Effect Of Low Dose Hydrocortisone On Duration Of Vasopressor Therapy In Septic Shock
Effect Of Low Dose Hydrocortisone In Septic Shock
DOI:
https://doi.org/10.70284/njirm.v5i1.2270Keywords:
Corticosteroids, management, sepsisAbstract
Background & objectives:Severe sepsis and septic shock are major health problems. Stress dose of hydrocortisone infusion reduces the time of cessation of vasopressor therapy in septic shock. This study was planned to see the role of low dose corticosteroids on duration of vasopressor therapy in patients with septic shock along with their outcome. Methods: The study was carried out in 40 patients of septic shock. The patients were randomized into two groups i.e. treatment (Group A) and the placebo (Group B) groups of 20 each. Both groups received antibiotics, vasopressors i.e. Dopamine and Norepinephrine and IV fluids along with low dose hydrocortisone being administered only to Group A. Mean values were compared statistically using t-test and z-test. Results: The mean time spent in shock (hours) in survivors was 44.00 ± 11.2 (p< 0.001) while in group B was 72.00 ± 0.00 (p< 0.05). Also, the number of survivors in group A was more with cortisol levels of 5-25 mcg/ml. Interpretation & conclusion:Low dose hydrocortisone reduced the time spent in shock in survivors of group A, thereby reducing duration of vasopressor therapy. It also reduced mortality in subgroup of patients with serum cortisol levels of 5-25 mcg/ml proving that moderately low cortisol levels are benefitted more with hydrocortisone therapy than those with relatively high cortisol levels
References
2. Dellinger RP: Cardiovascular management of septic shock. Crit Care Med 2003; 31: 946–55.
3. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29(7):1303-10.
4. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010; 362(23): 2155-65.
5. Beale R, Reinhart K, Brunkhorst FM, Dobb G, Levy M, Martin G, et al. Promoting Global Research Excellence in Severe Sepsis (PROGRESS): lessons from an international sepsis registry. Infection 2009; 37(3): 222-32.
6. Confalonieri M, Urbino R, Potena A, et al: Hydrocortisone infusion for severe community-acquired pneumonia: A preliminary randomized study. Am J Respir Crit Care Med 2005; 171: 242–48.
7. Meijvis SC, Hardeman H, Remmelts HH, Heijligenberg R, Rijkers GT, van Velzen-Blad H, et al. Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: A randomised, double-blind, placebo-controlled trial. Lancet 2011; 377: 2023–30.
8. Briegel J, Forst H, Haller M, Schelling G, Kilger E, Kuprat G, et al. Stress doses of hydrocortisone
reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single-center study. Crit Care Med 1999; 27(4): 723-32.
9. Adapted from Levy MM, Fink MP, Marshall JC, et al: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31:1250–6.
10. Chrousos GP: The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N Engl J Med 1995; 322(20):1351- 62.
11. Mesotten D, Vanhorebeek I, Van den Berghe G: The altered adrenal axis and treatment with glucocorticoids during critical illness. Nat Clin Pract Endocrinol Metab 2008, 4(9): 496-505.
12. Meduri GU, Muthiah MP, Carratu P, Eltorky M, Chrousos GP: Nuclear factor-kappaB- and glucocorticoid receptor alpha- mediated mechanisms in the regulation of systemic and pulmonary inflammation during sepsis and acute respiratory distress syndrome. Evidence for inflammation-induced target tissue resistance to glucocorticoids. Neuroimmunomodulation 2005, 12(6):321- 38.
13. Prigent H, Maxime V, Annane D: Science review: mechanisms of impaired adrenal function in sepsis and molecular actions of glucocorticoids. Crit Care 2004; 8(4): 243-52.
14. Rhen T, Cidlowski JA: Antiinflammatory action of glucocorticoids: new mechanisms for old drugs. N Engl J Med 2005; 353:1711- 23.
15. Annane D, Sébille V, Charpentier C, Bollaert PE, François B, Korach JM, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002; 288(7): 862-71.