title: Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: a randomized study.
abstract: OBJECTIVE
  Improvement in health-related quality of life is a major object of cardiac surgery. However, high stress exposure during the perioperative period of cardiac surgery can result in the formation of traumatic memories and symptoms of chronic stress or even posttraumatic stress disorder, which can have negative effects on health-related quality-of-life outcome. In this controlled study we examined whether exogenously administered stress doses of hydrocortisone during cardiac surgery reduce perioperative stress exposure and the long-term incidence of chronic stress symptoms and improve health-related quality of life after cardiac surgery.
  
  
  METHODS
  Thirty-six high-risk patients undergoing cardiac surgery were prospectively randomized to receive either stress doses of hydrocortisone or placebo. Of 28 available patients at 6 months after cardiac surgery, 14 had received hydrocortisone, and 14 had received placebo. Traumatic memories, chronic stress symptoms (posttraumatic stress disorder scores), and health-related quality of life were measured by using validated questionnaires.
  
  
  RESULTS
  Compared with patients from the placebo group, patients from the hydrocortisone group had a significantly shorter duration of intensive care unit treatment, required lower doses of the stress hormone norepinephrine during cardiac surgery, and had significantly fewer stress symptoms and a better health-related quality of life regarding physical function, chronic pain, general health, vitality, and mental health during follow-up. The groups did not differ with regard to the number or type of intensive care unit-related traumatic memories.
  
  
  CONCLUSIONS
  The use of stress doses of hydrocortisone in high-risk cardiac surgical patients reduces perioperative stress exposure, decreases chronic stress symptoms, and improves health-related quality of life at 6 months after cardiac surgery.
authors.affiliation: Department of Anesthesiology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Weis
authors.forename: Erich
authors.initials: E
authors.lastname: Kilger
authors.forename: Benno
authors.initials: B
authors.lastname: Roozendaal
authors.forename: Dominique J-F
authors.initials: DJ
authors.lastname: de Quervain
authors.forename: Peter
authors.initials: P
authors.lastname: Lamm
authors.forename: Michael
authors.initials: M
authors.lastname: Schmidt
authors.forename: Martin
authors.initials: M
authors.lastname: Schmölz
authors.forename: Josef
authors.initials: J
authors.lastname: Briegel
authors.forename: Gustav
authors.initials: G
authors.lastname: Schelling
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000517:prevention & control*; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control
chemical_list: D006854:Hydrocortisone