🧵1/
A very interesting RCT by @MirjanaCihoric & @BangFoss in @BJSurgery show the importance of dexamethasone (DXM) in acute abdominal surgery! DXM ⬇️inflammation,⬇️vasodilation,⬇️pressor dependency, and improves fluid balance and even 90-day ☠️
doi.org/10.1093/bjs/zn…
A very interesting RCT by @MirjanaCihoric & @BangFoss in @BJSurgery show the importance of dexamethasone (DXM) in acute abdominal surgery! DXM ⬇️inflammation,⬇️vasodilation,⬇️pressor dependency, and improves fluid balance and even 90-day ☠️
doi.org/10.1093/bjs/zn…
2/
DXM shows positive effects on various secondary endpoints with different levels of significance. Also, less fatigue, pain, immobilization and better peak exp flow.
DXM shows positive effects on various secondary endpoints with different levels of significance. Also, less fatigue, pain, immobilization and better peak exp flow.
3/
Interestingly, there were no more infections in the DXM-group; in fact, there were fewer infections of various subtypes, though statistically insignificant. However, DXM had more hyperglycemia.
Interestingly, there were no more infections in the DXM-group; in fact, there were fewer infections of various subtypes, though statistically insignificant. However, DXM had more hyperglycemia.
4/
One limitation is that the primary outcome was postop CRP, which is unfortunately not important for pts. The hypothesis was that dexamethasone⬇️postop inflammation, using CRP as a surrogate marker. This strategy requires ⬇️N to show an effect compared to mortality as outcome
One limitation is that the primary outcome was postop CRP, which is unfortunately not important for pts. The hypothesis was that dexamethasone⬇️postop inflammation, using CRP as a surrogate marker. This strategy requires ⬇️N to show an effect compared to mortality as outcome
5/
For me, this study shows that periop DXM is more than just threrapy for PONV/pain. Major surgery causes inflammation, leading to vasodilation, often mistaken as hypovolemia, and (mis)treated with fluids. DXM mitigates inflammation, addressing the underlying cause in most pts.
For me, this study shows that periop DXM is more than just threrapy for PONV/pain. Major surgery causes inflammation, leading to vasodilation, often mistaken as hypovolemia, and (mis)treated with fluids. DXM mitigates inflammation, addressing the underlying cause in most pts.
8/
I may not give my patients the full 1 mg/kg just yet, as this dose is currnently unusually high for my institution. However, I’m inclined to administer the standard 0.1-0.2 mg/kg IV to patients for acute abdominal surgery.
Thanks so much to the authors!
/end🧵
I may not give my patients the full 1 mg/kg just yet, as this dose is currnently unusually high for my institution. However, I’m inclined to administer the standard 0.1-0.2 mg/kg IV to patients for acute abdominal surgery.
Thanks so much to the authors!
/end🧵
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