Effects of Dexamethasone on Pulmonary Oxygenation Impairment | 45831

Journal of Neurology & Neurophysiology

ISSN - 2155-9562


Effects of Dexamethasone on Pulmonary Oxygenation Impairments in Therapeutic Hypothermia for Patients with Traumatic Brain Injury

Mayuki Aibiki, Kensuke Umakoshi, Saori Ohtsubo, Satoshi Kikuchi, Hironori Matsumoto, Muneaki Ohshita, Soichi Maekawa and Takashi Nishiyama

Objectives: We studied retrospectively to examine differences in the occurrence rate of pneumonia and the
time-course changes in pulmonary oxygenation between hypothermic and normothermic therapies with or without
dexamethasone (D) administration in patients with traumatic brain injury (TBI).
Design: A retrospective observational study.
Setting: Two university hospitals.
Subjects and Methods: In consecutive TBI patients (GCS ≤ 8) treated with hypothermic (N=23, 32-33°C) or
normothermic (N=16, 36-37.5°C) therapy, the occurrence rate of pneumonia, PaO2/FIO2 (P/F) ratios and C-reactive
protein (CRP) levels were examined. The comparisons were made among hypothermic and normothermic groups
with or without D administration. In several patients in both groups, neutrophil functions were examined. Data were
analyzed with ANOVA followed by Sheffe’s F-test, Mann-Whitney U-test, Kruskal-Wallis tests or chi-squared test
(p<0.05) as appropriate.
Results: The occurrence rate of pneumonia in a hypothermic group with D administration was significantly
lower than in a hypothermic group without D. In the hypothermic group without D treatment, CRP elevation during
the rewarming phase occurred, which was followed by more severe P/F ratio deteriorations as compared to the
hypothermic group given D. Neutrophil phagocytic functions in hypothermic patients without D were activated
around 35°C, which were followed by marked decreases in pulmonary oxygen. In contrast, phagocytic function in a
hypothermic patient receiving D was depressed, but without P/F ratios below 280.
Conclusion: This study poses hypotheses that neutrophils play a role in the pulmonary oxygenation impairment in
hypothermic therapy for TBI patients, and that dexamethasone improves the pulmonary complications in therapeutic