Effects of single dose of dexamethasone on patients with systemic inflammatory response

Abstract

CONTEXT AND OBJECTIVE: Systemic inflammatory response syndrome (SIRS) is a very common condition among critically ill patients. SIRS, sepsis, septic shock and multiple organ dysfunction syndrome (MODS) can lead to death. Our aim was to investigate the efficacy of a single dose of dexamethasone for blocking the progression of systemic inflammatory response syndrome. DESIGN AND SETTING: Prospective, randomized, double-blind, single-center study in a postoperative intensive care unit (Surgical Support Unit) at Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. METHODS: The study involved 29 patients with SIRS. All eligible patients were prospectively randomized to receive either a single dose of 0.2 mg/kg of dexamethasone or placebo, after SIRS was diagnosed. The patients were monitored over a seven-day period using Sequential Organ Failure Assessment score (SOFA). RESULTS: The respiratory system showed an improvement on the first day after dexamethasone was administered, demonstrated by the improved PaO2/FiO2 ratio (p < 0.05). The cardiovascular system of patients requiring vasopressor therapy also improved over the first two days, with a better evolution in the dexamethasone group (p < 0.05). Non-surviving patients presented higher lactate assays than did survivors (p < 0.05) during this period. CONCLUSIONS: Dexamethasone enhanced the effects of vasopressor drugs and evaluation of the respiratory system showed improvements (better PaO2/FiO2 ratio), one day after its administration. Despite these improvements, the single dose of dexamethasone did not block the evolution of SIRS.

Inhibition of endogenous glucocorticoid synthesis aggravates lung injury triggered by septic shock in rats

“…If inadequate secretion of CCT fails to suppress inflammation, hormonal administration should promote GC antiinflammatory function by decreasing the production of inflammatory cytokines, cytokine-driven HPA axis activity and cytokine-driven organ dysfunction (Meduri 1999). The effects of dex are repeatedly demonstrated, and the results of the present study are in agreement with the literature regarding the prevention of lung inflammation (Meduri et al 2002;Wang et al 2008), oxidative stress and MPO activity (Sun et al 2009), decreased alveolar collapsed area and improvement in the physiological parameters of respiratory mechanics (Meduri et al 2002;Rocco et al 2003) with a consequent increase in survival (Cicarelli et al 2006(Cicarelli et al , 2007.…”

Influence of Laser (λ670 nm) and Dexamethasone on the Chronology of Cutaneous Repair

“…24,25 The reduction of collagen synthesis demonstrated a potential negative effect of this drug in tissue repair. These findings were identified after an ultrastructural study performed on days 3 and 5 after use of dexamethasone, when fibroblasts exhibited few organelles and a reduced collagenous matrix.…”

Lipopolysaccharide (LPS) enhances prostate cancer metastasis potentially through NF‐κB activation and recurrent dexamethasone administration fails to suppress it in vivo

“…As an anti‐inflammatory drug, DEX is known to control the endotoxin‐induced lung inflammation and inflammatory cytokines . Clinical trial studies have shown the beneficial role of DEX in septic shock or systemic inflammatory condition . Moreover, DEX is often given to cancer patients before or after chemotherapy to control acute nausea and pain .…”

“…38,39 Clinical trial studies have shown the beneficial role of DEX in septic shock or systemic inflammatory condition. 40,41 Moreover, DEX is often given to cancer patients before or after chemotherapy to control acute nausea and pain. 42 Importantly, low dose of DEX is also used as a palliative therapy in castration-resistant PCa treatment.…”