Dexamethasone levels predict cortisol response after infant cardiopulmonary bypass

Sheri S. Crow, William C. Oliver, Jamie A. Kiefer, Melissa R. Snyder, Joseph A. Dearani, Zhuo Li, Harold M. Burkhart

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: We sought to evaluate whether there is variability in blood dexamethasone levels after a standard 1 mg/kg dose of dexamethasone administered before infant cardiopulmonary bypass. We hypothesized that postoperative dexamethasone drug levels are highly variable, and that the infant stress response is related inversely to the amount of dexamethasone measured in the blood. Methods: Thirty-two infants (age, ≤365 days) received 1 mg/kg of dexamethasone before cardiopulmonary bypass (CPB) initiation. Blood was analyzed for cortisol, adrenocorticotropin, and interleukin (IL)-6, IL-8, and IL-10 levels after anesthesia induction, after CPB, after intensive care unit (ICU) arrival, and 4, 8, 12, and 24 hours after surgery. Patients were grouped as high dexamethasone (≥15 μg/dL) or low dexamethasone (<15 μg/dL) based on their level at ICU arrival. Results: Dexamethasone levels varied significantly between the high (n = 22) and low (n = 10) dexamethasone groups throughout the entire postoperative course and were correlated highly with cortisol response. Patients with high dexamethasone levels had postoperative cortisol levels that were lower than their pre-CPB baseline cortisol levels. Cortisol levels remained low throughout the first 24 postoperative hours even after dexamethasone levels neared zero. There were no significant differences between groups in the duration of mechanical ventilation or ICU length of stay. Conclusions: Dexamethasone levels are highly variable at ICU arrival, despite standardized 1 mg/kg dosing before CPB initiation.

Original languageEnglish (US)
Pages (from-to)475-481
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Cardiopulmonary Bypass
Dexamethasone
Hydrocortisone
Intensive Care Units
Interleukin-8
Artificial Respiration
Interleukin-10
Adrenocorticotropic Hormone
Interleukin-6
Length of Stay
Anesthesia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Crow, S. S., Oliver, W. C., Kiefer, J. A., Snyder, M. R., Dearani, J. A., Li, Z., & Burkhart, H. M. (2014). Dexamethasone levels predict cortisol response after infant cardiopulmonary bypass. Journal of Thoracic and Cardiovascular Surgery, 147(1), 475-481. https://doi.org/10.1016/j.jtcvs.2013.09.023

Dexamethasone levels predict cortisol response after infant cardiopulmonary bypass. / Crow, Sheri S.; Oliver, William C.; Kiefer, Jamie A.; Snyder, Melissa R.; Dearani, Joseph A.; Li, Zhuo; Burkhart, Harold M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 1, 01.2014, p. 475-481.

Research output: Contribution to journalArticle

Crow, SS, Oliver, WC, Kiefer, JA, Snyder, MR, Dearani, JA, Li, Z & Burkhart, HM 2014, 'Dexamethasone levels predict cortisol response after infant cardiopulmonary bypass', Journal of Thoracic and Cardiovascular Surgery, vol. 147, no. 1, pp. 475-481. https://doi.org/10.1016/j.jtcvs.2013.09.023
Crow, Sheri S. ; Oliver, William C. ; Kiefer, Jamie A. ; Snyder, Melissa R. ; Dearani, Joseph A. ; Li, Zhuo ; Burkhart, Harold M. / Dexamethasone levels predict cortisol response after infant cardiopulmonary bypass. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 147, No. 1. pp. 475-481.
@article{84e71bba396f4f6d98dc1a65ae26282b,
title = "Dexamethasone levels predict cortisol response after infant cardiopulmonary bypass",
abstract = "Objectives: We sought to evaluate whether there is variability in blood dexamethasone levels after a standard 1 mg/kg dose of dexamethasone administered before infant cardiopulmonary bypass. We hypothesized that postoperative dexamethasone drug levels are highly variable, and that the infant stress response is related inversely to the amount of dexamethasone measured in the blood. Methods: Thirty-two infants (age, ≤365 days) received 1 mg/kg of dexamethasone before cardiopulmonary bypass (CPB) initiation. Blood was analyzed for cortisol, adrenocorticotropin, and interleukin (IL)-6, IL-8, and IL-10 levels after anesthesia induction, after CPB, after intensive care unit (ICU) arrival, and 4, 8, 12, and 24 hours after surgery. Patients were grouped as high dexamethasone (≥15 μg/dL) or low dexamethasone (<15 μg/dL) based on their level at ICU arrival. Results: Dexamethasone levels varied significantly between the high (n = 22) and low (n = 10) dexamethasone groups throughout the entire postoperative course and were correlated highly with cortisol response. Patients with high dexamethasone levels had postoperative cortisol levels that were lower than their pre-CPB baseline cortisol levels. Cortisol levels remained low throughout the first 24 postoperative hours even after dexamethasone levels neared zero. There were no significant differences between groups in the duration of mechanical ventilation or ICU length of stay. Conclusions: Dexamethasone levels are highly variable at ICU arrival, despite standardized 1 mg/kg dosing before CPB initiation.",
author = "Crow, {Sheri S.} and Oliver, {William C.} and Kiefer, {Jamie A.} and Snyder, {Melissa R.} and Dearani, {Joseph A.} and Zhuo Li and Burkhart, {Harold M.}",
year = "2014",
month = "1",
doi = "10.1016/j.jtcvs.2013.09.023",
language = "English (US)",
volume = "147",
pages = "475--481",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Dexamethasone levels predict cortisol response after infant cardiopulmonary bypass

AU - Crow, Sheri S.

AU - Oliver, William C.

AU - Kiefer, Jamie A.

AU - Snyder, Melissa R.

AU - Dearani, Joseph A.

AU - Li, Zhuo

AU - Burkhart, Harold M.

PY - 2014/1

Y1 - 2014/1

N2 - Objectives: We sought to evaluate whether there is variability in blood dexamethasone levels after a standard 1 mg/kg dose of dexamethasone administered before infant cardiopulmonary bypass. We hypothesized that postoperative dexamethasone drug levels are highly variable, and that the infant stress response is related inversely to the amount of dexamethasone measured in the blood. Methods: Thirty-two infants (age, ≤365 days) received 1 mg/kg of dexamethasone before cardiopulmonary bypass (CPB) initiation. Blood was analyzed for cortisol, adrenocorticotropin, and interleukin (IL)-6, IL-8, and IL-10 levels after anesthesia induction, after CPB, after intensive care unit (ICU) arrival, and 4, 8, 12, and 24 hours after surgery. Patients were grouped as high dexamethasone (≥15 μg/dL) or low dexamethasone (<15 μg/dL) based on their level at ICU arrival. Results: Dexamethasone levels varied significantly between the high (n = 22) and low (n = 10) dexamethasone groups throughout the entire postoperative course and were correlated highly with cortisol response. Patients with high dexamethasone levels had postoperative cortisol levels that were lower than their pre-CPB baseline cortisol levels. Cortisol levels remained low throughout the first 24 postoperative hours even after dexamethasone levels neared zero. There were no significant differences between groups in the duration of mechanical ventilation or ICU length of stay. Conclusions: Dexamethasone levels are highly variable at ICU arrival, despite standardized 1 mg/kg dosing before CPB initiation.

AB - Objectives: We sought to evaluate whether there is variability in blood dexamethasone levels after a standard 1 mg/kg dose of dexamethasone administered before infant cardiopulmonary bypass. We hypothesized that postoperative dexamethasone drug levels are highly variable, and that the infant stress response is related inversely to the amount of dexamethasone measured in the blood. Methods: Thirty-two infants (age, ≤365 days) received 1 mg/kg of dexamethasone before cardiopulmonary bypass (CPB) initiation. Blood was analyzed for cortisol, adrenocorticotropin, and interleukin (IL)-6, IL-8, and IL-10 levels after anesthesia induction, after CPB, after intensive care unit (ICU) arrival, and 4, 8, 12, and 24 hours after surgery. Patients were grouped as high dexamethasone (≥15 μg/dL) or low dexamethasone (<15 μg/dL) based on their level at ICU arrival. Results: Dexamethasone levels varied significantly between the high (n = 22) and low (n = 10) dexamethasone groups throughout the entire postoperative course and were correlated highly with cortisol response. Patients with high dexamethasone levels had postoperative cortisol levels that were lower than their pre-CPB baseline cortisol levels. Cortisol levels remained low throughout the first 24 postoperative hours even after dexamethasone levels neared zero. There were no significant differences between groups in the duration of mechanical ventilation or ICU length of stay. Conclusions: Dexamethasone levels are highly variable at ICU arrival, despite standardized 1 mg/kg dosing before CPB initiation.

UR - http://www.scopus.com/inward/record.url?scp=84890554154&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890554154&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2013.09.023

DO - 10.1016/j.jtcvs.2013.09.023

M3 - Article

C2 - 24210831

AN - SCOPUS:84890554154

VL - 147

SP - 475

EP - 481

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 1

ER -