Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study.
BACKGROUND
Traumatic experiences associated with cardiac surgery (CS) can result in traumatic memories and posttraumatic stress disorder (PTSD). Because it is known that subjects who develop PTSD often show sustained reductions in circulating cortisol concentrations, we performed a prospective, randomized study to examine whether exogenously administered stress doses of hydrocortisone during the perioperative period of CS reduces the long-term incidence of chronic stress and PTSD symptoms.


METHODS
Patients (n = 91) were prospectively randomized to receive either stress doses of hydrocortisone or standard treatment during the perioperative period of CS. Of 48 available patients at 6 months after CS, 26 had received stress doses of hydrocortisone and 22 standard treatment. Traumatic memories and PTSD symptoms were diagnosed with previously validated questionnaires.


RESULTS
As compared with patients after standard therapy, patients from the hydrocortisone group had significantly lower chronic stress symptom scores (p <.05). There was no significant difference regarding the number or type of traumatic memories between the hydrocortisone and the standard treatment groups.


CONCLUSIONS
Stress doses of hydrocortisone in patients undergoing CS are associated with a lower intensity of chronic stress and PTSD symptoms at 6 months after CS.
Schelling
Gustav
G
Department of Anesthesiology, Ludwig-Maximilians-University, Munich, Germany.
Kilger
Erich
E
Roozendaal
Benno
B
de Quervain
Dominique J-F
DJ
Briegel
Josef
J
Dagge
Alexander
A
Rothenhäusler
Hans-Bernd
HB
Krauseneck
Till
T
Nollert
Georg
G
Kapfhammer
Hans-Peter
HP
D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D011939:Mental Recall / Q000187:drug effects; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000517:prevention & control; D016037:Single-Blind Method; D013313:Stress Disorders, Post-Traumatic / Q000503:physiopathology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery
D006854:Hydrocortisone