Adjunctive Hydrocortisone Improves Hemodynamics in Critically Ill Patients with Septic Shock: An Observational Study Using Transpulmonary Thermodilution

被引：1

作者：

Jochheim, Leonie ^{[1
]}

Jochheim, David ^{[2
]}

Habenicht, Livia ^{[3
]}

Herner, Alexander ^{[3
]}

Ulrich, Joerg ^{[3
]}

Wiessner, Johannes ^{[3
]}

Heilmaier, Markus ^{[3
]}

Rasch, Sebastian ^{[3
]}

Schmid, R. M. ^{[3
]}

Lahmer, T. ^{[3
]}

Mayr, Ulrich ^{[3
]}

机构：

[1] Uniklinikum Essen, Klin Gastroenterol & Hepatol, Essen, Germany

[2] Med Versorgungszentrum MVZ Jochheim Med, Hattingen, Germany

[3] Tech Univ Munich, Med Klin & Poliklin 2, Klinikum Rechts Isar, Ismaninger Str 22, D-81675 Munich, Germany

来源：

JOURNAL OF INTENSIVE CARE MEDICINE | 2023年 / 38卷 / 08期

关键词：

septic shock; hydrocortisone; transpulmonary thermodilution; intensive care unit; vasopressor dependency index; cardiac power index; EXTRAVASCULAR LUNG WATER; INTERNATIONAL CONSENSUS DEFINITIONS; SEVERE SEPSIS; CARDIAC POWER; MORTALITY; FLUDROCORTISONE; GUIDELINES; MANAGEMENT; CARE;

D O I：

10.1177/08850666231160664

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Introduction: Septic shock is associated with high mortality and hemodynamic impairment. The use of corticoids is a common therapeutic tool in critically ill patients. However, data on the mechanisms and prognostic ability of hemodynamic improvement by adjunctive steroids are rare. This study primarily aimed to evaluate short-term effects of hydrocortisone therapy on catecholamine requirement and hemodynamics derived from transpulmonary thermodilution (TPTD) in 30 critically ill patients with septic shock and a 28 days mortality rate of 50%. Methods: Hydrocortisone was administered with an intravenous bolus of 200 mg, followed by a continuous infusion of 200 mg per 24 h. Hemodynamic assessment was performed immediately before as well as 2, 8, 16, and 24 h after the initiation of corticoids. For primary endpoint analysis, we evaluated the impact of hydrocortisone on vasopressor dependency index (VDI) and cardiac power index (CPI). Results: Adjunctive hydrocortisone induced significant decreases of VDI from 0.41 (0.29-0.49) mmHg(-1) at baseline to 0.35 (0.25-0.46) after 2 h (P < .001), 0.24 (0.12-0.35) after 8 h (P < .001), 0.18 (0.09-0.24) after 16 h (P < .001) and 0.11 (0.06-0.20) mmHg(-1) after 24 h (P < .001). In parallel, we found an improvement in CPI from 0.63 (0.50-0.83) W/m(2) at baseline to 0.68 (0.54-0.85) after 2 h (P = .208), 0.71 (0.60-0.90) after 8 h (P = .033), 0.82 (0.6-0.98) after 16 h (P = .004) and 0.90 (0.67-1.07) W/m(2) after 24 h (P < .001). Our analyses revealed a significant reduction in noradrenaline requirement in parallel with a moderate increase in mean arterial pressure, systemic vascular resistance index, and cardiac index. As a secondary endpoint, our results showed a significant decrease in lung water parameters. Moreover, changes in CPI (Delta CPI) and VDI (Delta VDI) after 24 h of hydrocortisone therapy revealed accurate prognostic ability to predict 28 days mortality (AUC = 0.802 vs 0.769). Conclusion: Adjunctive hydrocortisone leads to a rapid decrease in catecholamine requirement and a substantial circulatory improvement in critically ill patients with septic shock.

引用

页码：717 / 726

页数：10