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Multimodal analysis of the effects of dexamethasone on high-altitude cerebral oedema : protocol for a pilot study
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Fisher, O., Benson, R. A., Wayte, S., Kimani, Peter K., Hutchinson, Charles E. and Imray, C. (Chris) (2019) Multimodal analysis of the effects of dexamethasone on high-altitude cerebral oedema : protocol for a pilot study. Trials, 20 (1). p. 604. doi:10.1186/s13063-019-3681-0
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Official URL: http://dx.doi.org/10.1186/s13063-019-3681-0
Abstract
Background
Acute mountain sickness (AMS) is a cluster of symptoms that commonly occur in those ascending to high altitudes. Symptoms can include headaches, nausea, insomnia and fatigue. Exposure to high altitude can also lead to high-altitude cerebral oedema (HACE), which is a potential cause of death whilst mountaineering. Generally, AMS precedes the development of HACE. Historical studies have demonstrated the effectiveness of regular dexamethasone administration in reducing the symptoms of AMS. However, the mechanism by which dexamethasone works to reduce symptoms AMS remains poorly understood. Further studies, simulating altitude using hypoxic tents, have characterised the effect of prolonged exposure to normobaric hypoxia on cerebral oedema and blood flow using MRI. This randomised trial assesses the effect of dexamethasone on hypoxia-induced cerebral oedema in healthy adult volunteers.
Methods/design
D4H is a double-blind placebo-controlled randomised trial assessing the effect of dexamethasone on hypoxia-induced cerebral oedema. In total, 20 volunteers were randomised in pairs to receive either 8.25 mg dexamethasone or normal saline placebo intravenously after 8 h of hypoxia with an FiO2 of 12%. Serial MRI images of the brain and spinal cord were obtained at hours 0, 7, 11, 22 and 26 of the study along with serum and urinary markers to correlate with the severity of cerebral oedema and the effect of the intervention.
Discussion
MRI has been used to identify changes in cerebral vasculature in the development of AMS and HACE. Dexamethasone is effective at reducing the symptoms of AMS; however, the mechanism of this effect is unknown. If this study demonstrates a clear objective benefit of dexamethasone in this setting, future studies may be able to demonstrate that dexamethasone is an effective therapy for oedema associated with brain and spinal cord ischaemia beyond AMS.
| Item Type: | Journal Article | |||||||||
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| Subjects: | Q Science > QP Physiology | |||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School | |||||||||
| SWORD Depositor: | Library Publications Router | |||||||||
| Library of Congress Subject Headings (LCSH): | Altitude, Influence of -- Research, Human beings -- Effect of environment on, Anoxemia, Cerebral edema | |||||||||
| Journal or Publication Title: | Trials | |||||||||
| Publisher: | Biomed Central | |||||||||
| ISSN: | 1745-6215 | |||||||||
| Official Date: | 24 October 2019 | |||||||||
| Dates: |
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| Date of first compliant deposit: | 12 December 2019 | |||||||||
| Volume: | 20 | |||||||||
| Number: | 1 | |||||||||
| Page Range: | p. 604 | |||||||||
| DOI: | 10.1186/s13063-019-3681-0 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Publisher Statement: | ** From Europe PMC via Jisc Publications Router ** History: ppub 01-10-2019; epub 24-10-2019. ** Licence for this article: cc by | |||||||||
| Access rights to Published version: | Open Access | |||||||||
| RIOXX Funder/Project Grant: |
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