Corticosteroid Protocol for Pulmonary Surgery

Introduction to Corticosteroid Use

• The American Thoracic Society recommends metilprednisolona 30 mg/kg IV administered during at least 30 minutes immediately before anesthetic induction for adult patients undergoing pulmonary surgery, based on evidence from cardiopulmonary bypass surgery demonstrating reduced mortality, atrial fibrillation, and respiratory complications 1, 2

Specific Dosage Protocol

• The European Respiratory Society suggests an alternative: dexametasona 1 mg/kg perioperatively has shown similar benefits in reducing infections (RR 0.64), delirium (RR 0.79), and respiratory failure (RR 0.69) 2, 3

Clinical Context for Pulmonary Surgery

• The American College of Chest Physicians recommends that patients with chronic obstructive pulmonary disease (COPD) undergoing pulmonary surgery benefit from preoperative inhalation therapy (LAMAs/LABAs) for approximately 1 month before surgery, which significantly improves preoperative respiratory function, complementary to perioperative corticosteroids 3

Evidence of Benefits in Thoracic Surgery

• The Society of Critical Care Medicine found that perioperative corticosteroids in cardiopulmonary bypass surgery (a comparable model to major pulmonary surgery) demonstrated a reduction in respiratory failure (RR 0.69) 2, 3
• The same study showed a trend towards reduced mortality (RR 0.84-0.92) 1, 2

Critical Warnings and Contraindications

• The Infectious Diseases Society of America advises that corticosteroids are relatively contraindicated in patients with confirmed or suspected influenza, as they increase mortality (OR 3.06) and the risk of superinfection 1, 2, 3

Adverse Effects to Monitor

• The Endocrine Society notes that corticosteroids increase the risk of hyperglycemia (RR 1.49) even with short courses 1
• The American Heart Association found that metilprednisolona may increase CK-MB levels (RR 1.22) 1, 2

Special Considerations

• The International Society for Heart and Lung Transplantation recommends that lung transplant recipients with acute cellular rejection receive metilprednisolona 1000 mg IV daily for 3 days (or 10-15 mg/kg/day in smaller patients) 4, 5
• This protocol is applicable to situations of severe perioperative pulmonary inflammation 1