Preventive and therapeutic effect of low-dose corticosteroids on early acute lung injury after thoracoscopic lobectomy: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Liqiang ¹ , LI Shaoqiu ^1,2 , LIU Qiang ¹ , ZENG Min ¹ ,  LUO Weimin ^1,2

1. Department of Thoracic and Cardiovascular Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, P. R. China;
2. Hubei University of Medicine, Shiyan, 442000, Hubei, P. R. China;

Corresponding author：

LUO Weimin, Email: weiminluo120@163.com

Keywords：

Corticosteroids; video-assisted thoracoscopic lobectomy; early acute lung injury

DOI：

10.7507/1007-4848.202403022

Video：

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Objective To explore the effect of early short-term use of low-dose steroids on early acute lung injury (EALI) after video-assisted thoracoscopic lobectomy. Methods Patients who underwent video-assisted thoracoscopic lobectomy in our department from January 2019 to January 2022 were selected for this retrospective cohort study. They were divided into an early steroid treatment group and a control group based on whether steroids were used in the early postoperative period. In the early steroid treatment group, in addition to routine postoperative treatment, low-dose methylprednisolone was administered intravenously, at 80-120 mg/d for 3 consecutive days. In the control group, routine postoperative treatment was given, but no steroids were used in the first 3 days. A chest computed tomography (CT) scan was performed on postoperative day (POD) 1, and POD3 or POD4 to assess lung injury. Chest CT scores, the EALI incidence, the length of hospital stay, and the incidence of poor incision healing were recorded. Results A total of 521 patients were included, consisting of 255 males and 266 females, aged 11-80 years. There were 318 patients in the early steroid treatment group and 203 patients in the control group. On POD1, the incidence of EALI was 16.0% in the control group and 13.8% in the steroid group, with no significant difference between the two groups (P>0.05). There was also no significant difference in the CT scores of patients with EALI in the two groups (P>0.05). On POD3/4, the incidence of EALI was 33.6% in the control group and 22.7% in the steroid group, showing a significant difference (P=0.007). When comparing the CT scores of patients with EALI in both groups, the scores were lower in the steroid group, but the difference was not significant (P>0.05). The overall incidence of EALI on POD1-4 was 37.4% in the control group and 26.1% in the steroid group, showing a significant difference (P=0.007). Of these, 28.9% of patients in the control group showed radiological progression, which means new EALI occurred or existing EALI progressed, while the progression rate was 14.8% in the steroid group (P<0.001). The length of hospital stay was significantly shorter in the steroid group compared to the control group (P<0.001), but the incidence of poor incision healing was not (P>0.05). Conclusion Early use of corticosteroids cannot reduce the incidence and severity of EALI on POD1, but it can reduce the incidence of EALI on POD3/4 and decrease the risk of radiological progression, and also lower the overall risk of EALI after surgery, without extended postoperative hospital stays or increased incidence of poor incision healing. Therefore, early postoperative use of low-dose corticosteroids can help to inhibit the occurrence and progression of EALI. It is suggested to use as early as possible especially in patients with high risks of postoperative EALI.

1.	Kutlu CA, Williams EA, Evans TW, et al. Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg, 2000, 69(2): 376-380.
2.	Tang SS, Redmond K, Griffiths M, et al. The mortality from acute respiratory distress syndrome after pulmonary resection is reducing: A 10-year single institutional experience. Eur J Cardiothorac Surg, 2008, 34(4): 898-902.
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15.	Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
16.	Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19 patients: Correlation with disease severity and short-term prognosis. Eur Radiol, 2020, 30(12): 6808-6817.
17.	Pan F, Ye T, Sun P, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology, 2020, 295(3): 715-721.
18.	Jeon K, Yoon JW, Suh GY, et al. Risk factors for post-pneumonectomy acute lung injury/acute respiratory distress syndrome in primary lung cancer patients. Anaesth Intensive Care, 2009, 37(1): 14-19.
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20.	Meduri GU, Golden E, Freire AX, et al. Methylprednisolone infusion in early severe ARDS: Results of a randomized controlled trial. Chest, 2007, 131(4): 954-963.
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24.	Frieri M. Corticosteroid effects on cytokines and chemokines. Allergy Asthma Proc, 1999, 20(3): 147-159.
25.	Thompson BT. Glucocorticoids and acute lung injury. Crit Care Med, 2003, 31(4 Suppl): S253-S257.
26.	Reis FF, Reboredo Mde M, Lucinda LM, et al. Pre-treatment with dexamethasone attenuates experimental ventilator-induced lung injury. J Bras Pneumol, 2016, 42(3): 166-173.
27.	Della Rocca G, Coccia C. Acute lung injury in thoracic surgery. Curr Opin Anaesthesiol, 2013, 26(1): 40-46.
28.	Licker M, de Perrot M, Spiliopoulos A, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg, 2003, 97(6): 1558-1565.

