Intraoperative High-Dose Dexamethasone for Cardiac Surgery

Dieleman, Jan M.; Nierich, Arno P.; Rosseel, Peter; Maaten, Joost M. van der; Hofland, Jan; Diephuis, Jan C.; Schepp, Ronald M.; Boer, Christa; Moons, Karel G.M.; Herwerden, Lex A. van; Tijssen, Jan G.P.; Numan, Sandra; Kalkman, Cor J.; Dijk, Diederik van

doi:10.1001/jama.2012.14144

Cited by 372 publications

(313 citation statements)

References 23 publications

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“…increased in levels of creatine kinase myocardial band (RR = 1.22; 95% CI 1.07-1.38) [9]. In another trial (n = 4494), the RR for mortality was 0.92 (95% CI 0.57-1.49), for superinfection 0.64 (95% CI 0.54-0.75), for delirium 0.79 (95% CI 0.66-0.94), and for respiratory failure 0.69 (95% CI 0.51-0.94) in favor of dexamethasone (1 mg/kg perioperatively) [10]. See Appendix 2 in Supplementary material for evidence profile.…”

Section: Rationalementioning

confidence: 97%

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

2017

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Section: Rationalementioning

confidence: 97%

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017

2017

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“…In an isolated heart model, hydrocortisone significantly reduced the shedding of the endothelial surface layer after ischaemia, reperfusion and TNF-a infusion [22,36]. Prophylactic intra-operative glucocorticoids did not benefit patients undergoing cardiac surgery [49]. Similarly, the role of steroids in sepsis remains unclear: while glucocorticoids improve vasopressor efficacy, it is uncertain whether they benefit patients [50].…”

Section: Damage To the Endothelial Surface Layermentioning

confidence: 98%

The endothelial glycocalyx: a review of the vascular barrier

Alphonsus¹,

2014

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SummaryThe endothelial glycocalyx is an important part of the vascular barrier. The glycocalyx is intimately linked to the homoeostatic functions of the endothelium. Damage to the glycocalyx precedes vascular pathology. In the first part of this paper, we have reviewed the structure, physiology and pathology of the endothelial glycocalyx, based on a literature search of the past five years. In the second part, we have systematically reviewed interventions to protect or repair the glycocalyx. Glycocalyx damage can be caused by hypervolaemia and hyperglycaemia and can be prevented by maintaining a physiological concentration of plasma protein, particularly albumin.

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“…80 Some studies have shown that a single prophylactic dose of dexamethasone can cause mild hyperglycemia for 24 hr postoperatively, although one randomized controlled trial found this was associated with a lower risk of some postoperative complications such as pneumonia and catheter-related infection. 81 Furthermore, a recent randomized controlled trial has refuted the claim that a single low dose of dexamethasone (up to 8 mg at induction of anesthesia) raises blood glucose concentrations for 24 hr after administration, as blood glucose levels did not differ from those observed after saline administration. 82 The exact dose of glucocorticoids at which potential harm outweighs benefit is unknown.…”

Section: Glucocorticoidsmentioning

confidence: 99%