Timing,method and discontinuation of hydrocortisone administration for septic shock patients

• 作者: Claudia I Reynoso-Estrella Guadalupe Aguirre-Avalos Jorge Rios-Zermeno Miguel A García-Soto Miguel A Ibarra-Estrada Pável E Aguilera-González Quetzalcoatl Chavez-Pena
• 来源期刊: 世界重症医学杂志
• 学科: 医学
• 关键词: CORTICOSTEROIDS Hydrocortisone TIMING ADMINISTRATION DISCONTINUATION SEPTIC shock
• 年，卷（期）: 2017,（1）
• 页码范围: 65-73
• 页数: 9页
• 分类号: R

摘要

AIM To characterize the prescribing patterns for hydrocortisone for patients with septic shock and perform an exploratory analysis in order to identify the variables associated with better outcomes.METHODS This prospective cohort study included 59 patients with septic shock who received stress-dose hydrocortisone.It was performed at 2 critical care units in academic hospitals from June 1st,2015,to July 31st,2016.Demographic data,comorbidities,medical management details,adverse effects related to corticosteroids,and outcomes were collected after the critical care physician indicated initiation of hydrocortisone.Univariate comparison between continuous and bolus administration of hydrocortisone was performed,including multivariate analysis,as well as Kaplan-Meier analysis to compare the proportion of shock reversal at 7 d after presentation.Receiver operating characteristic(ROC)curves determined the best cut-off criteria for initiation of hydrocortisone associated with the highest probability of shock reversal.We addressed the effects of the taper strategy for discontinuation of hydrocortisone,noting risk of shock relapse and adverse effects.RESULTS All-cause 30-d mortality was 42%.Hydrocortisone was administered as a continuous infusion in 54.2%of patients;time to reversal of shock was 49 h longer in patients who were given a bolus administration[59 h(range,47.5-90.5)vs 108 h(range,63.2-189);P=0.001].The maximal dose of norepinephrine after initiation of hydrocortisone was lower in patients on continuous infusion[0.19μg/kg per minute(range,0.11-0.28μg)]compared with patients who were given bolus[0.34μg/kg per minute(range,0.16-0.49);P=0.004].Kaplan-Meier analysis revealed a higher proportion of shock reversal at 7 d in patients with continuous infusion compared to those given bolus(83%vs 63%;P=0.004).There was a good correlation between time to initiation of hydrocortisone and time to reversal of shock(r=0.80;P<0.0001);ROC curve analysis revealed that the best criteria for prediction of shock reversal was a tim