Postoperative systemic inflammatory dysregulation and corticosteroids : a narrative review

C. R. Bain, P. S. Myles, T. Corcoran, J. M. Dieleman

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)

Abstract

In some patients, the inflammatory-immune response to surgical injury progresses to a harmful, dysregulated state. We posit that postoperative systemic inflammatory dysregulation forms part of a pathophysiological response to surgical injury that places patients at increased risk of complications and subsequently prolongs hospital stay. In this narrative review, we have outlined the evolution, measurement and prediction of postoperative systemic inflammatory dysregulation, distinguishing it from a healthy and self-limiting host response. We reviewed the actions of glucocorticoids and the potential for heterogeneous responses to peri-operative corticosteroid supplementation. We have then appraised the evidence highlighting the safety of corticosteroid supplementation, and the potential benefits of high/repeated doses to reduce the risks of major complications and death. Finally, we addressed how clinical trials in the future should target patients at higher risk of peri-operative inflammatory complications, whereby corticosteroid regimes should be tailored to modify not only the a priori risk, but also further adjusted in response to markers of an evolving pathophysiological response.
Original languageEnglish
Pages (from-to)356-370
Number of pages15
JournalAnaesthesia
Volume78
Issue number3
DOIs
Publication statusPublished - Mar 2023

Open Access - Access Right Statement

© 2022 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Fingerprint

Dive into the research topics of 'Postoperative systemic inflammatory dysregulation and corticosteroids : a narrative review'. Together they form a unique fingerprint.

Cite this