Risk Factors Associated With Adrenal Insufficiency in Severely Injured Burn Patients

Reiff, Donald A.; Harkins, Cathy L.; McGwin, Gerald; Cross, James M.; Rue, Loring W.

doi:10.1097/bcr.0b013e318159bfbb

Cited by 14 publications

(6 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Those with massive burns have higher cortisol levels but may be resistant to serum cortisol increases in response to stimulation. The clinical relevance of this finding has not been established (81,82).…”

Section: Preventable Complicationsmentioning

confidence: 84%

Critical care of the burn patient: The first 48 hours

Latenser

2009

Critical Care Medicine

185

View full text Add to dashboard Cite

The critically burned patient differs from other critically ill patients in many ways, the most important being the necessity of a team approach to patient care. The burn patient is best cared for in a dedicated burn center where resuscitation and monitoring concentrate on the pathophysiology of burns, inhalation injury, and edema formation. Early operative intervention and wound closure, metabolic interventions, early enteral nutrition, and intensive glucose control have led to continued improvements in outcome. Prevention of complications such as hypothermia and compartment syndromes is part of burn critical care. The myriad areas where standards and guidelines are currently determined only by expert opinion will become driven by level 1 data only by continued research into the critical care of the burn patient.

show abstract

Section: Preventable Complicationsmentioning

confidence: 84%

Critical care of the burn patient: The first 48 hours

Latenser

2009

Critical Care Medicine

185

View full text Add to dashboard Cite

show abstract

“…Reiff et al found higher % TBSA (total body surface area) and older age to be risk factors for acute adrenal insufficiency in severely burned patients by case-control study [9].…”

Section: Discussionmentioning

confidence: 99%

Adrenal Haemorrhages and Burns - An Autopsy Study

U¹

2012

J Forensic Res

View full text Add to dashboard Cite

An estimated 1,95,000 deaths every year are caused by burns-the vast majority occurs in low-and middleincome countries. In India, over 10, 00,000 people are moderately or severely burnt every year. Women in the WHO SouthEast Asia Region have the highest rate of burns, accounting for 27% of global burn deaths and nearly 70% of burn deaths in the region. Adrenal haemorrhage occurs secondary to both traumatic conditions and atraumatic conditions. Burns accounts for maximum number of cases of traumatic haemorrhages. The purpose of this study was to investigate the prevalence of adrenal haemorrhage in non-surviving patients with burns by evaluating the compiled autopsy study data. During the period between 1 st July 2009 to 31 st June 2011, totally 51 burns cases were autopsied, among them, adrenal haemorrhage was seen in 14 cases, of which 10 cases showed bilateral haemorrhages and 04 cases showed unilateral haemorrhages. Extensive, bilateral adrenal haemorrhages were more commonly seen in males. Acute adrenal insufficiency is an uncommon but devastating complication of severe burn injury. The diagnosis is rarely made ante-mortem. The clinical importance of bilateral adrenal haemorrhage is that it may lead to acute adrenal insufficiency and possible death. Therefore, when a sudden deterioration in the patient with thermal injuries is encountered, adrenal insufficiency must be considered.

show abstract

“…The issue is central to the concept of adrenal insufficiency in the critically ill, but is clearly a difficult one to address. The pattern of a reduced cortisol increment can be observed in a number of other conditions apart from sepsis; these include head injury, trauma and burns, which may suggest that it is a general response to critical illness. At present, the evidence that treating patients with septic shock and a reduced cortisol increment results in an improved outcome is contentious.…”

Section: Controversiesmentioning

confidence: 99%

The utility of the corticotropin test to diagnose adrenal insufficiency in critical illness: an update

Venkatesh

Cohen

2015

Clinical Endocrinology

View full text Add to dashboard Cite

Objective One of the most common dynamic testing procedures for assessment of adrenocortical function is the standard corticotropin or the cosyntropin test. The aim of this review was to examine the evidence base underlying the corticotropin test in the management of the critically ill patient. Data synthesis The principle behind the corticotropin test is the demonstration of an inappropriately low cortisol production in response to exogenous ACTH, a situation analogous to physiological stress. The corticotropin test was originally described in nonstressed subjects, and its applicability and interpretation in the setting of critical illness continues to generate controversy. Attempting to determine the prevalence of an abnormal corticotropin test in critical illness is complicated by the use of different end-points and different populations. Moreover, the test result is also influenced by the assay used for measurement of plasma cortisol. Trials assessing the relationship between corticotropin response and severity of stress and organ dysfunction have produced divergent results, which may reflect differences in the methodology and the association being measured. Moreover, controversy exists with respect to the methodology and the interpretation with respect to the following variables: dose of corticotropin, end-points for assessment of total or free cortisol, effect of plasma cortisol variability, adrenal blood flow and its equivalence with other tests of adrenocortical function. Conclusions The corticotropin test is used widely in the evaluation of adrenocortical function in the endocrine clinics. Its role in the critically ill patient is less well established. Several confounding variables exist and to have a 'one-size-fits-all' approach with a single end-point in the face of several methodological and pathophysiological confounders may be flawed and may result in the institution of inappropriate therapy. The current evidence does not support the use of the corticotrophin test in critical illness to assess adrenocortical function and guiding steroid therapy in critical illness.

show abstract

Risk Factors Associated With Adrenal Insufficiency in Severely Injured Burn Patients

Cited by 14 publications

References 13 publications

Critical care of the burn patient: The first 48 hours

Critical care of the burn patient: The first 48 hours

Adrenal Haemorrhages and Burns - An Autopsy Study

The utility of the corticotropin test to diagnose adrenal insufficiency in critical illness: an update

Contact Info

Product

Resources

About