Relationship Between Plasma Adrenocorticotropin Hormone and Intensive Care Unit Survival in Early Traumatic Brain Injury

Abstract

The presence of a low plasma ACTH concentration at an early stage of TBI and lack of indication to provide second-level measures to control ICP were associated with a higher intensive care unit survival.

Acute Hypothalamic–pituitary–adrenal Response in Traumatic Brain Injury with and Without Extracerebral Trauma

“…However, at the current moment we agree with other authors that baseline cortisol values must be included in the definition of posttraumatic AI [7,10]. Therefore, we considered as diagnostic of AI the existence of baseline cortisol \5 lg/dl (7) or a delta cortisol after HDCST \9 lg/dl [8,12].…”

“…Studies have shown contradictory results when reporting patients who are more likely to present adrenal impairment [4][5][6][7][8][9][10][11][12][13][14], and in most cases, the population of TBI patients studied was not homogeneous. Recent studies have also shown that HPA axis disturbances are common in trauma patients without TBI [15,16].…”

“…In our initial report in TBI patients [8], we used a cortisol response less than 9 lg/dl after the HDCST as a diagnostic tool. However, at the current moment we agree with other authors that baseline cortisol values must be included in the definition of posttraumatic AI [7,10].…”

“…Management of the patients with ICP monitoring was done according to a standard TBI protocol used in our ICU, as previously discussed [8,13]. Briefly, sedation with midazolam and/or propofol and analgesia with morphine by continuous infusion i.v.…”

“…Consensus guidelines focusing on the screening of these neuroendocrine disorders in TBI patients have been recently published [2]. The study of HPA axis disturbances in acute trauma patients has become a relevant clinical and scientific topic [3,4], and recent studies support the existence of these disturbances in the acute phase after TBI [4][5][6][7][8], suggesting a relationship among HPA axis function with hemodynamic response [6,7], immunomodulation [6], and outcome [8,9]. Although mechanisms mediating these disturbances are not clear, both primary and secondary HPA failures have been suggested [6][7][8]10].…”