Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial.

CONTEXT: Prophylactic corticosteroids are often administered during cardiac surgery to attenuate the inflammatory response to cardiopulmonary bypass and surgical trauma; however, evidence that routine corticosteroid use can prevent major adverse events is lacking. OBJECTIVE: To quantify the effect of intraoperative high-dose dexamethasone on the incidence of major adverse events in patients undergoing cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, randomized, double-blind, placebo-controlled trial of 4494 patients aged 18 years or older undergoing cardiac surgery with cardiopulmonary bypass at 8 cardiac surgical centers in The Netherlands enrolled between April 13, 2006, and November 23, 2011. INTERVENTION: Patients were randomly assigned to receive a single intraoperative dose of 1 mg/kg dexamethasone (n = 2239) or placebo (n = 2255). MAIN OUTCOME MEASURES: A composite of death, myocardial infarction, stroke, renal failure, or respiratory failure, within 30 days of randomization. RESULTS: Of the 4494 patients who underwent randomization, 4482 (99.7%) could be evaluated for the primary outcome. A total of 157 patients (7.0%) in the dexamethasone group and 191 patients (8.5%) in the placebo group reached the primary study end point (relative risk, 0.83; 95% CI, 0.67-1.01; absolute risk reduction, -1.5%; 95% CI, -3.0% to 0.1%; P = .07). Dexamethasone was associated with reductions in postoperative infection, duration of postoperative mechanical ventilation, and lengths of intensive care unit and hospital stays. In contrast, dexamethasone was associated with higher postoperative glucose levels. CONCLUSION: In our trial of adults undergoing cardiac surgery, the use of intraoperative dexamethasone did not reduce the 30-day incidence of major adverse events compared with placebo. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00293592.

Multitasking during patient handover in the recovery room.

BACKGROUND: Loss of information occurs frequently during handover and affects the continuity of care. Improving handovers is therefore a key patient safety goal. After surgery, the patient is transferred to the postanesthesia care unit (PACU), and handover to the nurse includes both handover of monitoring equipment (connecting electrocardiogram, calibrating arterial lines, infusion pumps, etc.) and patient/procedure-specific information. Multitasking is likely to increase the risk of information loss during handover. It is unknown to what extent the transfer of equipment and information occurs simultaneously or sequentially in daily practice. METHODS: A nationwide questionnaire on the subject of patient handover was returned by 494 health care practitioners concerned with handovers from operating room (OR) to PACU. In addition, 101 handovers from the OR to the PACU were videotaped in 2 academic hospitals (n = 20), 3 teaching hospitals (n = 43) and 1 community hospital (n = 38). The occurrence of simultaneous or sequential transfer of equipment and information was recorded by two independent observers. RESULTS: Simultaneous handover of equipment and information was the preference for a minority of respondents to the national survey (11%, 95% confidence interval, 8% to 14%). Self-reported simultaneous handover was 43% (39% to 47%). In the videotaped handovers, simultaneous handover was used for 65% (56% to 74%), which was even higher in the academic centers. The simultaneous handovers were no more than 0.2 minute faster than sequential handovers (P = 0.38). CONCLUSIONS: In most videotaped handovers from OR to the PACU, there was simultaneous transfer of equipment and information. Although most health care providers are unaware of it, this form of multitasking during patient handover in the PACU is common. Future studies should evaluate whether this multitasking also leads to loss of critical patient information and reduced patient safety.