The effect of short-term prophylactic methylprednisolone on the incidence and severity of postpericardiotomy syndrome in children undergoing cardiac surgery with cardiopulmonary bypass

OBJECTIVE The aim of this study was to determine the effect of prophylactic immune suppression on the incidence and severity of postpericardiotomy syndrome (PPS in children after cardiac surgery with cardiopulmonary bypass (CPB). BACKGROUND Prophylactic suppression of the inflammatory response has all unknown effect on the incidence and severity of PPS in children undergoing surgery with CPB. METHODS This randomized double-blind placebo controlled trial included two study groups. Group A received pre-CPB intravenous methylprednisolone (1 mg/kg) plus four additional intravenous doses over 24 h, and Group B received intravenous saline placebo, at identical intervals. Data included patient demographics, cardiac diagnosis/operation, CPB time, incidence and st verity of PPS. Noncomplicated PPS--temperature >100.5 degreesF, pericardial friction rub, patient irritability, small pericardial +/- pleural effusion. Complicated PPS-noncomplicated PPS pins hospital readmission +/- pericardiocentesis or thoracentesis RESULTS We randomized 266 children: 20 exclusions (6 perioperative deaths, 14 reasons unrelated to treatment) leaving Group A (n = 126) and Group B (n = 120). There were no significant group differences in gender, cardiac diagnosis or CPB time. Group mean age differed (p = 0.05) and was treated as a covariate with no substantive outcome effect. In total, 39/246 children (16%) developed PPS (noncomplicated: n = 30, complicated: n = 9). There was no inter-group difference in overall PPS incidence (p = 0.73). However, Group A had a marginally significant increase in complicated PPS (p = 0.05. CONCLUSIONS Intravenous methylprednisolone at a standard anti-inflammatory dose administered pre-CPB and early post-CPB neither prevents nor attenuates PPS in children. Short-term pre-CPB and post-CPB methylprednisolone treatment may complicate PPS, (J Am Cell Cardiol 2001;37:1700-6) (C) 2001 by the American College of Cardiology.