INTRODUCTION. At the moment, assessing adrenal dysfunction in patients in critical condition and ways to correct this function with hormone replacement therapy are extremely difficult. OBJECTIVE. Analysis of changes in the dynamics of adrenocorticotropic hormone (ACTH) and cortisol levels in blood plasma during extracorporeal membrane oxygenation (ECMO). MATERIALS AND METHODS. The prospective study was performed in intensive care unit (47 patients on ECMO). After connecting ECMO (D0), (D1-D3-D5-D7-D9), and until the completion of ECMO, assessment of cortisol and ACTH levels was carried out. RESULTS. The median level of cortisol in blood plasma was higher in the deceased patients on the third day (D3) (p = 0.05), D7 (p = 0.03); D13 (p = 0.05) and the last day of observation (p = 0.001), respectively. The level of ACTH in the blood of deceased patients was higher immediately on the day of ECMO initiation (D0) and on day 3 (D3) of observation: D0 (p = 0.018); D3 (p = 0.04), respectively. Analysis of the ROC curve showed that cortisol levels show a sensitivity of 71 % and a specificity of 89 % to an adverse outcome during ECMO. DISCUSSION. The life-saving ECMO technique, in critical conditions, is associated with a high risk of increasing of complications, including potentially lethal ones. Critical illness-related corticosteroid insufficiency (CIRCI) clinically manifests itself as inadequate adrenal activity, taking into account the augmentation of the disease severity. This activity is expressed in the form of a decrease in production and/or resistance to endogenous cortisol, as confirmed by the study. Consideration of CIRCI during the usage of ECMO reflects more objectively the violation of the pituitary-adrenal system. CONCLUSIONS. 1. CIRCI is detected in patients during ECMO. 2. High plasma cortisol levels are the predictor of an adverse outcome. 3. The level of ACTH in blood plasma is higher in patients with adverse outcomes. 4. High levels of cortisol in plasma are not a criterion for making the decision to initiate hydrocortisone therapy.
INTRODUCTION: The severity of the patient's condition that required ECMO and the changes observed in the pituitary — thyroid system (decreased T4 and T3 levels, low-normal or decreased TSH level) can be considered as a lack of body reserves due to the developed critical illness. OBJECTIVES: Study changes of TSH, T3, T4 levels during the ECMO procedure, during weaning/death on the ECMO. MATERIALS AND METHODS: The prospective observational study was performed in intensive care unit (47 patients on ECMO). After connecting ECMO (D0), (D1-D3-D5-D7-D9), and until the completion of ECMO, assessment of TSH, FT4, FT3 levels was carried out. OBJECTIVE: Analysis of changes in thyroid hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3) levels in blood plasma during ECMO, at ECMO weaning/death on ECMO. RESULTS: On the day of ECMO (D 0) and every second day, median FT4 levels were D0 (p = 0.03); D1 (p = 0.03); D3 (p = 0.05), D11 (p = 0.02) and last observation day (p = 0.009) between surviving and dying patients respectively. T3 level D5 (3.1–1.9; p = 0.002); D11 (3.7–2.5; p = 0.05), last day of follow-up (3.1–2; p = 0.001), respectively. On the last day of ECMO between the survived and non-survived patients there were the following: differences in TSH levels; negative correlation of lactate levels, SOFA score and FT3, TSH, FT4. The analysis of the ROC curve (low levels of FT3, FT4, TSH in plasma in patients on the last day of ECMO) indicates a prognostically unfavorable outcome. CONCLUSIONS: The moment of ECMO connection initiation is regarded as subacute phase critical illness. Along with a high level of plasma lactate and high score of SOFA scale, the level of decrease in FT3, FT4 and TSH in patients correlates with the lethal outcome. Low levels of TSH, FT4, and FT3 may be considered as a predictor of adverse outcome at the time of weaning/death on ECMO.
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