INCIDENCE AND OUTCOME OF ADRENAL DYSFUNCTION IN CHILDREN WITH SEPTIC SHOCK

本研究的目的是确定被诊断为感染性休克的儿童肾上腺功能障碍的发生率，并比较伴有和不伴有肾上腺功能障碍的儿童的临床结果。我们假设，与感染性休克和肾上腺反应正常的儿童相比，被诊断为感染性休克和肾上腺功能不全的儿童死亡率和MOF增加。年龄从1个月到18岁不等的56名患者被诊断为感染性休克，并安装了动脉或中心静脉导管，将有资格参加这项研究。在进入PICU的8小时内，并在获得书面知情同意后，将对每个参与研究的患者进行ACTH刺激测试。将在时间0抽取并记录基线皮质醇和ACTH水平的血样。在这些基线实验室完成后，将开始静脉输注ACTH(促肾上腺皮质激素释放激素，Cortrosyn(R))。然后在30分钟和60分钟时获得额外的皮质醇水平。类固醇替代疗法的治疗将由初级保健团队自行决定。(如果患者接受类固醇治疗，则该患者将被排除在本研究的结果分析部分之外。)在PICU住院期间，将记录患者实验室、血流动力学数据和结果数据以及肌力调节剂的日常使用情况。死亡率、PRISM和预后数据将在肾上腺功能障碍患者和肾上腺反应正常患者之间进行比较。我们目前已经招募了必要的56名研究参与者中的7名患者。

The purpose of this study is to determine the incidence of adrenal dysfunction in pediatric patients diagnosed with septic shock and to compare the clinical outcome of children with and without adrenal dysfunction. We hypothesize that children diagnosed with septic shock and adrenal dysfunction have increased mortality and MOSF compared with those with septic shock and normal adrenal response. Fifty-six patients ranging in age from one month to 18 years diagnosed wih septic shock and who have an arterial or central venous catheter in place will be eligible for enrollment in the study. Within 8 hours of admission to the PICU, and after written informed consent is obtained, an ACTH stimulation test will be performed on each patient enrolled in the study. A blood sample for a baseline cortisol and ACTH level will be drawn and recorded at time 0. After these baseline labs are drawn, an intravenous infusion of ACTH (Cosyntropin, Cortrosyn(R)) will be started. Additional cortisol levels will then be obtained at 30 and 60 minutes. Treatment with steroid replacement therapy will be at the discretion of the primary care team. (If the patient is given steroid therapy, then this patient will be excluded from the outcome analysis part of this study.) While hospitalized in the PICU, patient laboratory, hemodynamic data, and outcome data along with daily use of inotropes will be recorded. Mortality rate, PRISM, and outcome data will be compared between patients to with adrenal dysfunction vs. those with normal adrenal response. We have currently enrolled 7 patients out of the necessary 56 study participants.