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May 14, 2017

Euroanaesthesia 2017

Effect of steroid administration during cardiopulmonary bypass on postoperative vasoactive inotropic score

;

Yuichiro Toda;

Saiko Fukunaga;

Etsuko Kido;

and Hideki Nakatsuka

steroid

vasoactive inotropic score

cardiac surgery

cardiopulmonary bypass

Abstract

Abstract

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Keywords

steroid

vasoactive inotropic score

cardiac surgery

cardiopulmonary bypass

Abstract

Background Steroid administration during cardiac surgery under cardiopulmonary bypass (CPB) remains controversial. It has been reported that steroid administration is effective for hemodynamic instability in septic shock refractory to a high-dose vasopressor. However, the effect of steroid administration during CPB on postoperative use of a vasoactive inotropic agent is unclear. Objective To investigate the effects of steroid administration during CPB on postoperative use of vasoactive agents. Methods This was a retrospective cohort study. Patients who underwent cardiac surgery under CPB during the period from Jan 1, 2014 to Dec 31, 2015 were included in the study. They were divided into two groups depending on steroid administration. Doses of dopamine, dobutamine, epinephrine, noradrenaline, milrinone, and vasopressin at weaning from CPB and at 0, 1, 2, 4 and 6 hours after ICU admission were collected from electronic medical charts and vasoactive inotropic score (VIS) was calculated at each time point. Statistical analyses were done by Student’s t test for numerical data, Fisher’s test for categorical data, and multivariate analysis of variance for VIS. A P value less than 0.05 was considered significant. Results There were 68 patients (Group S) who received a steroid during CPB and 77 patients (Group C) who did not. The characteristics of patients were not different between the two groups: age, Group S vs Group C: 70.0 (95%CI: 66.9 to 73.1) vs 70.7 (67.9 to 73.7); patients on chronic dialysis, S: 9.8% vs C: 15.2%; duration of CPB, S: 176.9 (160.1 to 193.6) vs C: 180.1 (164.4 to 195.9) min; duration of surgery, S: 358.5 (327.0 to 390.0) vs C: 374.7 (344.7 to 403.8) min. VIS was significantly higher in group S than in group C (Fig): VIS at ICU admission, S: 5.84 (4.37 to 7.31) vs C: 2.47 (1.72 to 3.23), p<0.001. Conclusion Doses of vasoactive agents were not reduced by steroid administration during cardiopulmonary bypass.

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All rights reserved.