The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function
The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function
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DOI：
10.1097/01.ccm.0000146133.52982.17
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发表时间：
2004-11-01
影响因子：
8.8
通讯作者：
Durbin, D
中科院分区：
文献类型：
--
作者：
Zuppa, AF;Nadkarni, V;Durbin, D
目标。为了确定甲状腺激素输注（T4）对器官恢复评估中神经功能停止（即脑死亡）儿童血管加压素需求的影响设计：回顾性队列研究。1998-2002年地区器官恢复计划数据库。在器官恢复评估期间伴有神经功能停止的小于或等于18岁的儿童（n = 171）被纳入。治疗组（91例）按器官采购机构方案按体重给药并持续输注T4。所有其他儿童（n = 80）被认为未经治疗。干预措施：根据临床医生的判断给予T4。所有儿童（治疗和未治疗）的体液、血压和器官功能标准目标相同。记录介入治疗时（T-O）和器官恢复时（T-OR）的血管加压素评分（[多巴胺x 1] +[多巴酚丁胺x 1] +[肾上腺素x 100] +[去甲肾上腺素x 100] +[苯肾上腺素x 100]）。使用Wilcoxon秩和和Student's双样本检验比较T-O和T-OR时的平均血管加压素评分。采用Wilcoxon符号秩检验分析T-O和T-OR时血管加压素中位评分的差异。多变量线性回归用于评估T4对断奶血管加压剂支持能力的影响，同时考虑几个潜在混杂因素的影响。测量方法和主要结果：最终分析纳入171名受试者。给予T4与血管加压素评分32分的未校正下降相关（95%可信区间，12-53;p = 0.002）。在调整类固醇给药、体液平衡和基线血管加压评分后，T4给药与血管加压评分降低相关（95%可信区间，6-43;P = 0.011）。结论：T4降低了神经功能停止和血流动力学不稳定儿童的血管加压素需求。在危重症和血流动力学不稳定的儿童中进行T4的前瞻性研究似乎是必要的。
Objective. To determine the impact of a thyroid hormone infusion (T4) on the vasopressor requirements in children with cessation of neurologic function (i.e., brain death) during evaluation for organ recoveryDesign: Retrospective cohort study.Setting. The 1998-2002 database of a regional organ recovery program.Patients. Children less than or equal to18 yrs with cessation of neurologic function during evaluation for organ recovery (n = 171) were included. The treated group (n = 91) received a weight-based bolus and continuous infusion of T4 according to the organ procurement agency protocol. All other children (n = 80) were considered untreated.Interventions: T4 was administered at the clinician's discretion. All children (treated and untreated) had identical goals for fluids, blood pressure, and organ function criteria. Vasopressor score ([dopamine x 1] + [dobutamine x 1] + [epinephrine x 100] + [norepinephrine x 100] + [phenylephrine x 100]) at the time of the program's involvement (T-O) and at organ recovery (T-OR) were recorded. The Wilcoxon rank sum and Student's two-samplet-test were used to compare the average vasopressor score at T-O vs. T-OR. The Wilcoxon signed rank test was used to analyze the difference in median vasopressor score at T-O vs. T-OR. Multivariable linear regression was used to assess the impact of T4 on the ability to wean vasopressor support while accounting for the effects of several potential confounders.Measurements and Main Results: One hundred seventy-one subjects were included in the final analysis. T4 administration was associated with an unadjusted decrease in the vasopressor score of 32 (95% confidence interval, 12-53; p =.002). After adjusting for steroid administration, fluid balance, and baseline vasopressor score, T4 administration was associated with a decrease in vasopressor score of 24 (95% confidence interval, 6-43; P =.011).Conclusions: T4 reduced vasopressor needs in children with cessatIon of neurologic function and hemodynamic instability. A prospective study of T4 in critically ill and hemodynamically unstable children appears warranted.