Defining normal adrenal function testing in the intensive care unit setting: a canine study.
Defining normal adrenal function testing in the intensive care unit setting: a canine study.
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定义重症监护病房环境中的正常肾上腺功能测试：一项犬类研究。
DOI：
10.1097/ccm.0b013e3181cb0a25
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发表时间：
2010
影响因子：
8.8
通讯作者：
Behrend,EllenN
中科院分区：
文献类型：
--
作者：
Sweeney,DanielA;Natanson,Charles;Banks,StevenM;Solomon,StevenB;Behrend,EllenN
目的：确定重症监护药物治疗和检测是否影响下丘脑-垂体-肾上腺试验结果。这是常规的重症监护医学来衡量下丘脑-垂体-肾上腺功能，通常利用促肾上腺皮质激素刺激试验来诊断绝对或相对adrenocorticotropic hormone sufficiency.Design：前瞻性，96小时动物study.Setting：Research laboratory.Subjects：Twenty-four healthy canines.Interventions：动物被随机分为两组清醒和不受限制或重症监护药物治疗，包括镇静，插管和机械通气。动物进一步随机接受地塞米松（或安慰剂）或在96小时内接受总共四次或七次促肾上腺皮质激素刺激试验。测量和主要结果：镇静、插管和机械通气在前24小时内与基线相比短暂增加了基础和后促肾上腺皮质激素总浓度和游离皮质醇浓度> 2倍（p≤. 05两人）。在96小时的研究期间，7次刺激试验使基础和后促肾上腺皮质激素总浓度和游离皮质醇浓度均较基线增加> 1.5倍（p≤. 05）。无论是镇静，插管，机械通气，也没有更多的刺激测试的性能影响δ皮质醇测量（总或游离皮质醇，p= NS）。相比之下，地塞米松抑制基础总皮质醇浓度> 2倍（p≤. 005)并且在研究的前24小时内短暂增加δ总皮质醇约35%（p≤.结论：总皮质醇和游离皮质醇测量值--无论是促肾上腺皮质激素前或后，还是作为计算的δ--都被重症监护治疗或频繁的促肾上腺皮质激素刺激试验改变，只有一个例外。δ游离皮质醇是唯一不受镇静、插管和机械通气、完成更多促肾上腺皮质激素刺激试验或地塞米松治疗影响的下丘脑-垂体-肾上腺测量值。这些发现支持在建立诊断相对肾上腺功能不全的实验室标准之前，需要确定接受重症监护药物的受试者的下丘脑-垂体-肾上腺试验的正常范围。
Objective:To determine whether intensive care medicine therapies and testing influence hypothalamic-pituitary-adrenal test results. It is routine in intensive care medicine to measure hypothalamic-pituitary-adrenal function, commonly utilizing the adrenocorticotropic hormone stimulation test to diagnose absolute or relative adrenal insufficiency.Design:Prospective, 96-hr animal study.Setting:Research laboratory.Subjects:Twenty-four healthy canines.Interventions:Animals were randomized into two groups—awake and unrestrained or treated with intensive care medicine therapies, including sedation, intubation, and mechanical ventilation. Animals were further randomized to receive dexamethasone (or placebo) or undergo either a total of four or seven adrenocorticotropic hormone stimulation tests over 96 hrs.Measurements and Main Results:Sedation, intubation, and mechanical ventilation transiently increased both basal and postadrenocorticotropic hormone total and free cortisol concentrations> 2-fold as compared with baseline for the first 24 hrs (p≤. 05 for both). Performance of seven stimulation tests increased both basal and postadrenocorticotropic hormone total and free cortisol concentrations from baseline by> 1.5-fold for the duration of the 96-hr study (p≤. 05). Neither sedation, intubation, and mechanical ventilation nor the performance of more stimulation tests affected delta cortisol measurements (total or free cortisol, p= NS). In contrast, dexamethasone suppressed basal total cortisol concentrations by> 2-fold (p≤. 005) at all time points and transiently increased delta total cortisol by approximately 35% during the first 24 hrs of the study (p≤. 05).Conclusions:Total and free cortisol measurements—whether pre-or post-adrenocorticotropic hormone or as a calculated delta—were altered by intensive care therapies or frequent adrenocorticotropic hormone stimulation testing with one exception. Delta free cortisol was the only hypothalamic-pituitary-adrenal measurement unaffected by sedation, intubation, and mechanical ventilation, completion of more adrenocorticotropic hormone stimulation tests, or dexamethasone therapy. These findings support the need to determine normal ranges for hypothalamic-pituitary-adrenal testing in subjects receiving intensive care medicine before establishing laboratory criteria for the diagnosis of relative adrenal insufficiency.