Steroids for adult cardiac surgery with cardiopulmonary bypass: Update on dose and key randomized trials

摘要

STEROID THERAPY significantly attenuates the inflammatory response to cardiac surgery and cardiopulmonary bypass. The effect of steroids on clinical outcomes remains controversial. Available data does not demonstrate that corticosteroid prophylaxis reduces mortality after cardiac surgery. However, multiple aspects of clinical recovery may be beneficially impacted by steroid exposure, even when used in reduced doses. These outcome benefits include improved hemodynamic stability, less vasopressor support, a lower risk of atrial fibrillation, and shorter duration of tracheal intubation and length of stay. Furthermore, steroid prophylaxis reduces nausea, vomiting, shivering, and fatigue, and improves short-term and long-term quality of recovery. Importantly, the incidence of postoperative complications does not appear to be increased by steroid exposure. However, before low-dose steroid therapy is accepted as standard clinical practice, it is important that these findings be evaluated in large-scale trials. The recently published dexamethasone randomized trial demonstrated the safety of this steroid in adult cardiac surgery with cardiopulmonary bypass. Furthermore, this landmark randomized trial strongly suggested that steroid prophylaxis reduces delirium, respiratory failure, and infection with even more outcome benefits in high-risk patients. The global methylprednisolone randomized controlled trial is currently completing enrollment in 2013 with the release of its results expected in 2014. It is likely that the results of this definitive trial will significantly determine the practice of steroid prophylaxis.