Surgical Trauma-Induced Adrenal Insufficiency is Associated with Postoperative Inflammatory Responses

Kashiwabara, Moto; Miyashita, Masao; Nomura, Tsutomu; Makino, Hiroshi; Matsutani, Takeshi; Kim, Chol; Takeda, Satoru; Yamashita, Kiyohiko; Chaudry, Irshad H.; Tajiri, Takashi

doi:10.1272/jnms.74.274

Cited by 18 publications

(15 citation statements)

References 39 publications

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“…There is ample evidence that such an imbalance may occur in conditions of sustained stress. It was shown that severe surgical stress, such as thoracoabdominal surgery, resulted in postoperative relative adrenal insufficiency and subsequent high circulating levels of proinflammatory mediators and development of organ dysfunction [6]. Very similar findings have been reported for trauma patients, after cardiac or liver surgery [7-9].…”

Section: Rationale For Using Corticosteroidsmentioning

confidence: 55%

Corticosteroids for severe sepsis: an evidence-based guide for physicians

Annane

2011

Ann. Intensive Care

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Septic shock is characterized by uncontrolled systemic inflammation that contributes to the progression of organ failures and eventually death. There is now ample evidence that the inability of the host to mount an appropriate hypothalamic-pituitary and adrenal axis response plays a major in overwhelming systemic inflammation during infections. Proinflammatory mediators released in the inflamed sites oppose to the anti-inflammatory response, an effect that may be reversed by exogenous corticosteroids. With sepsis, via nongenomic and genomic effects, corticosteroids restore cardiovascular homeostasis, terminate systemic and tissue inflammation, restore organ function, and prevent death. These effects of corticosteroids have been consistently found in animal studies and in most recent frequentist and Bayesian meta-analyses. Corticosteroids should be initiated only in patients with sepsis who require 0.5 μg/kg per minute or more of norepinephrine and should be continued for 5 to 7 days except in patients with poor hemodynamic response after 2 days of corticosteroids and with a cortisol increment of more than 250 nmol/L after a standard adrenocorticotropin hormone (ACTH) test. Hydrocortisone should be given at a daily dose of 200 mg and preferably combined to enteral fludrocortisone at a dose of 50 μg. Blood glucose levels should be kept below 150 mg/dL.

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Section: Rationale For Using Corticosteroidsmentioning

confidence: 55%

Corticosteroids for severe sepsis: an evidence-based guide for physicians

Annane

2011

Ann. Intensive Care

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“…Postoperative serum IL-6 elevations that are proportional to the magnitude of the surgical stress have been described. 19-21 …”

Section: Surgerymentioning

confidence: 99%

Interleukin-6 in Surgery, Trauma, and Critical Care Part II: Clinical Implications

Jawa

Anillo

Huntoon

et al. 2010

J Intensive Care Med

178

112

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A variety of cytokines play a role in the inflammatory response. Interleukin-6 (IL-6)-type cytokines are released in response to tissue injury or an inflammatory stimulus, and act locally and systemically to generate a variety of physiologic responses. Interleukin-6 concentrations are elevated after surgery, trauma, and critical illness. The magnitude of IL-6 elevation correlates with the extent of tissue trauma/injury severity. Furthermore, there is an association between IL-6 elevation and adverse outcome. Interleukin-6 levels can also be used to stratify patients for therapeutic intervention.

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“…1 Systemic inflammatory reaction is a postoperative condition that occurs with or without infection on a fairly regular basis. [2][3][4] In cases of systemic infection, multiple organ system failure frequently leads to postoperative mortality. 5,6 For the postoperative patient experiencing systemic inflammatory reaction with infection, there is an evident need for the earliest possible onset of antibiotic treatment, following the principle of the 'golden hour'.…”

Section: Introductionmentioning

confidence: 99%

Intensive Care Infection Score – A new approach to distinguish between infectious and noninfectious processes in intensive care and medicosurgical patients

et al. 2015

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Objectives: Clinicians regularly encounter substantial time delays in diagnosing sepsis and administering appropriate antibiotic treatment. This study investigated the ability of the Intensive Care Infection Score (ICIS) to distinguish between infectious and noninfectious processes, and to assess the justified commencement of antibiotic therapy retrospectively, in line with hospital actual best practice and applied laboratory parameters. Methods: Intensive-care unit (ICU) patients were enrolled in this retrospective, observational study. Clinical data and laboratory parameters were determined daily. The cohort was divided into infected and noninfected patient groups. Results: Out of 172 ICU patients, including 72 postoperative patients, the predictive value for infection throughout the first 5 days in 'all patients' and the 'postoperative patient' group was highest for ICIS. An ICIS cut-off value of three could predict infection in postoperative patients with 82.9% sensitivity and 75.1% specificity. ICIS showed the lowest rate of potentially 'falsely encouraged' and 'discouraged' antibiotic therapies for noninfected and for septic postoperative patients, respectively, compared with C-reactive protein, procalcitonin and white blood cell levels.

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Surgical Trauma-Induced Adrenal Insufficiency is Associated with Postoperative Inflammatory Responses

Cited by 18 publications

References 39 publications

Corticosteroids for severe sepsis: an evidence-based guide for physicians

Corticosteroids for severe sepsis: an evidence-based guide for physicians

Interleukin-6 in Surgery, Trauma, and Critical Care Part II: Clinical Implications

Intensive Care Infection Score – A new approach to distinguish between infectious and noninfectious processes in intensive care and medicosurgical patients

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