Effects of Dexamethasone on Pulmonary and Renal Functions in Patients Undergoing CABG With Cardiopulmonary Bypass

Amr, Yasser Mohamed; Elmistekawy, Elsayed; El-Serogy, Hesham

doi:10.1177/1089253209351598

Cited by 17 publications

(8 citation statements)

References 16 publications

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“…Three studies excluded patients with preoperative creatinine >2, 1.4, and 1.2 mg/dL, respectively . The remaining studies involved elective first‐time CBP CABG patients . In three studies , inclusion of patients with chronic kidney disease was not specified, while in five studies diabetic patients were included .…”

Section: Resultsmentioning

confidence: 99%

“…Creatinine levels were measured in six studies . Dexamethasone was used in four studies , methylprednisolone in eight studies , hydrocortisone in one study ; in one study (three groups study), patients were randomized to receive dexamethasone or methylprednisolone or placebo .…”

Section: Resultsmentioning

confidence: 99%

“…In steroids analysis, nine studies had a Jadad score ≥3, while in leukocyte filters only two studies were of good quality. In MECC analysis, no studies had a Jadad score ≥3 because of the impossibility to blind the treatment to investigators.…”

Section: Resultsmentioning

confidence: 99%

“…Considering the important role of the inflammatory response in AKI pathogenesis, the modulation of systemic inflammatory response may attenuate renal tubular cell damage associated with CPB. Few studies specifically analyzed the impact of anti‐inflammatory strategies on AKI development after cardiac surgery . It has been demonstrated that steroid administration, leukocyte filter utilization, and miniaturized extracorporeal circuits (MECCs) adoption significantly reduce inflammatory response after CPB .…”

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confidence: 99%

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Anti‐Inflammatory Strategies to Reduce Acute Kidney Injury in Cardiac Surgery Patients: A Meta‐Analysis of Randomized Controlled Trials

et al. 2013

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Acute kidney injury (AKI) after cardiac operations is a serious complication associated with postoperative mortality. Multiple factors contribute to AKI development, principally ischemia-reperfusion injury and inflammatory response. It is well proven that glucocorticoid administration, leukocyte filter application, and miniaturized extracorporeal circuits (MECC) modulate inflammatory response. We conducted a systematic review of randomized controlled trials (RCTs) in which one of these inflammatory system modulation strategies was used, with the aim to evaluate the effects on postoperative AKI. MEDLINE and Cochrane Library were screened through November 2011 for RCTs in which an inflammatory system modulation strategy was adopted. Included were trials that reported data about postoperative renal outcomes. Because AKI was defined by different criteria, including biochemical determinations, urine output, or dialysis requirement, we unified renal outcome as worsening renal function (WRF). We identified 14 trials for steroids administration (931 patients, WRF incidence [treatment vs. placebo]: 2.7% vs. 2.4%; OR: 1.13; 95% CI: 0.53-2.43; P = 0.79), 9 trials for MECC (947 patients, WRF incidence: 2.4% vs. 0.9%; OR: 0.47; 95% CI: 0.18-1.25; P = 0.13), 6 trials for leukocyte filters (374 patients, WRF incidence: 1.1% vs. 7.5%; OR: 0.18; 95% CI: 0.05-0.64; P = 0.008). Only leukocyte filters effectively reduced WRF incidence. Not all cardiopulmonary bypass-related anti-inflammatory strategies analyzed reduced renal damage after cardiac operations. In adult patients, probably other factors are predominant on inflammation in determining AKI, and only leukocyte filters were effective. Large multicenter RCTs are needed in order to better evaluate the role of inflammation in AKI development after cardiac operations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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Anti‐Inflammatory Strategies to Reduce Acute Kidney Injury in Cardiac Surgery Patients: A Meta‐Analysis of Randomized Controlled Trials

et al. 2013

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“…Nowadays, the CBP circuits are usually coated with heparin, but the systemic inflammation resulting from the contact of blood with a foreign surface has not been resolved (1, 2, 5, 11-15). So far, several methods to control inflammation in patients undergoing bypass CBP have been proposed, those worth mentioning include; impregnation of the tubes with heparin (1, 2), administration of high doses of corticosteroids to prevent inflammation (7, 16, 17), using anti-inflammatory drugs (12), although none have proved to be totally effective (18-29). …”

Section: Introductionmentioning

confidence: 99%

Acute Effect of Intravenous Administration of Magnesium Sulfate on Serum Levels of Interleukin-6 and Tumor Necrosis Factor-α in Patients Undergoing Elective Coronary Bypass Graft With Cardiopulmonary Bypass

et al. 2014

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Background:Cardiovascular problems are among the most common health issues. A considerable number of cardiac patients undergo cardiac surgery, and coronary artery disease patients constitute about two-thirds of all these surgeries. The application of cardiopulmonary bypass (CBP) usually results in some untoward effects.Objectives:Studies have suggested magnesium sulfate (MgSO4) as an anti-inflammatory agent in a coronary artery bypass graft (CABG). This study aimed to assess the effect of an IV MgSO4 infusion during elective CABG (with CBP) on the blood levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α).Materials and Methods:During a 12 month period, after review board approval and based on inclusion and exclusion criteria, 90 patients were selected and entered randomly into one of the two study groups (MgSO4 or placebo). Anesthesia, surgery and CBP were performed in exactly the same way, except for the use of MgSO4 or a placebo. Both preoperative and postoperative plasma levels of IL-6 and TNF-α were checked and compared between the two groups using an ELISA.Results:There was no difference found between the two groups with regard to; gender, basic variables, Ejection Fraction (EF), CBP time and aortic cross-clamp time. The preoperative levels of IL-6 and TNF-α were not different; however, their postoperative levels were significantly higher in the placebo group (P value = 0.01 for IL-6 and 0.005 for TNF-α).Conclusions:This study showed that MgSO4 infusion could suppress part of the inflammatory response after CABG with CBP. This was demonstrated by decreased levels of interleukin-6 and TNF-α in postoperative serum levels in elective CABG with CBP.

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Prophylactic corticosteroids for cardiopulmonary bypass in adults

Dieleman

Paassen

Dijk

et al. 2011

Cochrane Database of Systematic Reviews

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Effects of Dexamethasone on Pulmonary and Renal Functions in Patients Undergoing CABG With Cardiopulmonary Bypass

Abstract: Dexamethasone offers no renal protective effect and the drug is associated with significant improvement in A-a O(2) gradient, respiratory index, PaO(2)/FiO( 2) at 12, 24 hours postoperatively and had no effect on extubation time and lung compliance.

Cited by 17 publications

References 16 publications

Anti‐Inflammatory Strategies to Reduce Acute Kidney Injury in Cardiac Surgery Patients: A Meta‐Analysis of Randomized Controlled Trials

Anti‐Inflammatory Strategies to Reduce Acute Kidney Injury in Cardiac Surgery Patients: A Meta‐Analysis of Randomized Controlled Trials

Acute Effect of Intravenous Administration of Magnesium Sulfate on Serum Levels of Interleukin-6 and Tumor Necrosis Factor-α in Patients Undergoing Elective Coronary Bypass Graft With Cardiopulmonary Bypass

Prophylactic corticosteroids for cardiopulmonary bypass in adults

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