves preperfusion and postperfusion pulmonary function and haemodynamics.

Method

Sixteen newborn piglets (2.5 ± 0.5 kg body weight) were subjected to CPB, and deep hypothermic circulatory arrest (DHCA) was induced for 2 h. Group 1 (n = 8; control group) did not receive any drug treatment and group 2 (n = 8) received 30 mg/kg methylprednisolone preoperatively. Before CPB and 20 min after bypass, blood samples and haemodynamic data (cardiac output, mean arterial blood pressure, left and right atrial pressure, pulmonary artery pressure [PAP]) were measured. Pulmonary oxygenation function was assessed by calculating alveolar-arterial oxygen gradient index (AaI) and respiratory index.

Results

Methylprednisolone pretreatment resulted in an increase in prebypass values of PAP (14.0 ± 3.2 versus 10.3 ± 1.9 mmHg; P < 0.05), pulmonary vascular resistance index (308 ± 81 versus 119 ± 44 dyns/cm5 per m2; P < 0.05), AaI (279.8 ± 10 versus 174.5 ± 8.5 mmHg; P < 0.05) and intrapulmonary shunt (10.12 ± 2.4 versus 4.6 ± 1.2%) as compared with control animals, with no change in cardiac output, stroke volume or systemic vascular resistance. All animals in both groups had significantly (P < 0.05) and severely impaired haemodynamics and lung function after CPB, including elevation of pulmonary vascular resistance with decreased pulmonary oxygenation function and lower cardiac output, without any intergroup differences.

Conclusion

Considering the significant increase in prebypass pulmonary haemodynamic and oxygenation variables after high-dose methylprednisolone pretreatment, these data do not provide evidence that either postperfusion pulmonary haemodynamics or oxygenation function are significantly influenced by this treatment.

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Abdul-Khaliq, H., Troitzsch, D., Wehsack, A. et al. Effects of high-dose methylprednisolone on neonatal pulmonary function after cardiopulmonary bypass and deep hypothermic circulatory arrest. Crit Care 5, P5 (2001). https://doi.org/10.1186/cc998

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Keywords

  • Cardiac Output
  • Methylprednisolone
  • Cardiopulmonary Bypass
  • Pulmonary Vascular Resistance
  • Gradient Index