title: Dexamethasone for the prevention of postpericardiotomy syndrome: A DExamethasone for Cardiac Surgery substudy.
abstract: BACKGROUND
  The postpericardiotomy syndrome (PPS) is a common complication following cardiac surgery. The pathophysiology remains unclear, although evidence exists that surgical trauma and the use of cardiopulmonary bypass provoke an immune response leading to PPS. We hypothesized that an intraoperative dose of dexamethasone decreases the risk of PPS, by reducing this inflammatory response.
  
  
  METHODS
  We performed a subanalysis of the DECS study, which is a multicenter, double-blind, placebo-controlled, randomized trial of 4,494 patients undergoing cardiac surgery with use of cardiopulmonary bypass. The aim of the DECS study was to investigate whether a single intraoperative dose of 1 mg/kg dexamethasone reduced the incidence of a composite of death, myocardial infarction, stroke, renal failure, or respiratory failure, within 30 days of randomization. In this substudy, we retrospectively analyzed the occurrence of PPS in 822 patients who were included in the DECS trial and underwent valvular surgery. Postpericardiotomy syndrome was diagnosed if 2 of 5 listed symptoms were present: unexplained fever, pleuritic chest pain, pericardial or pleural rub, new or worsening pericardial or pleural effusion. All medical charts, x-rays, and echocardiograms were reviewed. Secondary end point was the occurrence of complicated PPS, defined as PPS with need for evacuation of pleural effusion, pericardiocentesis, and tamponade requiring intervention or hospital readmission for PPS. This is a blinded, single-center, post hoc analysis.
  
  
  RESULTS
  Postpericardiotomy syndrome occurred in 119 patients (14.5%). The incidence of PPS after dexamethasone compared with placebo was 13.5% vs 15.5% (relative risk 0.88, 95% CI 0.63-1.22). For complicated PPS, the incidence was 3.8% versus 3.2% (relative risk 1.17, 95% CI 0.57-2.41, P = .66), respectively.
  
  
  CONCLUSIONS
  In patients undergoing valvular cardiac surgery, high-dose dexamethasone treatment had no protective effect on the occurrence of PPS or complicated PPS.
authors: Departments of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Jeroen J H
authors: JJ
authors: Bunge
authors: Departments of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Dirk
authors: D
authors: van Osch
authors: Departments of Anaesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Jan M
authors: JM
authors: Dieleman
authors: Departments of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Anaesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Kirolos A
authors: KA
authors: Jacob
authors: Departments of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Jolanda
authors: J
authors: Kluin
authors: Departments of Anaesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Diederik
authors: D
authors: van Dijk
authors: Departments of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: h.m.nathoe@umcutrecht.nl.
authors: Hendrik M
authors: HM
authors: Nathoe
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011185:Postpericardiotomy Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone