Dexamethasone in Patients with Spontaneous Intracerebral Hemorrhage: An Updated Meta-Analysis

Wintzer, Stephanie; Heckmann, Josef G.; Huttner, Hagen B.; Schwab, Stefan

doi:10.1159/000510040

Cited by 13 publications

(11 citation statements)

References 44 publications

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“…365 A 1998 RCT suggests that dexamethasone does not likely cause an unacceptably high rate of complications but also does not provide a benefit. 366 More recently, a Cochrane review 367 and a meta-analysis 369 demonstrated no clear benefit to patients with ICH treated with dexamethasone or glucocorticoids. Taken together, these studies suggest that there may be some risk, in addition to a lack of benefit, for corticosteroid administration in the setting of ICH.…”

Section: Medical and Neurointensive Treatment For Ichmentioning

confidence: 99%

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

Greenberg¹,

Ziai²,

Cordonnier³

et al. 2022

Stroke

692

472

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other entities (RWI) can be found at https://professional. heart.org/-/media/phd-files/guidelines-and-statements/ policies-devolopment/aha-asa-disclosure-rwi-policy-5118. pdf?la=en.Beginning in 2017, numerous modifications to AHA/ ASA guidelines have been implemented to make guidelines shorter and enhance user-friendliness. Guidelines are written and presented in a modular knowledge chunk format; each chunk includes a table of recommendations, a brief synopsis, recommendation-specific supportive text, and, when appropriate, flow diagrams or additional tables. Hyperlinked references are provided to facilitate quick access and review. Other modifications to the guidelines include the addition of Knowledge Gaps and Future Research segments in some sections and a web guideline supplement (Online Data Supplement) for useful but noncritical tables and figures.

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Section: Medical and Neurointensive Treatment For Ichmentioning

confidence: 99%

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

Greenberg¹,

Ziai²,

Cordonnier³

et al. 2022

Stroke

692

472

View full text Add to dashboard Cite

show abstract

“…These effects may predispose patients to coronary heart disease and elevated risk profiles following surgical interventions especially in case of high doses and prolonged dexamethasone intake. Though the risk of secondary hemorrhage in cranial surgery dependent on the use of dexamethasone has not intensively been studied and clear evidence of a beneficial or negative effect of dexamethasone is still lacking, so far [33], there are reports pointing at a potential association of glucocorticoid intake and postoperative hemorrhage. In a real-world practice setting with 36 US children's hospitals, retrospective analysis of 139,715 patients that had undergone surgery for tonsillectomy revealed dexamethasone use to be associated with an absolute increased risk of revisits for bleeding [34].…”

Section: Discussionmentioning

confidence: 99%

Unplanned intensive care unit readmission after surgical treatment in patients with newly diagnosed glioblastoma — forfeiture of surgically achieved advantages?

et al. 2023

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Postoperative intensive care unit (ICU) monitoring is an established option to ensure patient safety after resection of newly diagnosed glioblastoma. In contrast, secondary unplanned ICU readmission following complicating events during the initial postoperative course might be associated with severe morbidity and impair initially intended surgical benefit. In the present study, we assessed the prognostic impact of secondary ICU readmission and aimed to identify preoperatively ascertainable risk factors for the development of such adverse events in patients treated surgically for newly diagnosed glioblastoma. Between 2013 and 2018, 240 patients were surgically treated for newly diagnosed glioblastoma at the authors’ neuro-oncological center. Secondary ICU readmission was defined as any unplanned admission to the ICU during initial hospital stay. A multivariable logistic regression analysis was performed to identify preoperatively measurable risk factors for unplanned ICU readmission. Nineteen of 240 glioblastoma patients (8%) were readmitted to the ICU. Median overall survival of patients with unplanned ICU readmission was 9 months compared to 17 months for patients without secondary ICU readmission (p=0.008). Multivariable analysis identified “preoperative administration of dexamethasone > 7 days” (p=0.002) as a significant and independent predictor of secondary unplanned ICU admission. Secondary ICU readmission following surgery for newly diagnosed glioblastoma is significantly associated with poor survival and thus may negate surgically achieved prerequisites for further treatment. This underlines the indispensability of precise patient selection as well as the importance of further scientific debate on these highly relevant aspects for patient safety.

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“…While there is evidence to recommend routine use in the setting of vasogenic edema as seen with intracerebral malignancy, steroids have failed to show benefit while increasing adverse events in ischemic stroke, intracerebral hemorrhage, spinal cord injury, and SAH, and are associated with increased mortality in the setting of traumatic brain injury. [20][21][22][23][24][25] Their association with multiple adverse events including infection, hyperglycemia, gastrointestinal hemorrhage, and delirium raises concern. 26 In our cohort, 12.7% of patients were diagnosed with an infection, a rate of infection lower than that recently reported by Miller et al, though the duration of therapy was considerably longer in their study.…”

Section: Discussionmentioning

confidence: 99%

Steroids Provide Temporary Improvement of Refractory Pain Following Subarachnoid Hemorrhage

Jaffa

Podell

Foroutan

et al. 2023

The Neurohospitalist

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Introduction Evidence for optimal analgesia following subarachnoid hemorrhage (SAH) is limited. Steroid therapy for pain refractory to standard regimens is common despite lack of evidence for its efficacy. We sought to determine if steroids reduced pain or utilization of other analgesics when given for refractory headache following SAH. Methods We performed a retrospective within-subjects cohort study of SAH patients who received steroids for refractory headache. We compared daily pain scores, total daily opioid, and acetaminophen doses before, during, and after steroids. Repeated measures were analyzed with a multivariable general linear model and generalized estimating equations. Results Included 52 patients treated with dexamethasone following SAH, of whom 11 received a second course, increasing total to 63 treatment epochs. Mean pain score on the first day of therapy was 7.92 (standard error of the mean [SEM] .37) and decreased to 6.68 (SEM .36) on the second day before quickly returning to baseline levels, 7.36 (SEM .33), following completion of treatment. Total daily analgesics mirrored this trend. Mean total opioid and acetaminophen doses on days one and two and two days after treatment were 47.83mg (SEM 6.22) and 1848mg (SEM 170.66), 34.24mg (SEM 5.12) and 1809mg (SEM 150.28), and 46.38mg (SEM 11.64) and 1833mg (SEM 174.23), respectively. Response to therapy was associated with older age, decreasing acetaminophen dosing, and longer duration of steroids. Hyperglycemia and sleep disturbance/delirium effected 28.6% and 55.6% of cases, respectively. Conclusion Steroid therapy for refractory pain in SAH patients may have modest, transient effects in select patients.

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Dexamethasone in Patients with Spontaneous Intracerebral Hemorrhage: An Updated Meta-Analysis

Cited by 13 publications

References 44 publications

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association

Unplanned intensive care unit readmission after surgical treatment in patients with newly diagnosed glioblastoma — forfeiture of surgically achieved advantages?

Steroids Provide Temporary Improvement of Refractory Pain Following Subarachnoid Hemorrhage

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