| Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials. | |
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MedLine Citation:
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PMID: 18664462 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality, myocardial infarction, neurological events, new onset atrial fibrillation, transfusion requirements, postoperative bleeding, duration of ventilation, intensive care unit (ICU) stay, hospital stay, wound complications, gastrointestinal complications, and infectious complications. We included 44 trials randomizing 3205 patients. Steroids reduced new onset atrial fibrillation [relative risk (RR) 0.71, 95% confidence interval (CI) 0.59 to 0.87], postoperative bleeding [weighted mean difference (WMD) -99.6 mL, 95% CI -149.8 to -49.3], and duration of ICU stay (WMD -0.23 days, 95% CI -0.40 to -0.07). Length of hospital stay was also reduced (WMD -0.59 days, 95% CI -1.17 to -0.02), but this result was less robust. A trend towards reduction in mortality was observed (RR 0.73, 95% CI 0.45 to 1.18). Randomized trials suggest that perioperative steroids have significant clinical benefit in CPB patients by decreasing the risk of new onset atrial fibrillation, while results are encouraging for reducing bleeding, length of stay, and mortality. These data do not raise major safety concerns, however, a sufficiently powered trial is warranted to confirm or refute these findings. |
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Authors:
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Richard P Whitlock; Simon Chan; P J Devereaux; Jack Sun; Fraser D Rubens; Kristian Thorlund; Kevin H T Teoh |
Publication Detail:
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Type: Journal Article; Meta-Analysis; Review Date: 2008-07-28 |
Journal Detail:
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Title: European heart journal Volume: 29 ISSN: 1522-9645 ISO Abbreviation: Eur. Heart J. Publication Date: 2008 Nov |
Date Detail:
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Created Date: 2008-11-03 Completed Date: 2009-03-11 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 2592-600 Citation Subset: IM |
Affiliation:
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Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada. rwhitlock@mountaincable.net |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anti-Arrhythmia Agents / therapeutic use* Atrial Fibrillation / prevention & control Blood Loss, Surgical / prevention & control Cardiopulmonary Bypass / adverse effects*, mortality Coagulants / therapeutic use* Epidemiologic Methods Humans Perioperative Care Randomized Controlled Trials as Topic Steroids / therapeutic use* |
| Chemical | |
Reg. No./Substance:
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0/Anti-Arrhythmia Agents; 0/Coagulants; 0/Steroids |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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