Effect of low-dose dexamethasone on extra vascular lung water in patients following on-pump elective primary coronary artery bypass graft surgery

• Published in: Annals of cardiac anaesthesia Vol. 22; no. 4; pp. 372 - 378
• Main Authors: Maddali, Madan, Waje, Niranjan, Arora, Nishant, Panchatcharam, Sathiya
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.10.2019; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Anesthesia; Anti-inflammatory agents/pharmacology; Cardiac patients; Catheters; Coronary artery bypass; Coronary vessels; Dexamethasone; dexamethasone/administration and dosage; Dosage and administration; Drug dosages; Edema; extravascular lung water; Glucocorticoids; Health aspects; heart diseases/surgery; Heart surgery; Hospital patients; Inflammation; inflammation/prevention and control; Medical personnel; Original; Ostomy; Patient outcomes; Patients; Permeability; Physiological aspects; Pulmonary circulation; Pulmonary edema; Steroids; Veins & arteries; Water; India; United States > US; heart diseases/surgery; dexamethasone/administration and dosage; Anti-inflammatory agents/pharmacology; extravascular lung water; inflammation/prevention and control
• ISSN: 0971-9784; 0974-5181
• DOI: 10.4103/aca.ACA_122_18

Background: The primary objective was to compare the effect of a low-dose dexamethasone as against a saline placebo on extravascular lung water index (EVLWI) in patients undergoing elective primary coronary artery bypass surgery. The secondary endpoints were to assess the effect of dexamethasone on other volumetric parameters (pulmonary vascular permeability index, global end diastolic volume index, and intrathoracic blood volume index), Vasoactive Inotrope Scores, hemodynamic parameters and serum osmolality in both groups. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Materials and Methods: Twenty patients were randomized to receive either dexamethasone (steroid group, n = 10) or placebo (nonsteroid group, n = 10) twice before the institution of cardiopulmonary bypass (CPB). EVLWI and other volumetric parameters were obtained with the help of VolumeView™ Combo Kit connected to EV 1000 clinical platform at predetermined intervals. Hemodynamic parameters, vasoactive-inotropic Scores, hematocrit values were recorded at the predetermined time intervals. Baseline and 1st postoperative day serum osmolality values were also obtained. Results: The two groups were evenly matched in terms of demographic and CPB data. Intra- and inter-group comparison of the baseline EVLWI including other volumetric and hemodynamic parameters with those recorded at subsequent intervals revealed no statistical difference and was similar. Generalized estimating equation model was obtained to compare the changes between the groups over the entire study period which showed that on an average the changes between the steroid and nonsteroid group in terms of all volumetric parameters were not statistically significant. Conclusions: There were no beneficial effects of low-dose dexamethasone on EVLWI or other volumetric parameters in patients subjected to on-pump primary coronary bypass surgery. Hemodynamic parameters were also not affected. Probably, the advanced hemodynamic monitoring aided in optimal fluid management in the nonsteroidal group impacting EVLW accumulation.