Plasma cortisol levels before and during "low-dose" hydrocortisone therapy and their relationship to hemodynamic improvement in patients with septic shock.

摘要: Objectives: To compare cortisol levels during "low-dose" hydrocortisone therapy to basal and ACTH-stimulated endogenous assess whether clinical course the need for catecholamines depend on and/or pretreatment adrenocortical responsiveness. Design setting: Prospective observational study in a medical ICU of university hospital. Patients: Twenty consecutive patients with septic shock cardiac index 3.5 l/min or higher, started (100 mg bolus, 10 mg/h 7 days subsequent tapering) within 72 h onset shock. Measurements results: Basal total free plasma ranged from 203 2169 17 372 nmol/l. In 11 production was considered "inadequate" because there neither response ACTH at least 200 nmol/l nor baseline level 1000 nmol/l. Following initiation increased 4.2- 8.5-fold median 3587 (interquartile range 2679–5220) 1210 750–1846) nmol/l day 1, thereafter declined 1310 nmol/l 345 nmol/l 7. Patients steroid could be weaned vasopressor significantly faster, although their concentrations treatment period did not differ. Conclusions: (a) During proposed regimens therapy, initially achieved considerably exceed stimulated levels. (b) Cortisol decline subsequently, despite continuous application constant dose. (c) "Inadequate" appears sensitize hemodynamic effects "therapeutic rise"