ABSTRACT
PURPOSE: P Perioperative administration of single-dose dexamethasone helps reduce postoperative nausea and vomiting, inflammation, and pain. However, it is unclear which dose achieves these effects while minimizing the hyperglycemic impact in patients with diabetes. The purpose of this review was to elucidate the most appropriate perioperative dose of dexamethasone for diabetic patients, and whether it is necessary to withhold it in patients with poor glycemic control. DESIGN: A systematic review. METHODS: A literature search using PubMed and Cochrane Database of Systematic Reviews revealed 17 potential evidence sources. Eight sources met the inclusion criteria. Sources included one systematic review with meta-analysis, one randomized control trial, and six observational studies. FINDINGS: Evidence suggests diabetic patients who receive dexamethasone perioperatively are more likely to develop postoperative hyperglycemia, with a maximum blood glucose increase of 30 to 45 mg/dL in the first 24 hours following a single dose. One study described increased blood glucose levels with escalating doses, but no other sources have supported that finding. The available studies were markedly heterogeneous in both design and proportion of diabetic subjects included, and most were of low quality. CONCLUSIONS: There is not enough evidence to quantify the hyperglycemic effect of commonly used dexamethasone doses, and rigorous studies are needed to inform practice.
Subject(s)
Dexamethasone , Diabetes Mellitus , Blood Glucose , Dexamethasone/therapeutic use , Diabetes Mellitus/drug therapy , Diabetes Mellitus/surgery , Humans , Hyperglycemia/prevention & control , Postoperative Nausea and VomitingABSTRACT
Chronic obstructive pulmonary disease (COPD) is a progressive disease, its prevalence increases with age. COPD is frequently associated with co-morbidities such as cognitive impairment, and their clinical relevance has risen in the recent past. Cognitive function may fluctuate with the variable components of COPD like hypoxaemia, hypercapnia, lung function, exacerbations or severity of the disease. The objectives of this study were to examine whether the cognitive status of COPD patients is different across clinical stages (exacerbation, at discharge and stable COPD) and also if there are cognitive areas that have more potential to change than others. Prospective observational clinical study: 62 patients admitted to hospital due to acute exacerbation of COPD were evaluated at hospital admission; 61 at discharge; and finally, 48 patients with stable COPD completed the study and were included in the analysis. Cognitive status was assessed with the Montreal Cognitive Assessment (MoCA). Our results show that all clinical variables improved from exacerbation to discharge COPD. MoCA total score, visuoconstructional, attention, language, abstraction, delayed recall and orientation subscores improved significantly from exacerbation to discharge COPD (p < 0.05). MoCA total score, visuoconstructional and naming subscores worsened significantly from discharge to stable COPD (p < 0.05). Finally, from exacerbation to stable COPD all the clinical variables improved; MoCA total score and naming, attention, language, abstraction and delayed recall subscores have shown significant differences (p < 0.05). Cognitive status of COPD patients is different across clinical stages, and there are cognitive areas with more potential to change than others.
Subject(s)
Cognition , Cognitive Dysfunction/etiology , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/psychology , Aged , Attention , Disease Progression , Female , Humans , Language , Male , Mental Recall , Mental Status and Dementia Tests , Middle Aged , Orientation , Patient Admission , Patient Discharge , Prospective Studies , Severity of Illness IndexABSTRACT
The objective of this study was to analyze the results of a multimodal therapeutic program during hospitalization in obese AECOPD patients. This was a randomized, single-blind clinical trial conducted at two university hospitals in Granada, Spain. Forty-nine patients hospitalized due to AECOPD were randomly allocated to a control group (CG), in which patients received standard care, or to an intervention group (IG), in which patients were included in a multimodal therapeutic program, added to the standard care. The main outcome measures were pulmonary, physical (strength and exercise capacity) and perceived (dyspnea, quality of life and psychological distress) variables. Within-group significant improvements (p < 0.05) were found in physical and perceived variables in the IG after the treatment. In the CG, a significant decrease was found in lower limb strength and a significant improvement in dyspnea and in three subscales of the EuroQol-5D questionnaire. The between-groups analysis showed significant differences after the treatment on lower limb strength and exercise capacity values (p < 0.05), in three of the EuroQol-5D subscales, and in the total score and the depression subscale of the Hospital Anxiety and Depression Scale. A multimodal therapeutic program has a beneficial effect on physical functioning and perceived variables in hospitalized obese patients with AECOPD.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Breathing Exercises/methods , Bronchodilator Agents/therapeutic use , Exercise Therapy/methods , Obesity/therapy , Oxygen Inhalation Therapy/methods , Pulmonary Disease, Chronic Obstructive/therapy , Aged , Aged, 80 and over , Anxiety/psychology , Combined Modality Therapy , Depression/psychology , Disease Progression , Dyspnea/etiology , Dyspnea/physiopathology , Dyspnea/therapy , Exercise Tolerance , Female , Forced Expiratory Volume , Hospitalization , Humans , Male , Middle Aged , Muscle Strength , Obesity/complications , Obesity/physiopathology , Obesity/psychology , Oximetry , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/psychology , Quality of Life , Single-Blind Method , Stress, Psychological/psychology , Surveys and Questionnaires , Treatment OutcomeABSTRACT
BACKGROUND: Frailty is a key issue in the care of elderly patients. Patients with COPD are more likely to be frail, with a prevalence of 57.8%. Frailty is associated with a low level of physical activity. The aim of this study was to analyze the predictive power and identify the cutoffs of physical activity in their different domains (household, leisure time, and sport) for the absence of frailty in subjects with COPD exacerbation and stable COPD. METHODS: A cross-sectional study was conducted. The participants underwent an individual interview, including sociodemographic and clinical aspects. The total physical activity and its domains were assessed by the modified Baecke questionnaire, and frailty was measured according to the modified version of Fried. A total of 212 subjects with COPD (104 stable and 108 with COPD exacerbation) were enrolled, along with 100 healthy subjects. RESULTS: The prevalence of frailty was higher in subjects with COPD compared with the control group. An activity level of 3.54 for COPD exacerbation, 3.88 for stable COPD, and 3.50 for healthy subjects assessed using the Baecke questionnaire were recommended as the cutoff points for frailty. Sensitivity and specificity values were 0.95 and 0.807; 0.95 and 0.815; and 0.95 and 0.947, respectively. CONCLUSIONS: Physical activity level can predict the absence or presence of frailty in subjects with stable and exacerbated COPD.
