Impaired pressor sensitivity to noradrenaline in septic shock patients with and without impaired adrenal function reserve

Annane,; Bellissant,; Sebille, Véronique; Lesieur, Olivier; [], Mathieu; Raphael,; Gajdos,

doi:10.1046/j.1365-2125.1998.00833.x

Cited by 259 publications

(185 citation statements)

References 33 publications

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“…40 Not surprisingly, cortisol is important in the maintenance of vascular tone and permeability in severe sepsis. Finally, cortisol increases the vascular and cardiac response to the renin-angiotensin and the sympathetic nervous systems, 13,19 the two most important homeostatic mechanisms in the maintenance of arterial pressure during severe sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…31 In patients with severe sepsis, it is frequently associated with shock refractory to vasopressor drugs, multiple organ failure, and death. 11,13,[15][16][17][18][19] However, making the diagnosis before development of refractory shock is important. Therefore, as performed in the current study, diagnosis of relative adrenal insufficiency in critically ill patients relies on the measurement of plasma cortisol levels before and after adrenal stimulation with synthetic corticotrophin.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14][15][16][17][18] It also has been reported that patients with septic shock and relative adrenal insufficiency show resistance to vasoconstrictor drugs, 19 a higher incidence of refractory shock, 13 and very high hospital mortality rate. 11,15,17,18 Finally, various trials 12,20,21 and two meta-analyses 10,22 show that the administration of low doses of hydrocortisone (stress doses) during several days improves shock reversal and survival in septic shock.…”

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Adrenal insufficiency in patients with cirrhosis and septic shock: Effect of treatment with hydrocortisone on survival

et al. 2006

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Relative adrenal insufficiency is frequent in patients with severe sepsis and is associated with hemodynamic instability, renal failure, and increased mortality. This study prospectively evaluated the effects of steroids on shock resolution and hospital survival in a series of 25 consecutive patients with cirrhosis and septic shock (group 1). Adrenal function was evaluated by the short corticotropin test within the first 24 hours of admission. Patients with adrenal insufficiency were treated with stress doses of intravenous hydrocortisone (50 mg/6 h). Data were compared to those obtained from the last 50 consecutive patients with cirrhosis and septic shock admitted to the same intensive care unit in whom adrenal function was not investigated and who did not receive treatment with steroids (group 2). Incidence of adrenal insufficiency in group 1 was 68% (17 patients). Adrenal dysfunction was frequent in patients with advanced cirrhosis (Child C: 76% vs. Child B: 25%, P ‫؍‬ .08). Resolution of septic shock (96% vs. 58%, P ‫؍‬ .001), survival in the intensive care unit (68% vs. 38%, P ‫؍‬ .03), and hospital survival (64% vs. 32%, P ‫؍‬ .003) were significantly higher in group 1. The main causes of death in group 1 were hepatorenal syndrome or liver failure (7 of 9 patients). In contrast, refractory shock caused most of the deaths in group 2 (20 of 34 patients). In conclusion, relative adrenal insufficiency is very frequent in patients with advanced cirrhosis and septic shock. Hydrocortisone administration in these patients is associated with a high frequency of shock resolution and high survival rate. (HEPATOLOGY 2006;44:1288-1295 B acterial infections are a frequent complication and an important cause of death in patients with advanced cirrhosis. 1-3 The mortality rate for patients admitted to the hospital with severe bacterial infections but without septic shock is approximately 30%, 4-6 although it may decrease to 10% if circulatory support with intravenous albumin is given at infection diagnosis. 7 The development of a complex syndrome characterized by acute deterioration of circulatory, hepatic, and renal function and hepatic encephalopathy is the main cause of death in these patients. 6,7 Prognosis of patients with cirrhosis admitted with septic shock is even worse. Hospital mortality in these patients ranges between 60% and 100%, 8,9 which is higher than that reported in the general population of patients with septic shock (25%-70%). [10][11][12] In our experience, survival of patients with cirrhosis in septic shock has not improved greatly during the past decades despite important advances in antibiotic treatment and general supportive measures.During the last few years, several studies have shown that septic shock is frequently associated with relative adrenal insufficiency, a condition characterized by an inadequate production of cortisol with respect to the peripheral demands. [11][12][13][14][15][16][17][18] It also has been reported that patients with septic shock and relative adrenal insufficiency sho...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Adrenal insufficiency in patients with cirrhosis and septic shock: Effect of treatment with hydrocortisone on survival

et al. 2006

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“…Several clinical studies published recently [4][5][6] have suggested potential benefit to early corticosteroids, with or without mineralocorticoids, for hemodynamically unstable septic patients, with or without relative or absolute adrenal insufficiency. A French multicentre randomized trial of exogenous glucocorticoid and mineralocorticoid treatment is currently undergoing peer review; it suggests a beneficial effect on mortality with early treatment.…”

Section: Corticosteroidsmentioning

confidence: 99%

Special Article Toronto critical care medicine symposium report

Skrobik

Kavanagh

Mazer

et al. 2002

Can J Anesth/J Can Anesth

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“…8,9 In the late 1990s, it was speculated that lower doses (stressdose) could reduce vasopressor doses in critically ill patients. [10][11][12] The article that reinforced this thesis and made an immediate impact on clinical practice was published by Annane et al 13 and proposed the use of low doses over a longer period of time. This approach produced very inconsistent results in many randomized trials, which ended up concluding that this conduct not only did not reduce mortality but also could be associated with increased morbidity.…”

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confidence: 99%

Corticosteroids in septic shock: What should the decision in pediatrics be?

Darmaros

Delgado

Carvalho

2016

Rev. Assoc. Med. Bras.

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Severe sepsis and septic shock are major global causes of morbidity and mortality in children. In this context, consensuses and guidelines were created for early and effective identification and therapeutic approach. As with adults, the guidelines for septic shock in pediatrics suggest the use of corticosteroids in cases that are refractory to vasoactive drugs. 1 However, there are no pediatric clinical studies supporting the recommendation satisfactorily, and it is important to remember the fact that children are not small adults and that the steroid metabolism in both differs. 2

show abstract

Impaired pressor sensitivity to noradrenaline in septic shock patients with and without impaired adrenal function reserve

Cited by 259 publications

References 33 publications

Adrenal insufficiency in patients with cirrhosis and septic shock: Effect of treatment with hydrocortisone on survival

Adrenal insufficiency in patients with cirrhosis and septic shock: Effect of treatment with hydrocortisone on survival

Special Article Toronto critical care medicine symposium report

Corticosteroids in septic shock: What should the decision in pediatrics be?

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