title: Stress doses of hydrocortisone reduce severe systemic inflammatory response syndrome and improve early outcome in a risk group of patients after cardiac surgery.
abstract: OBJECTIVE
  Severe systemic inflammation with a vasodilatory syndrome occurs in about one third of all patients after cardiac surgery with cardiopulmonary bypass. Hydrocortisone has been used successfully to reverse vasodilation in septic patients. We evaluated if stress doses of hydrocortisone attenuate severe systemic inflammatory response syndrome in a predefined risk group of patients after cardiac surgery with cardiopulmonary bypass.
  
  
  METHODS
  Randomized, nonblinded, controlled trial.
  
  
  METHODS
  Anesthesiologic intensive care unit for cardiac surgical patients of an university hospital.
  
  
  METHODS
  After a risk analysis, we enrolled 91 patients into a prospective randomized trial. Patients were included according to the evaluated criteria (preoperative ejection fraction, duration of cardiopulmonary bypass, type of surgery).
  
  
  METHODS
  The treatment group received stress doses of hydrocortisone perioperatively: 100 mg before induction of anesthesia, then 10 mg/hr for 24 hrs, 5 mg/hr for 24 hrs, 3 x 20 mg/day, and 3 x 10 mg/day.
  
  
  RESULTS
  We measured various laboratory (e.g., lactate) and clinical variables (e.g., duration of ventilation and length of stay in the intensive care unit), characterizing the patients' outcome. The two study groups did not differ regarding age, preoperative medication, duration of the cardiopulmonary bypass, and type of surgery. The patients in the treatment group had significantly lower concentrations of IL-6 and lactate, higher antithrombin III concentration, lower need for circulatory and ventilatory support and for transfusions, lower Therapeutic Intervention Scoring System values, and shorter length of stay in the intensive care unit and in the hospital. The mortality rate did not differ significantly between the groups.
  
  
  CONCLUSIONS
  Although we acknowledge the limitations of a nonblinded interventional trial, stress doses of hydrocortisone seem to attenuate systemic inflammation in a predefined risk group of patients after cardiac surgery with cardiopulmonary bypass and improve early outcome.
authors.affiliation: Department of Anesthesiology, University of Munich, Klinikum Grosshadern, Munich, Germany.
authors.forename: Erich
authors.initials: E
authors.lastname: Kilger
authors.forename: Florian
authors.initials: F
authors.lastname: Weis
authors.forename: Josef
authors.initials: J
authors.lastname: Briegel
authors.forename: Lorenz
authors.initials: L
authors.lastname: Frey
authors.forename: Alwin E
authors.initials: AE
authors.lastname: Goetz
authors.forename: Daniel
authors.initials: D
authors.lastname: Reuter
authors.forename: Andreas
authors.initials: A
authors.lastname: Nagy
authors.forename: Albert
authors.initials: A
authors.lastname: Schuetz
authors.forename: Peter
authors.initials: P
authors.lastname: Lamm
authors.forename: Anette
authors.initials: A
authors.lastname: Knoll
authors.forename: Klaus
authors.initials: K
authors.lastname: Peter
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D015850:Interleukin-6 / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000893:Anti-Inflammatory Agents; D015850:Interleukin-6; D019344:Lactic Acid; D006854:Hydrocortisone