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

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 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-Glucose Regulation for Intensive care Patients (GRIP

Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients

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Brief Report: Mothers' long-term posttraumatic stress symptoms following a burn event of their child

OBJECTIVE:This prospective longitudinal study examines the course of posttraumatic stress symptoms (PTSS) in mothers of children with burns between 1 and 11 years after the burn event and the role of burn severity and feelings of guilt on this course.METHOD:Self-reported PTSS of 48 mothers were measured with the Impact of Event Scale. Guilt feelings were assessed during an in-depth interview 2 years after the burn event. Eleven years after the burn event, mothers marked their child's scars at the present time on a drawing.RESULTS:Over a period of 10 years, maternal PTSS decreased. Multiple regression analysis showed that the interaction between guilt and burn severity predicted the course of PTSS.CONCLUSIONS:Although PTSS substantially decreases through the years, a subset of mothers, in particular mothers who feel guilty about the burn event and whose children have more extensive permanent scarring seem at risk for longer term PTSS

The effect of dexamethasone on symptoms of posttraumatic stress disorder and depression after cardiac surgery and intensive care admission: Longitudinal follow-up of a randomized controlled trial.

OBJECTIVE\nCardiac surgery and postoperative admission to the ICU may lead to posttraumatic stress disorder and depression. Perioperatively administered corticosteroids potentially alter the risk of development of these psychiatric conditions, by affecting the hypothalamic-pituitary-adrenal axis. However, findings of previous studies are inconsistent. We aimed to assess the effect of a single dose of dexamethasone compared with placebo on symptoms of posttraumatic stress disorder and depression and health-related quality of life after cardiac surgery and ICU admission.\nDESIGN\nFollow-up study of a randomized clinical trial.\nSETTING\nFive Dutch heart centers.\nPATIENTS\nCardiac surgery patients (n = 1,244) who participated in the Dexamethasone for Cardiac Surgery trial.\nINTERVENTIONS\nA single intraoperative IV dose of dexamethasone or placebo was administered in a randomized, double-blind way.\nMEASUREMENTS AND MAIN RESULTS\nSymptoms of posttraumatic stress disorder, depression, and health-related quality of life were assessed with validated questionnaires 1.5 years after randomization. Data were available for 1,125 patients (90.4%); of which 561 patients received dexamethasone and 564 patients received placebo. Overall, the prevalence of psychopathology was not influenced by dexamethasone. Posttraumatic stress disorder and depression were present in, respectively, 52 patients (9.3%) and 69 patients (12.3%) who received dexamethasone and in 66 patients (11.7%) and 78 patients (13.8%) who received placebo (posttraumatic stress disorder: odds ratio, 0.82; 95% CI, 0.55-1.20; p = 0.30; depression: odds ratio, 0.92; 95% CI, 0.64-1.31; p = 0.63). Subgroup analysis revealed a lower prevalence of posttraumatic stress disorder (odds ratio, 0.23; 95% CI, 0.07-0.72; p FSW - Self-regulation models for health behavior and psychopathology - ou

A new horizon for insulin administration in the intensive care unit

Treatment of so-called stress-hyperglycaemia is usually neglected in the intensive care unit. However, there are good pathophysiological reasons to believe that this habit is unjustified. Insulin treatment may mitigate chronic inflammatory responses and oxidative stress. Moreover, an improvement of the immune function can be expected. Beneficial effects of insulin administration have already been found in the setting of cardiac surgery and acute myocardial infarction. Other indications in which a beneficial effect may be expected include vascular surgery, transplantation, systemic inflammatory response syndrome, and intravenous usage of X-ray contrast media.</p