The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function

Zuppa, Athena F.; Nadkarni, Vinay; Davis, Loyal; Adamson, Peter C.; Helfaer, Mark A.; Elliott, Michael R.; Abrams, John; Durbin, Dennis R.

doi:10.1097/01.ccm.0000146133.52982.17

Cited by 77 publications

(49 citation statements)

References 23 publications

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“…In humans, there is little evidence regarding thyroid hormone substitution during critical illness. Of note, some relevant clinical studies have suggested that T 4 supplementation can lead to reduction in the needs for vasoactive drug administration in circulatory shock (37).…”

Section: Discussionmentioning

confidence: 99%

Association between thyroid function tests at baseline and the outcome of patients with sepsis or septic shock: a systematic review

Angelousi

Karageorgopoulos

Kapaskelis

et al. 2011

European Journal of Endocrinology

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Introduction: The severity of critical illness is associated with various patterns of thyroid hormone abnormalities. We sought to evaluate whether the outcome of patients with, specifically, sepsis or septic shock is associated with the thyroid function tests evaluated at diagnosis or admission in the intensive care unit (ICU). Methods: We performed a systematic review of relevant studies by searching PubMed. Results: We included nine studies that all had a prospective cohort design. Seven involved children or neonates, and two involved adults. Mortality was the outcome evaluated in eight studies, while the length of ICU stay was evaluated in the remaining study. In univariate analysis, six of the nine included studies showed that either, free or total, triiodothyronine or thyroxine was lower in the group of patients with sepsis or septic shock who had unfavorable outcome than in those who had favorable outcome. Two other studies showed higher TSH values in the group of patients with unfavorable outcome. No significant relevant findings were observed in the remaining study. Regarding the correlation of sepsis prognostic scoring systems with thyroid function tests, the three studies that provided specific relevant data showed variable findings. Discussion: Most of the relevant studies identified favor the concept that decreased thyroid function at baseline might be associated with a worse outcome of patients with sepsis or septic shock. Although these findings are not consistent, the role of thyroid function in affecting or merely predicting the outcome of sepsis or septic shock merits further investigation.

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Section: Discussionmentioning

confidence: 99%

Association between thyroid function tests at baseline and the outcome of patients with sepsis or septic shock: a systematic review

Angelousi

Karageorgopoulos

Kapaskelis

et al. 2011

European Journal of Endocrinology

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“…41 Some studies have shown that T4 substitution can result in reduction in the need for vasopressors in circulatory shock. 42 Follow-up thyroid function tests are recommended if abnormal levels are detected during sepsis, as usually most of these abnormalities are transient and do not represent a true underlying thyroid disease.…”

Section: Leptinmentioning

confidence: 99%

Endocrine dysfunction in sepsis: a beneficial or deleterious host response?

Gheorghiță¹,

Gheorghiu

et al. 2015

GERMS

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Sepsis is a systemic, deleterious inflammatory host response triggered by an infective agent leading to severe sepsis, septic shock and multi-organ failure. The host response to infection involves a complex, organized and coherent interaction between immune, autonomic, neuroendocrine and behavioral systems. Recent data have confirmed that disturbances of the autonomic nervous and neuroendocrine systems could contribute to sepsis-induced organ dysfunction.Through this review, we aimed to summarize the current knowledge about the endocrine dysfunction as response to sepsis, specifically addressed to vasopressin, copeptin, cortisol, insulin and leptin. We searched the following readily accessible, clinically relevant databases: PubMed, UpToDate, BioMed Central.The immune system could be regarded as a "diffuse sensory organ" that signals the presence of pathogens to the brain through different pathways, such as the vagus nerve, endothelial activation/dysfunction, cytokines and neurotoxic mediators and the circumventricular organs, especially the neurohypophysis. The hormonal profile changes substantially as a consequence of inflammatory mediators and microorganism products leading to inappropriately low levels of vasopressin, sick euthyroid syndrome, reduced adrenal responsiveness to ACTH, insulin resistance, hyperglycemia as well as hyperleptinemia.In conclusion, clinical diagnosis of this "pan-endocrine illness" is frequently challenging due to the many limiting factors. The most important benefits of endocrine markers in the management of sepsis may be reflected by their potential to be used as biomarkers in different scoring systems to estimate the severity of the disease and the risk of death.

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“…In 2009, Schnuelle et al suggested that hemodynamic support by dopamine could improve kidney graft function [25]. Hormone replacement with methylprednisolone, vasopressin (as diabetes insipidus is observed in 78 % of DBD children) [23] and thyroid hormone (to reduce vasopressor requirement) [25] is a widely used therapy, but controversial in the USA [22,26].…”

Section: Pediatric Organ Donors and Their Managementmentioning

confidence: 99%

Strategies to optimize kidney recovery and preservation in transplantation: specific aspects in pediatric transplantation

et al. 2014

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In renal transplantation, live donor kidney grafts are associated with optimum success rates due to the shorter period of ischemia during the surgical procedure. The current shortage of donor organs for adult patients has caused a shift towards deceased donors, often with co-morbidity factors, whose organs are more sensitive to ischemia-reperfusion injury, which is unavoidable during transplantation. Donor management is pivotal to kidney graft survival through the control of the ischemiareperfusion sequence, which is known to stimulate numerous deleterious or regenerative pathways. Although the key role of endothelial cells has been established, the complexity of the injury, associated with stimulation of different cell signaling pathways, such as unfolded protein response and cell death, prevents the definition of a unique therapeutic target. Preclinical transplant models in large animals are necessary to establish relationships and kinetics and have already contributed to the improvement of organ preservation. Therapeutic strategies using mesenchymal stem cells to induce allograft tolerance are promising advances in the treatment of the pediatric recipient in terms of reducing/withdrawing immunosuppressive therapy. In this review we focus on the different donor management strategies in kidney graft conditioning and on graft preservation consequences by highlighting the role of endothelial cells. We also propose strategies for preventing ischemia-reperfusion, such as cell therapy.

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The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function

Cited by 77 publications

References 23 publications

Association between thyroid function tests at baseline and the outcome of patients with sepsis or septic shock: a systematic review

Association between thyroid function tests at baseline and the outcome of patients with sepsis or septic shock: a systematic review

Endocrine dysfunction in sepsis: a beneficial or deleterious host response?

Strategies to optimize kidney recovery and preservation in transplantation: specific aspects in pediatric transplantation

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