Effect of high-dose dexamethasone on perioperative lactate levels and glucose control: a randomized controlled trial

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• 作者：Thomas H Ottens (1)
  Maarten WN Nijsten (2)
  Jan Hofland (3)
  Jan M Dieleman (1)
  Miriam Hoekstra (4)
  Diederik van Dijk (1)
  Joost MAA van der Maaten (2) (4)
  
  1. Department of Anesthesiology and Intensive Care ; University Medical Center Utrecht ; Mail stop Q.04.2.313 ; PO Box 85500 ; Utrecht ; 3508 ; GA ; The Netherlands
  2. Department of Critical Care ; University Medical Center ; University of Groningen ; Hanzeplein 1 ; Groningen ; RB ; 9700 ; The Netherlands
  3. Department of Anesthesiology ; Erasmus University Medical Center ; 鈥檚 Gravendijkwal 230 ; Rotterdam ; CE ; 3015 ; The Netherlands
  4. Department of Anesthesiology ; University Medical Center Groningen ; University of Groningen ; Hanzeplein 1 ; Groningen ; RB ; 9700 ; The Netherlands
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：717 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Blood lactate levels are increasingly used to monitor patients. Steroids are frequently administered to critically ill patients. However, the effect of steroids on lactate levels has not been adequately investigated. We studied the effect of a single intraoperative high dose of dexamethasone on lactate and glucose levels in patients undergoing cardiac surgery. Methods The Dexamethasone for Cardiac Surgery (DECS) trial was a multicenter randomized trial on the effect of dexamethasone 1聽mg/kg versus placebo on clinical outcomes after cardiac surgery in adults. Here we report a pre-planned secondary analysis of data from DECS trial participants included at the University Medical Center Groningen. The use of a computer-assisted glucose regulation protocol鈥擥lucose Regulation for Intensive care Patients (GRIP)鈥攚as part of routine postoperative care. GRIP aimed at glucose levels of 4 to 8聽mmol/L. Primary outcome parameters were area under the lactate and glucose curves over the first 15聽hours of ICU stay (AUC15). ICU length of stay and mortality were observed as well. Results The primary outcome could be determined in 497 patients of the 500 included patients. During the first 15聽hours of ICU stay, lactate and glucose levels were significantly higher in the dexamethasone group than in the placebo group: lactate AUC15 25.8 (13.1) versus 19.9 (11.2) mmol/L鈥壝椻€塰our, P 15 126.5 (13.0) versus 114.4 (13.9) mmol/L鈥壝椻€塰our, P P鈥?鈥?.001), and 30-day mortality rates were 1.6% and 2.4%, respectively (P鈥?鈥?.759). Conclusions Intraoperative high-dose dexamethasone increased postoperative lactate and glucose levels in the first 15聽hours of ICU stay. Still, patients in the dexamethasone group had a shorter ICU length of stay and similar mortality compared with controls. Trial registration ClinicalTrials.gov NCT00293592. Registered 16 February 2006.