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Randomized Controlled Trial
. 2006 Mar 2;124(2):90-5.
doi: 10.1590/s1516-31802006000200008.

Effects of single dose of dexamethasone on patients with systemic inflammatory response

Domingos Dias Cicarelli  1 , Fábio Ely Martins Benseñor, Joaquim Edson Vieira
Affiliations
Randomized Controlled Trial

Effects of single dose of dexamethasone on patients with systemic inflammatory response

Domingos Dias Cicarelli et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context and objective: Systemic inflammatory response syndrome (SIRS) is a very common condition among critically ill patients. SIRS, sepsis, septic shock and multiple organ dysfunction syndrome (MODS) can lead to death. Our aim was to investigate the efficacy of a single dose of dexamethasone for blocking the progression of systemic inflammatory response syndrome.

Design and setting: Prospective, randomized, double-blind, single-center study in a postoperative intensive care unit (Surgical Support Unit) at Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.

Methods: The study involved 29 patients with SIRS. All eligible patients were prospectively randomized to receive either a single dose of 0.2 mg/kg of dexamethasone or placebo, after SIRS was diagnosed. The patients were monitored over a seven-day period using Sequential Organ Failure Assessment score (SOFA).

Results: The respiratory system showed an improvement on the first day after dexamethasone was administered, demonstrated by the improved PaO2/FiO2 ratio (p < 0.05). The cardiovascular system of patients requiring vasopressor therapy also improved over the first two days, with a better evolution in the dexamethasone group (p < 0.05). Non-surviving patients presented higher lactate assays than did survivors (p < 0.05) during this period.

Conclusions: Dexamethasone enhanced the effects of vasopressor drugs and evaluation of the respiratory system showed improvements (better PaO2/FiO2 ratio), one day after its administration. Despite these improvements, the single dose of dexamethasone did not block the evolution of SIRS.

CONTEXTO E OBJETIVO:: A síndrome da resposta inflamatória sistêmica (SRIS) acomete muitos pacientes internados em unidades de terapia intensiva. A evolução destes pacientes com SRIS para sepse, choque séptico e síndrome da disfunção de múltiplos órgãos (SDMO) pode conduzi-los rapidamente para o óbito. A proposta do trabalho é avaliar a eficácia da dexametasona em dose única como tratamento da SRIS.

TIPO DE ESTUDO E LOCAL:: Estudo prospectivo, aleatório, duplamente encoberto, realizado na Unidade de Terapia Intensiva pós-operatória (Unidade de Apoio Cirúrgico) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

MÉTODOS:: Foram estudados 29 pacientes com diagnóstico de SRIS. Os participantes foram aleatoriamente divididos em dois grupos que receberam dexametasona (0,2 mg/kg em dose única) ou placebo após o diagnóstico de SRIS. Os pacientes foram acompanhados durante sete dias de internação na UTI através do escore SOFA (Sequential Organ Failure Assessment).

RESULTADOS:: Os pacientes que receberam dexametasona apresentaram melhora do sistema respiratório no primeiro dia, com aumento da relação PaO2/FiO2 (p < 0,05). Entre os pacientes que faziam uso de vasopressores, os que receberam dexametasona tiveram diminuição da necessidade destas medicações nos primeiros dois dias após a dose de dexametasona (p < 0,05).

CONCLUSÃO:: A dexametasona diminuiu a necessidade de medicações vasopressoras e causou aumento da relação PaO2/FiO2 no primeiro dia após sua administração. Apesar destes efeitos, a dexametasona em dose única não bloqueou a evolução dos pacientes com SRIS.

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Conflict of interest statement

Conflicts of interest: Not declared.

Figures

Figure 1
Figure 1. Progression of organ dysfunction in 29 patients with systemic inflammatory response syndrome, as assessed using the different components of the Sequential Organ Failure Assessment score (SOFA).
Figure 2
Figure 2. Improvement in the respiratory system and better evolution of the PaO2/FiO2 ratio in the first day after diagnosis of systemic inflammatory response syndrome in patients that received a single dose of dexamethasone, compared with those who received placebo.
Figure 3
Figure 3. Improvement in the cardiovascular system during the first and second days after diagnosis of systemic inflammatory response syndrome in the group of patients that received a single dose of dexamethasone, compared with placebo, including only the patients that received vasopressor therapy.
Figure 4
Figure 4. Evolution of lactate (mg/dl) and C-reactive protein (µg/ml) in the survivor and non-survivor groups of patients with systemic response syndrome.
See this image and copyright information in PMC

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