Abstract

LLOMPART-POU, Juan A. et al. Immediate hemodynamic response to steroid treatment in septic shock. Med. Intensiva [online]. 2008, vol.32, n.8, pp.385-390. ISSN 0210-5691.

Objective. Treatment with low dose steroids (LDST) in patients with septic shock treated with vasoactive agents has been related to earlier shock reversal. Patients with low baseline cortisol and a blunted response to the corticotropin test are more likely to benefit from LDST, so we compared the immediate hemodynamic response in patients with septic shock who received LDST with that of those who did not receive LDST. Design. Retrospective study. Scope. Intensive Care Unit (ICU) of a tertiary university hospital. Patients. We studied 96 patients admitted to the ICU. Patients were classified in two groups of 48 patients: group A received LDST and group B did not; patients were matched according to baseline cortisol levels and norepinephrine requirements. Interventions. All patients underwent a short corticotropin test (250 μg ACTH) within 72 h of septic shock onset. Main variables of interest. Baseline cortisol, delta cortisol, peak cortisol, norepinephrine reduction after LDST, and duration of shock. Results. The two groups were comparable: baseline and stimulated cortisol levels before corticotropin test were similar, and there were no differences in the norepinephrine dose before and 24 h after testing adrenal response (p = 0.98 and p = 0.53, respectively). Norepinephrine reduction at 24 h after testing was not correlated with baseline cortisol or with adrenal response to the corticotropin test. Conclusions. LDST was not associated to improved 24-hour hemodynamic response, irrespective of the baseline and stimulated cortisol levels.

Keywords : Cortisol; Septic shock; Hemodynamic response; Adrenal insufficiency; Steroids.

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