Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients
Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients
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DOI：
10.1001/archsurg.143.1.62
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发表时间：
2008-01-01
影响因子：
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通讯作者：
Arbogast, Patrick G.
中科院分区：
文献类型：
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作者：
Cotton, Bryan A.;Guillamondegui, Oscar D.;Arbogast, Patrick G.
背景：肾上腺功能不全（AI）的及时诊断和治疗可显著降低创伤患者的死亡率.设计：回顾性登记研究，设置：学术一级创伤中心，患者：重症监护室的所有创伤患者，从2002年1月1日到2004年12月31日，他们接受了促肾上腺皮质激素刺激试验（CST），以推测AI。促肾上腺皮质激素刺激试验，其中反应定义为增加9 μ g/dL结果：137例危重创伤患者行CST检查，其中137例患者的皮质醇水平在248 nmol/L以上，137例患者的皮质醇水平在248 nmol/L以上，137例患者的皮质醇水平在248 nmol/L以上。83例（60.6%）为无应答者，54例（39.4%）为应答者。年龄、性别、种族、创伤机制、损伤严重度评分和修订的创伤评分在组间无统计学差异。两组的脓毒症/脓毒性休克、机械通气和死亡率也相似。然而，无应答组入院时出血性休克的发生率（45 [54%] vs 16 [30%]）、血管加压药支持的需要率（65 [78%] vs 28 [52%]）和咪哒唑胺暴露率（59 [71%] vs 28 [52%]）均显著高于无应答组（P
Background:: Timely diagnosis and treatment of adrenal insufficiency (AI) dramatically reduces mortality in trauma patients. We sought to identify risk factors and populations with a high risk of developing AI.Design: Retrospective registry study.Setting: Academic level I trauma center.Patients: All trauma patients in the intensive care unit who underwent cosyntropin stimulation testing (CST) for presumed AI from January 1, 2002, through December 31, 2004.Intervention: Cosyntropin stimulation testing, in which response was defined as an increase of 9 mu g/dL (248 nmol/L) or more in cortisol level.Main Outcome Measure: Risk factors for developing AI in critically ill trauma patients.Results:: In 137 patients, CST was performed; 83 (60.6%) were nonresponders and 54 (39.4%) were responders. Age, sex, race, trauma mechanism, Injury Severity Score, and Revised Trauma Score were not statistically different between the groups. Rates of sepsis/septic shock, mechanical ventilation, and mortality were also similar between the 2 groups. However, rates of hemorrhagic shock on admission (45 [54%] vs 16 [30%]), requirement of vasopressor support (65 [78%] vs28 [52%]), andetomidateexposure (59 [71%] vs28 [52%]) were all significantly higher in the nonresponder group (P