Timing, method and discontinuation of hydrocortisone administration for septic shock patients
Timing, method and discontinuation of hydrocortisone administration for septic shock patients作者机构：Critical Care Unit Instituto Jalisciense de Cancerología Critical Care Unit Hospital General Regional #180 Instituto Mexicano del Seguro Social Transplant Care Unit Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social Centro Universitario de Ciencias de la Salud Universidad de Guadalajara Critical Care Unit Hospital Civil Fray Antonio Alcalde
出 版 物：《World Journal of Critical Care Medicine》 (世界重症医学杂志)
年 卷 期：2017年第6卷第1期
页 面：65-73页
学科分类：100218[医学-急诊医学] 1002[医学-临床医学] 1010[医学-医学技术（可授医学、理学学位）] 10[医学]
主 题：Corticosteroids Hydrocortisone Timing Administration Discontinuation Septic shock
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 *** This prospective cohort study included 59 patients with septic shock who received stress-dose *** was performed at 2 critical care units in academic hospitals from June 1st, 2015, to July 31 st, 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 *** 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 [0.19 μg/kg per minute(range, 0.11-0.28 μg)] compared with patients who were given bolus [0.34 μg/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)
维普期刊数据库