Role of corticosteroids in the development of pneumonia in mechanically ventilated head-trauma victims

Braun, Sheldon R.; Levin, Allan B.; Clark, Karen

doi:10.1097/00003246-198603000-00006

Cited by 58 publications

(12 citation statements)

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“…Those patients treated with thiopentone showed a greater incidence of pneumonia than those without thiobarbiturate administration (24). I n this case, a suppressive effect on the patient's unspecific cellular immune response cannot be ruled out, especially in an already compromised critically ill individual.…”

Section: Discussionmentioning

confidence: 81%

Suppression of neutrophil migration and chemiluminescence is due to the sulphur atom in the thiobarbiturate molecule

Kress

Eberlein

Hörber

et al. 1989

Acta Anaesthesiol Scand

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In this study the hypothesis was tested that the substituent at the C 2 position of the barbiturate molecule is crucial for the obvious differences in inhibitory potencies between various barbiturates with respect to neutrophil functions in vitro. Using isolated neutrophils from healthy volunteers, the comparative effects of two pairs of sulphur or oxygen-substituted analogues on chemiluminescence, random and chemotactic migration were examined. Five other i.v. barbiturates were also tested in the chemiluminescence assay. The key observation with all the assay systems was that the oxybarbiturates proved ten to a hundredfold less suppressive than their sulphurated analogues or the other thiobarbiturates. Thus, enhanced inhibitory potency was dependent on the presence of the sulphur atom in the barbiturate molecule and could no longer be explained exclusively on the basis of divergent physicochemical features.

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Section: Discussionmentioning

confidence: 81%

Suppression of neutrophil migration and chemiluminescence is due to the sulphur atom in the thiobarbiturate molecule

Kress

Eberlein

Hörber

et al. 1989

Acta Anaesthesiol Scand

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“…The combined search strategies identified 18 reports of trials that satisfied the inclusion criteria 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31. Two were reports of the same trial28 29: this trial was excluded after contact with the first author showed that concealment of allocation had been inadequate.…”

Section: Resultsmentioning

confidence: 99%

Corticosteroids in acute traumatic brain injury: systematic review of randomised controlled trials

Alderson

Roberts

1997

BMJ

159

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Objective: To quantify the effectiveness and safety of corticosteroids in the treatment of acute traumatic brain injury. Design: Systematic review of randomised controlled trials of corticosteroids in acute traumatic brain injury. Summary odds ratios were estimated as an inverse variance weighted average of the odds ratios for each study. Setting: Randomised trials available by March 1996. Subjects: The included trials with outcome data comprised 2073 randomised participants. Results: The effect of corticosteroids on the risk of death was reported in 13 included trials. The pooled odds ratio for the 13 trials was 0.91 (95% confidence interval 0.74 to 1.12). Pooled absolute risk reduction was 1.8% ( − 2.5% to 5.7%). For the 10 trials that reported death or disability the pooled odds ratio was 0.90 (0.72 to 1.11). For infections of any type the pooled odds ratio was 0.92 (0.69 to 1.23) and for the seven trials reporting gastrointestinal bleeding it was 1.05 (0.44 to 2.52). With only those trials with the best quality of concealment of allocation, the pooled odds ratio estimates for death and death or disability became closer to unity. Conclusions: This systematic review of randomised controlled trials of corticosteroids in acute traumatic brain injury shows that there remains considerable uncertainty over their effects. Neither moderate benefits nor moderate harmful effects can be excluded. The widely practicable nature of the drugs and the importance of the health problem suggest that large simple trials are feasible and worth while to establish whether there are any benefits from use of corticosteroids in this setting.

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“…14,18 The action of corticoids on the immune system is well known, but their direct responsibility should be tempered. 21,22 Over the last few years, complex interactions among the immune system, central nervous system and endocrine system have been discovered. Patients with a neurological dysfunction have been shown to have a de®cient lymphocyte response and impaired natural killer cytotoxic activity, which would at least partially explain their increased…”

Section: Discussionmentioning

confidence: 99%

Pharmacological therapy of spinal cord injury during the acute phase

et al. 2000

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Study design: Prospective, randomized clinical trial. Setting: France. Objectives: To evaluate the safety and e ect on neurological outcome of nimodipine, methylprednisolone, or both versus no medical treatment in spinal-cord injury during the acute phase. Method: One hundred and six patients who had spinal trauma (including 48 with paraplegia and 58 with tetraplegia) were randomly separated into four groups: M=methylprednisolone (30 mg×kg 71 over 1 h, followed by 5.4 mg×kg 71 ×h 71 for 23 h), N=nimodipine (0.015 mg×kg 71 ×h 71 for 2 h followed by 0.03 mg×kg 71 ×h 71 for 7 days), MN (both agents) or P (neither medication). Neurological assessment (ASIA score) was performed by a blinded senior neurologist before treatment and at 1-year follow-up. Early spinal decompression and stabilization was performed as soon as possible after injury. Results: One hundred patients were reassessed at 1 year. Neurological improvement was seen in each group (P50.0001), however no additional neurological bene®t from treatment was observed. Infectious complications occurred more often in patients treated with M. Early surgery (49 patients underwent surgery within 8 h of their accident) did not in¯uence the neurological outcome. The only predictor of the latter was the extent of the spinal injury (complete or incomplete lesion). Conclusion: The present study con®rms the absence of bene®t of pharmacological therapy in this indication. Because of the paucity of clinical studies that demonstrate the e cacy of pharmacological treatment in spinal injury during the acute phase, systematic use of pharmaceutical agents should be reconsidered. Spinal Cord (2000) 38, 71 ± 76

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Role of corticosteroids in the development of pneumonia in mechanically ventilated head-trauma victims

Cited by 58 publications

References 0 publications

Suppression of neutrophil migration and chemiluminescence is due to the sulphur atom in the thiobarbiturate molecule

Suppression of neutrophil migration and chemiluminescence is due to the sulphur atom in the thiobarbiturate molecule

Corticosteroids in acute traumatic brain injury: systematic review of randomised controlled trials

Pharmacological therapy of spinal cord injury during the acute phase

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