1. Kutlu CA, Williams EA, Evans TW, et al. Acute lung injury and acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg, 2000, 69(2): 376-380.
2. Tang SS, Redmond K, Griffiths M, et al. The mortality from acute respiratory distress syndrome after pulmonary resection is reducing: A 10-year single institutional experience. Eur J Cardiothorac Surg, 2008, 34(4): 898-902.
3. Kometani T, Okamoto T, Yoshida S, et al. Acute respiratory distress syndrome after pulmonary resection. Gen Thorac Cardiovasc Surg, 2013, 61(9): 504-512.
4. Thompson BT, Chambers RC, Liu KD. Acute respiratory distress syndrome. N Engl J Med, 2017, 377(6): 562-572.
5. Choi H, Shin B, Yoo H, et al. Early corticosteroid treatment for postoperative acute lung injury after lung cancer surgery. Ther Adv Respir Dis, 2019, 13: 1753466619840256.
6. Lee HS, Lee JM, Kim MS, et al. Low-dose steroid therapy at an early phase of postoperative acute respiratory distress syndrome. Ann Thorac Surg, 2005, 79(2): 405-410.
7. Steinberg KP, Hudson LD, Goodman RB, et al. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med, 2006, 354(16): 1671-1684.
8. Peter JV, John P, Graham PL, et al. Corticosteroids in the prevention and treatment of acute respiratory distress syndrome (ARDS) in adults: meta-analysis. BMJ, 2008, 336(7651): 1006-1009.
9. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med, 2001, 345(19): 1368-1377.
10. Levitt JE, Matthay MA. Clinical review: Early treatment of acute lung injury--Paradigm shift toward prevention and treatment prior to respiratory failure. Crit Care, 2012, 16(3): 223.
11. Levitt JE, Calfee CS, Goldstein BA, et al. Early acute lung injury: Criteria for identifying lung injury prior to the need for positive pressure ventilation. Crit Care Med, 2013, 41(8): 1929-1937.
12. Levitt JE, Bedi H, Calfee CS, et al. Identification of early acute lung injury at initial evaluation in an acute care setting prior to the onset of respiratory failure. Chest, 2009, 135(4): 936-943.
13. Rackley CR, Levitt JE, Zhuo H, et al. Clinical evidence of early acute lung injury often precedes the diagnosis of ALI. J Intensive Care Med, 2013, 28(4): 241-246.
14. Cardinale L, Priola AM, Priola SM, et al. Radiological contribution to the diagnosis of early postoperative complications after lung resection for primary tumor: A revisional study. J Thorac Dis, 2016, 8(8): E643-652.
15. Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
16. Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19 patients: Correlation with disease severity and short-term prognosis. Eur Radiol, 2020, 30(12): 6808-6817.
17. Pan F, Ye T, Sun P, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology, 2020, 295(3): 715-721.
18. Jeon K, Yoon JW, Suh GY, et al. Risk factors for post-pneumonectomy acute lung injury/acute respiratory distress syndrome in primary lung cancer patients. Anaesth Intensive Care, 2009, 37(1): 14-19.
19. El Tahan MR, Pasin L, Marczin N, et al. Impact of low tidal volumes during one-lung ventilation. A meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth, 2017, 31(5): 1767-1773.
20. Meduri GU, Golden E, Freire AX, et al. Methylprednisolone infusion in early severe ARDS: Results of a randomized controlled trial. Chest, 2007, 131(4): 954-963.
21. Meduri GU, Bridges L, Shih MC, et al. Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: Analysis of individual patients' data from four randomized trials and trial-level meta-analysis of the updated literature. Intensive Care Med, 2016, 42(5): 829-840.
22. Yadav H, Thompson BT, Gajic O. Fifty years of research in ARDS. Is acute respiratory distress syndrome a preventable disease? Am J Respir Crit Care Med, 2017, 195(6): 725-736.
23. Gong MN, Thompson BT. Acute respiratory distress syndrome: Shifting the emphasis from treatment to prevention. Curr Opin Crit Care, 2016, 22(1): 21-37.
24. Frieri M. Corticosteroid effects on cytokines and chemokines. Allergy Asthma Proc, 1999, 20(3): 147-159.
25. Thompson BT. Glucocorticoids and acute lung injury. Crit Care Med, 2003, 31(4 Suppl): S253-S257.
26. Reis FF, Reboredo Mde M, Lucinda LM, et al. Pre-treatment with dexamethasone attenuates experimental ventilator-induced lung injury. J Bras Pneumol, 2016, 42(3): 166-173.
27. Della Rocca G, Coccia C. Acute lung injury in thoracic surgery. Curr Opin Anaesthesiol, 2013, 26(1): 40-46.
28. Licker M, de Perrot M, Spiliopoulos A, et al. Risk factors for acute lung injury after thoracic surgery for lung cancer. Anesth Analg, 2003, 97(6): 1558-1565.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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