Document Detail


Low-dose hydrocortisone improves shock reversal and reduces cytokine levels in early hyperdynamic septic shock.
MedLine Citation:
PMID:  16276166     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To investigate the effect of low-dose hydrocortisone on time to shock reversal, the cytokine profile, and its relation to adrenal function in patients with early septic shock. DESIGN: Prospective, randomized, double-blind, single-center study. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Forty-one consecutive patients with early hyperdynamic septic shock. INTERVENTIONS: After inclusion and a short adrenocorticotropic hormone test, all patients were randomized to receive either low-dose hydrocortisone (50-mg bolus followed by a continuous infusion of 0.18 mg/kg body of weight/hr) or matching placebo. After shock reversal, the dose was reduced to 0.06 mg/kg/hr and afterward slowly tapered. Severity of illness was estimated using Acute Physiology and Chronic Health Evaluation II score and Sequential Organ Failure Assessment score. MEASUREMENTS AND MAIN RESULTS: Time to cessation of vasopressor support (primary end point) was significantly shorter in hydrocortisone-treated patients compared with placebo (53 hrs vs. 120 hrs, p < .02). This effect was more profound in patients with impaired adrenal reserve. Irrespective of endogenous steroid production, cytokine production was reduced in the treatment group with lower plasma levels of interleukin-6 and a diminished ex vivo lipopolysaccharide-stimulated interleukin-1 and interleukin-6 production. Interleukin-10 levels were unaltered. Adverse events were not more frequent in the treatment group. CONCLUSIONS: Treatment with low-dose hydrocortisone accelerates shock reversal in early hyperdynamic septic shock. This was accompanied by reduced production of proinflammatory cytokines, suggesting both hemodynamic and immunomodulatory effects of steroid treatment. Hemodynamic improvement seemed to be related to endogenous cortisol levels, whereas immune effects appeared to be independent of adrenal reserve.
Authors:
Michael Oppert; Ralf Schindler; Claudia Husung; Katrin Offermann; Klaus-Jürgen Gräf; Olaf Boenisch; Detlef Barckow; Ulrich Frei; Kai-Uwe Eckardt
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Critical care medicine     Volume:  33     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-08     Completed Date:  2005-12-06     Revised Date:  2007-05-24    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2457-64     Citation Subset:  AIM; IM    
Affiliation:
Department of Nephrology and Medical Intensive Care, Charite Universitätsmedizin Berlin, Humboldt University, Berlin, Germany.
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MeSH Terms
Descriptor/Qualifier:
APACHE
Anti-Inflammatory Agents / therapeutic use*
Blood Pressure / drug effects
Cytokines / biosynthesis,  blood*
Dose-Response Relationship, Drug
Double-Blind Method
Female
Heart Rate / drug effects
Humans
Hydrocortisone / administration & dosage,  therapeutic use*
Male
Middle Aged
Shock, Septic / blood,  classification,  drug therapy*
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Cytokines; 50-23-7/Hydrocortisone
Comments/Corrections
Comment In:
Pediatr Crit Care Med. 2007 Mar;8(2):174-6   [PMID:  17273119 ]
Crit Care Med. 2005 Nov;33(11):2683-4   [PMID:  16276199 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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