title: Effects of dexamethasone on intravascular and extravascular fluid balance in patients undergoing coronary bypass surgery with cardiopulmonary bypass.
abstract: BACKGROUND
  Cardiac surgery with cardiopulmonary bypass is often associated with postoperative hemodynamic instability. In this regard beneficial effects of corticosteroids are known. The purpose of this study was to investigate whether these effects are due mainly to a modification of the intravascular and extravascular volume status or whether a more direct improvement of cardiovascular performance by corticosteroids is the underlying mechanism.
  
  
  METHODS
  Twenty patients undergoing elective coronary bypass grafting were included in this randomized double-blind study. Patients of the treatment group received 1 mg/kg-1 dexamethasone after induction of anesthesia. In addition to the use of standard monitors and detailed fluid balance assessments, the transpulmonary double-indicator technique was used to measure extravascular lung water, total blood volume, and intrathoracic blood volume. Measurements were done after induction of anesthesia and 1 h, 6 h, and 20 h after the end of surgery.
  
  
  RESULTS
  After cardiopulmonary bypass, no relevant increase in extravascular lung water was observed, despite highly positive fluid balances in all patients. A significantly smaller increase in extravascular fluid content was observed in the dexamethasone group. Total blood volume and intrathoracic blood volume did not differ in the two groups. Patients pretreated with dexamethasone had a decreased requirement for vasoactive substances and, in contrast with the control group, no increase in pulmonary artery pressure.
  
  
  CONCLUSIONS
  Extravascular fluid but not extravascular lung water is increased in patients after surgery with cardiopulmonary bypass. Pretreatment of adult patients with 1 mg/kg-1 dexamethasone before coronary bypass grafting decreases extravascular fluid gain and seems to improve postoperative cardiovascular performance. This effect is not caused by a better intravascular volume status.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany. vspiegel@mailer.ukb.un-bonn.de
authors.forename: Tilman
authors.initials: T
authors.lastname: von Spiegel
authors.forename: Savvas
authors.initials: S
authors.lastname: Giannaris
authors.forename: Götz J K
authors.initials: GJ
authors.lastname: Wietasch
authors.forename: Stefan
authors.initials: S
authors.lastname: Schroeder
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Buhre
authors.forename: Bernd
authors.initials: B
authors.lastname: Schorn
authors.forename: Andreas
authors.initials: A
authors.lastname: Hoeft
mesh_terms: D000328:Adult; D000368:Aged; D002199:Capillary Permeability / Q000187:drug effects*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003907:Dexamethasone / Q000494:pharmacology*; D004311:Double-Blind Method; D015633:Extravascular Lung Water / Q000378:metabolism*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D003907:Dexamethasone