Beneficial effect of corticosteroids in catecholamine-dependent septic burn patients.
Recent studies indicated the benefit of hydrocortisone in septic patients based on the significant reduction of catecholamines and improved outcome in common intensive care patients. The treatment of intensive care burn patients with corticosteroids was discussed with great caution due to the especially compromised immune status of severely burned patients. The purpose of this study was to investigate the influence of corticosteroids in burn patients during septic shock. In our burn unit, we started with the administration of cortisol in 2001. In this retrospective study, 10 severely burned patients received, > or = 24h after norepinephrine dependency, hydrocortisone infusions of 200 mg/24 h. The course of norepinephrine dose, hemodynamic measurements (Swan-Ganz-Catheter) and daily Sequential Organ Failure Assessment (SOFA-Score) were analyzed and compared to nine (catecholamine-dependent) burn patients without cortisol therapy. Statistical analysis by means of Fisher's Exact Test revealed beneficial effects (morbidity and mortality) of low dose cortisol therapy compared to control patients. However, the results of this study must be interpreted with caution because of its limited number of patients and its retrospective character. Further randomized prospective controlled studies are necessary to determine the efficacy and safety of cortisol therapy in burn patients.
Fuchs
P Ch
PCh
Department of Plastic, Reconstructive, and Hand Surgery, Burn Center, University Hospital RWTH, Aachen, Germany.
Bozkurt
A
A
Johnen
D
D
Smeets
R
R
Groger
A
A
Pallua
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002056:Burns / Q000188:drug therapy* / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D013252:Steroid 11-beta-Hydroxylase / Q000037:antagonists & inhibitors; D014552:Urinary Tract Infections / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014946:Wound Infection / Q000209:etiology
D000893:Anti-Inflammatory Agents; D014662:Vasoconstrictor Agents; D013252:Steroid 11-beta-Hydroxylase; D006854:Hydrocortisone; D009638:Norepinephrine