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Titolo:
REVERSAL OF LATE SEPTIC SHOCK WITH SUPRAPHYSIOLOGICAL DOSES OF HYDROCORTISONE
Autore:
BOLLAERT PE; CHARPENTIER C; LEVY B; DEBOUVERIE M; AUDIBERT G; LARCAN A;
Indirizzi:
CTR HOSP UNIV,SERV REANIMAT MED,HOP CENT F-54035 NANCY FRANCE CTR HOSP UNIV,SURG INTENS CARE UNIT,HOP CENT F-54035 NANCY FRANCE CTR HOSP UNIV,DEPT NEUROSCI,HOP CENT F-54035 NANCY FRANCE CTR HOSP UNIV,MED INTENS CARE UNIT,HOP CENT F-54035 NANCY FRANCE
Titolo Testata:
Critical care medicine
fascicolo: 4, volume: 26, anno: 1998,
pagine: 645 - 650
SICI:
0090-3493(1998)26:4<645:ROLSSW>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
SEVERE SEPSIS; METHYLPREDNISOLONE; CORTICOTROPIN; METAANALYSIS; STIMULATION; FAILURE;
Keywords:
SEPSIS; SEPTIC SHOCK; CORTICOSTEROIDS; ADRENERGIC RECEPTORS; ADRENAL INSUFFICIENCY; CATECHOLAMINES; VASOMOTOR SYSTEM; SYMPATHETIC NERVOUS SYSTEM;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
35
Recensione:
Indirizzi per estratti:
Citazione:
P.E. Bollaert et al., "REVERSAL OF LATE SEPTIC SHOCK WITH SUPRAPHYSIOLOGICAL DOSES OF HYDROCORTISONE", Critical care medicine, 26(4), 1998, pp. 645-650

Abstract

Objectives: Preliminary studies have suggested that low doses of corticosteroids might rapidly improve hemodynamics in late septic shock treated with catecholamines, We examined the effect of hydrocortisone onshock reversal, hemodynamics, and survival in this particular setting. Design: Prospective, randomized, double-blind, placebo-controlled study. Setting: Two intensive care units of a University hospital. Patients: Forty one patients with septic shock requiring catecholamine for >48 hrs. Interventions: Patients were randomly assigned either hydro cortisone (100 mg iv three times daily for 5 days) or matching placebo. Measurements and Main Results: Reversal of shock was defined by a stable systolic arterial pressure (>90 mm Hg) for greater than or equal to 24 hrs without catecholamine or fluid infusion, Of the 22 hydrocortisone-treated patients and 19 placebo-treated patients, 15 (68%) and 4 (21%) achieved 7-day shock reversal, respectively, a difference of 47%(95% confidence interval 17% to 77%; p=.007). Serial invasive hemodynamic measurements for 5 days did not show significant differences between both groups. At 28 day follow up, reversal of shock was higher in the hydrocortisone group (p=.005). Crude 28-day mortality was 7 (32%) of 22 treated patients and 12 (63%) of 19 placebo patients, a difference of 31% (95% confidence interval 1% to 61%; p=.091). Shock reversal within 7 days after the onset of corticosteroid therapy was a very strong predictor of survival. There were no significant differences in outcome in responders and nonresponders to a short corticotropin test, The respective rates of gastrointestinal bleeding and secondary infections did not differ between both groups. Conclusions: Administration ofmodest doses of hydrocortisone in the setting of pressor-dependent septic shock for a mean of >96 hrs resulted in a significant improvementin hemodynamics and a beneficial effect on survival. These beneficialeffects do not appear related to adrenocortical insufficiency.

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Documento generato il 28/09/20 alle ore 12:17:03