Hydrocortisone Therapy for Patients With Multiple Trauma

Roquilly, Antoine; Mahé, Pierre; Séguin, Philippe; Guitton, Christophe; Floch, H. Le; Tellier, Anne Charlotte; Merson, L.; Renard, B.; Malledant, Yannick; Flet, Laurent; Sebille, Véronique; Volteau, Christelle; Masson, Damien; Nguyen, Jean Michel; Lejus, C.; Asehnoune, Karim

doi:10.1001/jama.2011.360

Cited by 181 publications

(112 citation statements)

References 33 publications

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“…This study is a sub-study of the HYPOLYTE trial, a multi-centre, randomized, double-blind, placebo-controlled trial of hydrocortisone in severe trauma patients [17]. Following approval by the Institutional Review Board of Angers (France), patients in seven French ICUs were enrolled in the HYPOLYTE trial from 15 November 2006 to 4 August 2009.…”

Section: Methodsmentioning

confidence: 99%

“…In the HYPOLYTE trial, the inclusion criteria were multiple trauma, age of [15 years 3 months and the expectation that mechanical ventilation would be required for [48 h. Exclusion criteria were previous adrenal insufficiency, previous immunosuppression (See [17] for definitions), treatment with corticosteroids within the last 6 months and pregnancy. Etomidate use was not controlled for in the study.…”

Section: Patientsmentioning

confidence: 99%

“…It has been demonstrated that up to 70 % of trauma patients developed a critical illness-related corticosteroid insufficiency (CIRCI) [12][13][14] and that this could increase the risk of hospital-acquired pneumonia (HAP) [15,16]. We have recently demonstrated that lowdose hydrocortisone decreases the rate of HAP in multiple trauma patients with CIRCI [17]. Etomidate may increase the rate of post-traumatic complications, but little data are available to date on this specific population of patients [18].…”

Section: Introductionmentioning

confidence: 99%

“…For the study reported here, we used data from the HYPOLYTE trial, a prospective multi-centre study of lowdose hydrocortisone treatment in intubated trauma patients [17]. We hypothesized that a single dose of etomidate increases the proportion of CIRCI and the rate of HAP.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Etomidate increases susceptibility to pneumonia in trauma patients

Asehnoune

Mahé²,

Séguin

et al. 2012

Intensive Care Med

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Section: Methodsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Etomidate increases susceptibility to pneumonia in trauma patients

Asehnoune

Mahé²,

Séguin

et al. 2012

Intensive Care Med

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“…Development of clinical practice guidelines, summarized in Table 1, has been challenged by contradictory results of clinical trials. [1][2][3][4][5][6][7][8][9][10] One expert panel recommended corticosteroids for patients with acute respiratory distress syndrome (ARDS) and for septic shock; 11 however, perceived indications and contraindications for corticosteroid therapy often coexist in critically ill patients. This phenomenon may explain why only half the patients received corticosteroids in recent sepsis and ARDS studies where no protocol was established for their use.…”

mentioning

confidence: 99%

Corticosteroid use in the intensive care unit: a survey of intensivists

Lamontagne

Martinez

Adhikari

et al. 2013

Can J Anesth/J Can Anesth

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Objective The efficacy of systemic corticosteroids in many critical illnesses remains uncertain. Our primary objective was to survey intensivists in North America about their perceived use of corticosteroids in clinical practice. Design Self-administered paper survey.Population Intensivists in academic hospitals with clinical trial expertise in critical illness. Measurements We generated questionnaire items in focus groups and refined them after assessments of clinical sensibility and test-retest reliability and pilot testing. We administered the survey to experienced intensivists practicing in selected -013-9929-3 North American centres actively enrolling patients in the multicentre Oscillation for ARDS Treated Early (OSCILLATE) Trial (ISRCTN87124254). Respondents used a four-point scale to grade how frequently they would administer corticosteroids in 14 clinical settings. They also reported their opinions on 16 potential near-absolute indications or contraindications for the use of corticosteroids. Main results Our response rate was 82% (103/125). Respondents were general internists (50%), respirologists (22%), anesthesiologists (21%), and surgeons (7%) who practiced in mixed medical-surgical units. A majority of respondents reported almost always prescribing corticosteroids in the setting of significant bronchospasm in a mechanically ventilated patient (94%), recent corticosteroid use and low blood pressure (93%), and vasopressorrefractory septic shock (52%). Although more than half of respondents stated they would almost never prescribe corticosteroids in severe community-acquired pneumonia (81%), acute lung injury (ALI, 76%), acute respiratory distress syndrome (ARDS, 65%), and severe ARDS (51%), variability increased with severity of acute lung injury. Near-absolute indications selected by most respondents included known adrenal insufficiency (99%) and suspicion of cryptogenic organizing pneumonia (89%), connective tissue disease (85%), or other potentially corticosteroidresponsive illnesses (85%). Conclusions Respondents reported rarely prescribing corticosteroids for ALI, but accepted them for bronchospasm, suspected adrenal insufficiency due to previous corticosteroid use, and vasopressor-refractory septic shock. These competing indications will complicate the design and interpretation of any future large-scale trial of corticosteroids in critical illness.123 Can J Anesth/J Can Anesth (2013) 60:652-659 DOI 10.1007/s12630 RésuméObjectif L'efficacite´des corticoste´roı¨des syste´miques demeure incertaine pour plusieurs maladies graves. Notre objectif primaire e´tait d'obtenir l'opinion des intensivistes en Ame´rique du Nord concernant leur perception de l'utilisation des corticoste´roı¨des dans la pratique clinique. Méthodologie Sondage auto-administre´sur papier. Population Intensivistes dans des hôpitaux universitaires ayant une expertise en matie`re d'e´tudes cliniques sur les maladies graves. Mesures Les e´le´ments du questionnaire ont e´te´cre´e´s dans des groupes de discussion; nous les ...

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