Hydrocortisone effects on cardiovascular variability in septic shock: a spectral analysis approach.
BACKGROUND
Septic shock may be associated with a loss in cardiovascular variability and adrenal dysfunction.


OBJECTIVE
To investigate the relationship between cardiovascular autonomic modulation and adrenal function during sepsis.


RESULTS
Seventy-five volunteers with septic shock and six healthy volunteers were prospectively included in the study. Cardiovascular variability was assessed by spectral analysis of heart rate and diastolic blood pressure signals, which included computation of normalized low (LF(nu)) and high frequency (HF(nu)) components. Cardiovascular variability was investigated in patients and healthy volunteers immediately before and 1 hr after a single bolus of 50 mg of hydrocortisone (study phase I); in patients according to adrenal function (study phase II); and in patients with septic shock and adrenal insufficiency, before and 72 hrs after a treatment with 50 mg every 6 hrs of hydrocortisone and 50 microg daily of fludrocortisone or their placebos (study phase III). As compared to healthy volunteers, patients had decreased LF(nu)-HR (.16 +/- .05 vs. .23 +/- .07 p = .01) and LF(nu)-DBP (.18 +/- .11 vs. .28 +/- .02 p = .01) and, after hydrocortisone, they had a greater increase in LF(nu)-DBP (p = .01). As compared to patients with normal adrenal function, those with adrenal failure had decreased LF(nu)-HR (.1 +/- .01 vs. .2 +/- .15 p = .01) and LF(nu)-DBP (.008 +/- .01 vs. .14 +/- .22 p = .0003). In patients with adrenal failure, as compared to placebos, hydrocortisone plus fludrocortisone increased significantly LF(nu)-DBP (p = .02) and low frequency/high volume ratio (p = .009).


CONCLUSIONS
In septic shock, the loss in cardiovascular variability is more marked in patients with adrenal insufficiency and is partly restored by exogenous administration of corticosteroids.
Aboab
Jerome
J
Réanimation Polyvalente, Hôpital Raymond Poincaré, AP-HP, Université de Versailles Saint Quentin, Garches, France.
Polito
Andrea
A
Orlikowski
David
D
Sharshar
Tarek
T
Castel
Muriel
M
Annane
Djillali
D
D000309:Adrenal Insufficiency / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D001341:Autonomic Nervous System / Q000187:drug effects*; D002319:Cardiovascular System / Q000187:drug effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications / Q000503:physiopathology*
D006854:Hydrocortisone