Adrenal exhaustion in septic patients with vasopressor dependency
Adrenal exhaustion in septic patients with vasopressor dependency
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DOI：
10.1016/j.jcrc.2007.05.003
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发表时间：
2007-12-01
影响因子：
3.7
通讯作者：
Guzman, Cristina B.
中科院分区：
文献类型：
--
作者：
Guzman, Jorge A.;Guzman, Cristina B.
目的：建议对充分液体复苏后仍依赖血管升压剂的感染性休克患者使用小剂量皮质类固醇，但对于如何诊断相对肾上腺皮质功能不全(RAI)以及何时开始补充类固醇缺乏共识。本病例系列报道了血管加压剂依赖型败血症休克过程中皮质醇浓度的变化。方法：在一所大学医院的内科重症监护病房进行观察研究。对连续入院的成年血管加压药依赖型败血症休克患者进行了研究。记录感染性休克过程中不同时间的临床数据、皮质醇浓度和加压药剂量，并以平均+/-SD表示。结果：纳入13例患者。平均年龄59岁+/-15岁。平均基础非刺激性皮质醇水平为41.7+/-30.9µg/dL(除2例患者外，其余患者均在重症监护病房入院后24小时内)。8名患者开始使用类固醇，在获得皮质醇水平并排除RAI后停用。由于无法停止血管加压药支持，皮质醇测试在最初评估的6.2+/-4.8天后再次进行。重复浓度为10.0+/-6.3微克/分升(P<；.001)。然后再次使用激素，1.5+/-1.4天后血管升压药依赖得到缓解。结论：危重患者的肾上腺功能是一个动态过程，适当的初始肾上腺反应不排除RAI的进一步发展。(C)2007 Elsevier Inc.保留所有权利。
Purpose: The use of low-dose corticosteroids for patients with septic shock who remain vasopressor dependent after adequate fluid resuscitation is recommended, but there is lack of agreement on how to diagnose relative adrenal insufficiency (RAI) and when to start steroid supplementation among these patients. This case series reports changes in cortisol concentrations during the course of vasopressor-dependent septic shock.Methods: Observational study was performed at a university hospital medical intensive care unit. Consecutive adult patients with vasopressor-dependent septic shock admitted to the medical intensive care unit were studied. Clinical data, cortisol concentrations, and dose of vasopressor agents at different times during the course of septic shock were recorded and reported as mean +/- SD.Results: Thirteen patients were included. Mean age was 59 +/- 15 years. Mean basal nonstimulated cortisol level was 41.7 +/- 30.9 mu g/dL (within 24 hours of intensive care unit admission in all but 2 patients). Steroids were initiated in 8 patients and then discontinued after cortisol values were obtained and RAI was ruled out. Because of inability to discontinue vasopressor support, cortisol testing was repeated after 6.2 +/- 4.8 days of initial assessment. Repeated concentrations were 10.0 +/- 6.3 mu g/dL (P < .001). Steroids were then reinitiated, and resolution of vasopressor dependence was achieved 1.5 +/- 1.4 days later.Conclusions: Adrenal function in the critically ill is a dynamic process, and an appropriate initial adrenal response does not preclude later development of RAI. (c) 2007 Elsevier Inc. All rights reserved.