Hydrocortisone Therapy for Patients With Multiple Trauma

Abstract

clinicaltrials.gov Identifier: NCT00563303.

Etomidate increases susceptibility to pneumonia in trauma patients

“…This study is a sub-study of the HYPOLYTE trial, a multi-centre, randomized, double-blind, placebo-controlled trial of hydrocortisone in severe trauma patients [17]. Following approval by the Institutional Review Board of Angers (France), patients in seven French ICUs were enrolled in the HYPOLYTE trial from 15 November 2006 to 4 August 2009.…”

“…In the HYPOLYTE trial, the inclusion criteria were multiple trauma, age of [15 years 3 months and the expectation that mechanical ventilation would be required for [48 h. Exclusion criteria were previous adrenal insufficiency, previous immunosuppression (See [17] for definitions), treatment with corticosteroids within the last 6 months and pregnancy. Etomidate use was not controlled for in the study.…”

“…It has been demonstrated that up to 70 % of trauma patients developed a critical illness-related corticosteroid insufficiency (CIRCI) [12][13][14] and that this could increase the risk of hospital-acquired pneumonia (HAP) [15,16]. We have recently demonstrated that lowdose hydrocortisone decreases the rate of HAP in multiple trauma patients with CIRCI [17]. Etomidate may increase the rate of post-traumatic complications, but little data are available to date on this specific population of patients [18].…”

“…For the study reported here, we used data from the HYPOLYTE trial, a prospective multi-centre study of lowdose hydrocortisone treatment in intubated trauma patients [17]. We hypothesized that a single dose of etomidate increases the proportion of CIRCI and the rate of HAP.…”

Corticosteroid use in the intensive care unit: a survey of intensivists

“…Development of clinical practice guidelines, summarized in Table 1, has been challenged by contradictory results of clinical trials. [1][2][3][4][5][6][7][8][9][10] One expert panel recommended corticosteroids for patients with acute respiratory distress syndrome (ARDS) and for septic shock; 11 however, perceived indications and contraindications for corticosteroid therapy often coexist in critically ill patients. This phenomenon may explain why only half the patients received corticosteroids in recent sepsis and ARDS studies where no protocol was established for their use.…”