Hydrocortisone Supplementation Enhances Hemodynamic Stability in Brain-dead Patients

Nicolas-Robin, Armelle; Barouk, Jérôme; Amour, Julien; Coriat, Pierre; Riou, Bruno; Langeron, Olivier

doi:10.1097/aln.0b013e3181d4f34d

Cited by 32 publications

(10 citation statements)

References 36 publications

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“…Although in our study, adrenal insufficiency frequency (77.6%) was similar to the results of both studies cited above [19, 20], no significant difference was noted in the frequency of vasopressor weaning of brain-dead patients compared to plasma cortisol level at baseline or to initial response to ACTH stimulation. Our results did not confirm those of Nicolas-Robin et al .…”

Section: Discussionsupporting

confidence: 88%

“…Our study confirms that prescription of a replacement dose of hydrocortisone during resuscitation of a potential brain-dead donor makes vasopressor weaning possible and also decreases vasopressor doses, which are necessary to maintain a stable hemodynamic state in unweaned patients. These results are in agreement with those of a single-center observational cohort of 30 patients with brain death who were administered 50 mg of hydrocortisone: in 58% of patients norepinephrine doses were reduced by 30% after three hours [19]. Another study compared two groups of donors including during two consecutive periods and studied the impact of high doses of methylprednisolone (15 mg/kg) versus low doses of hydrocortisone (300 to 500 mg): frequency of vasopressor weaning was 39% in the first group and 47% in the second group, with no significant difference between both groups [20].…”

Section: Discussionsupporting

confidence: 88%

“…Our results did not confirm those of Nicolas-Robin et al . [19], who suggested that steroid administration would be more beneficial in patients with documented adrenal insufficiency. However our results are consistent with other studies conducted in different settings, such as in septic shock, showing that the ACTH stimulation test had no predictive value for hemodynamic response of patients receiving corticosteroids [23–26].…”

Section: Discussionmentioning

confidence: 99%

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Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study

et al. 2014

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IntroductionCirculatory failure during brain death organ donor resuscitation is a problem that compromises recovery of organs. Combined administration of steroid, thyroxine and vasopressin has been proposed to optimize the management of brain deceased donors before recovery of organs. However the single administration of hydrocortisone has not been rigorously evaluated in any trial.MethodsIn this prospective multicenter cluster study, 259 subjects were included. Administration of low-dose steroids composed the steroid group (n = 102).ResultsAlthough there were more patients in the steroid group who received norepinephrine before brain death (80% vs. 66%: P = 0.03), mean dose of vasopressor administered after brain death was significantly lower than in the control group (1.18 ± 0.92 mg/H vs. 1.49 ± 1.29 mg/H: P = 0.03), duration of vasopressor support use was shorter (874 min vs. 1160 min: P < 0.0001) and norepinephrine weaning before aortic clamping was more frequent (33.8% vs. 9.5%: P < 0.0001). Using a survival approach, probability of norepinephrine weaning was significantly different between the two groups (P < 0.0001) with a probability of weaning 4.67 times higher in the steroid group than in the control group (95% CI: 2.30 – 9.49).ConclusionsDespite no observed benefits of the steroid administration on primary function recovery of transplanted grafts, administration of glucocorticoids should be a part of the resuscitation management of deceased donors with hemodynamic instability.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study

et al. 2014

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“…Multiple large randomized control trials (RCT) have evaluated the effects on steroid administration on the outcomes of lung, kidney and liver transplant [35-37]. In a RCT, Bonser et al evaluated the effects of 1g of methylprednisolone administration to BD organ donors 7 hours prior to lung explantation, demonstrating no effect on increasing lung yields [29].…”

Section: Discussionmentioning

confidence: 99%

Prednisolone has a positive effect on the kidney but not on the liver of brain dead rats: a potencial role in complement activation

et al. 2014

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BackgroundContradictory evidence has been published on the effects of steroid treatments on the outcomes of kidney and liver transplantation from brain dead (BD) donors. Our study aimed to evaluate this disparity by investigating the effect of prednisolone administration on BD rats.MethodsBD induction was performed in ventilated rats by inflating a Fogarty catheter placed in the epidural space. Prednisolone (22.5 mg/kg) was administered 30 min prior to BD induction. After four hours of determination of BD: serum, kidney and liver tissues samples were collected and stored. RT-qPCR, routine biochemistry and immunohistochemistry were performed.ResultsPrednisolone treatment reduced circulating IL-6 and creatinine plasma levels but not serum AST, ALT or LDH. Polymorphonuclear influx assessed by histology, and inflammatory gene expression were reduced in the kidney and liver. However, complement component 3 (C3) expression was decreased in kidney but not in liver. Gene expression of HSP-70, a cytoprotective protein, was down-regulated in the liver after treatment.ConclusionsThis study shows that prednisolone decreases inflammation and improves renal function, whilst not reducing liver injury. The persistence of complement activation and the negative effect on protective cellular mechanisms in the liver may explain the disparity between the effects of prednisolone on the kidney and liver of BD rats. The difference in the molecular and cellular responses to prednisolone administration may explain the contradictory evidence of the effects of prednisolone on different organ types from brain dead organ donors.

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“…In conclusion, our findings show that in septic shock, CT of the adrenal gland may contribute to assess adrenal function and a total adrenal gland volume less than 10 cm 3 may identify high-risk patients. Further studies may evaluate the adrenal gland volume in association with the cosyntropin stimulation test in other populations at high risk of critical illness-related corticosteroid insufficiency such as brain dead 34 or multiple trauma patients 35 and whether assessment of adrenal gland morphology on CT may identify patients likely to respond to corticosteroids. Other variables entered in the model were age, medical versus surgical, site of sepsis (lung, abdominal, other), and SAPS II (Simplified Acute Physiology Score).…”

Section: Discussionmentioning

confidence: 99%

The Absence Of Adrenal Gland Enlargement During Septic Shock Predicts Mortality: A CT-Scan Study Of 239 Patients

Jung

Nougaret

Chanques

et al. 2011

B104. Translating Sepsis: Epidemiology to Mechanisms

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Background: Assessment and management of septic shock associated adrenal function remain controversial. The aim of this study was to explore the prognostic value of adrenal gland volume in adults with septic shock. Methods: A short cosyntropin test and determination of adrenal volume by computed tomography were performed within 48 h of shock in patients with septic shock (n ϭ 184) and in 2 control groups: 40 ambulatory patients and 15

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Hydrocortisone Supplementation Enhances Hemodynamic Stability in Brain-dead Patients

Abstract: Adrenal insufficiency with hemodynamic instability is frequent in brain-dead patients. After ACTH stimulation testing and hydrocortisone infusion, hemodynamic stability is enhanced especially in patients with true adrenal nonfunction.

Cited by 32 publications

References 36 publications

Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study

Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study

Prednisolone has a positive effect on the kidney but not on the liver of brain dead rats: a potencial role in complement activation

The Absence Of Adrenal Gland Enlargement During Septic Shock Predicts Mortality: A CT-Scan Study Of 239 Patients

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