The Effect of Steroids in Patients Undergoing Cardiopulmonary Bypass: An Individual Patient Meta-Analysis of Two Randomized Trials

Whitlock, Richard; Dieleman, Jan M.; Belley‐Côté, Emilie P.; Vincent, Jessica; Zhang, Michelle; Devereaux, P.J.; Kalkman, Cor J.; Dijk, Diederik A Van; Yusuf, Salim

doi:10.1053/j.jvca.2019.06.012

Cited by 19 publications

(17 citation statements)

References 17 publications

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“…790 Perioperative steroid use, renin-angiotensin system inhibitors, digoxin prophylaxis, calcium antagonist prophylaxis, n-3 polyunsaturated fatty acids, glucose-insulinpotassium therapy, vasopressin, and NSAIDs have been shown to lack promise. 771,[791][792][793][794][795][796] Intraoperative injection of botulinum toxin into epicardial neural ganglia has been shown to be promising in small RCTs with a larger study in progress. 797…”

Section: Other Potential Therapiesmentioning

confidence: 99%

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Andrade

Aguilar

Atzema

et al. 2020

Canadian Journal of Cardiology

405

496

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The Canadian Cardiovascular Society (CCS) atrial fibrillation (AF) guidelines program was developed to aid clinicians in the management of these complex patients, as well as to provide direction to policy makers and health care systems regarding related issues. The most recent comprehensive CCS AF guidelines update was published R ESUM ELe programme de lignes directrices de la Soci et e canadienne de cardiologie (SCC) en matière de fibrillation auriculaire (FA) a et e elabor e pour aider les cliniciens à prendre en charge ces patients complexes, ainsi que pour orienter les d ecideurs politiques et les systèmes de soins de sant e sur des questions connexes. La dernière edition

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Section: Other Potential Therapiesmentioning

confidence: 99%

The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation

Andrade

Aguilar

Atzema

et al. 2020

Canadian Journal of Cardiology

405

496

View full text Add to dashboard Cite

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“…The use of prophylactic steroids is controversial, although when combined and time prolonged surgery is planned, it might be useful to reduce the inflammatory cascade due to ischemia/reperfusion injury of the lung [ 30 – 32 ]. The emerging antibiotic resistance, an important issue that prolongs hospitalization and consequently increases the costs, can be contained paying attention to avoid unjustified antibiotic treatments, in patients undergoing cardiac surgery, in the days immediately preceding.…”

Section: Risk Factorsmentioning

confidence: 99%

Nosocomial Extracardiac Infections After Cardiac Surgery

Zardi

Chello

Zardi³

et al. 2022

Curr Infect Dis Rep

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Purpose of Review Nosocomial extracardiac infections after cardiac surgery are a major public health issue affecting 3–8.2% of patients within 30–60 days following the intervention. Recent Findings Here, we have considered the most important postoperative infective complications that, in order of frequency, are pneumonia, surgical site infection, urinary tract infection, and bloodstream infection. The overall picture that emerges shows that they cause a greater perioperative morbidity and mortality with a longer hospitalization time and excess costs. Preventive interventions and corrective measures, diminishing the burden of nosocomial extracardiac infections, may reduce the global costs. A multidisciplinary team may assure a more appropriate management of nosocomial extracardiac infections leading to a reduction of hospitalization time and mortality rate. Summary The main and most current data on epidemiology, prevention, microbiology, diagnosis, and management for each one of the most important postoperative infective complications are reported. The establishment of an antimicrobial stewardship in each hospital seems to be, at the moment, the more valid strategy to counteract the challenging problems.

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“…Notably, this includes recent findings from Whitlock et al in a meta-analysis of all patients enrolled in both the Dexamethasone for Cardiac Surgery (DECS) and Steroids in Cardiac Surgery (SIRS) trials, the 2 largest randomized controlled trials evaluating the effect of prophylactic steroid administration on adult cardiac surgery outcomes. [1][2][3] In the most comprehensive meta-analysis to date, the authors found that steroids offered no benefit on mortality. A decreased incidence of respiratory failure (>48-hour ventilator requirement) and infection diagnoses was observed; however, these modest benefits occurred in the setting of potential harm in the form of increased myocardial injury, a finding consistent in both trials.…”

mentioning

confidence: 99%