Association between adrenal insufficiency and ventilator weaning.
BACKGROUND
Adrenal insufficiency is a common disorder in critically ill patients with mechanical ventilation and is usually associated with higher mortality and poor clinical outcome.


OBJECTIVE
To determine whether stress dose corticosteroid supplementation can improve ventilator weaning and clinical outcome in patients with adrenal insufficiency.


METHODS
A prospective, randomized, placebo controlled, double-blinded study was conducted in the intensive care unit of a tertiary teaching hospital. A total of 93 mechanically ventilated patients were enrolled in the ventilator weaning trial. Adrenal function was assessed in all patients. Patients with adrenal insufficiency were randomized to the treatment group (50 mg intravenous hydrocortisone every 6 h) and the placebo group.


RESULTS
The successful ventilator weaning percentage was significantly higher in the adequate adrenal reserve group (88.4%) and in the stress dose hydrocortisone treatment group (91.4%) than in the placebo group (68.6%). The weaning period was shorter in the hydrocortisone treatment group than in the placebo group. No significant adverse effects were observed in the corticosteroid treatment group.


CONCLUSIONS
For patients with respiratory failure, early identification of adrenal insufficiency and appropriate supplementation with stress dose hydrocortisone increase the success of ventilator weaning and shortens the weaning period.
Huang
Chung-Jen
CJ
Department of Thoracic Medicine II, Chang Gung Memorial Hospital, 5 Fushing Street, Gueishan Shiang, Taoyuan, Taiwan.
Lin
Horng-Chyuan
HC
D000309:Adrenal Insufficiency / Q000097:blood / Q000188:drug therapy*; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013312:Stress, Physiological / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000009:adverse effects / Q000379:methods*
D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone