INCIDENCE AND OUTCOME OF ADRENAL DYSFUNCTION IN CHILDREN WITH SEPTIC SHOCK

本研究的目的是确定感染性休克患儿肾上腺功能障碍的发生率，并比较有无肾上腺功能障碍患儿的临床结局。 我们假设，与感染性休克和肾上腺反应正常的儿童相比，感染性休克和肾上腺功能不全的儿童死亡率和MOSF增加。 五十六例年龄在一个月至18岁之间的被诊断为感染性休克并且具有动脉或中心静脉导管的患者将有资格入组本研究。 在进入PICU后8小时内，并在获得书面知情同意书后，将对入组研究的每例患者进行ACTH刺激试验。 将在时间0采集并记录基线皮质醇和ACTH水平的血液样本。 在抽取这些基线实验室数据后，将开始静脉输注ACTH（促肾上腺皮质激素，Cortrosyn（R））。 然后在30和60分钟时获得额外的皮质醇水平。 类固醇替代治疗将由初级保健团队决定。 (If患者接受类固醇治疗，则该患者将被排除在本研究的结局分析部分之外。） 在PICU住院期间，将记录患者实验室检查、血流动力学数据和结局数据沿着每日使用的正性肌力药物。 将比较肾上腺功能障碍患者与肾上腺反应正常患者的死亡率、PRISM和结局数据。

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.