title: [The effect of stress dose glucocorticoid on patients with acute respiratory distress syndrome combined with critical illness-related corticosteroid insufficiency].
abstract: OBJECTIVE
  To investigate the effect of stress dose glucocorticoid on patients with acute respiratory distress syndrome (ARDS) combined with critical illness-related corticosteroid insufficiency (CIRCI).
  
  
  METHODS
  All early ARDS patients combined with CIRCI were screened by an adrenal corticotrophic hormone (ACTH) test and randomly divided into treatment group (hydrocortisone 100 mg intravenous, 3 times/day, consecutively for 7 days, n = 12) and control group (equivalent normal saline, n = 14). General clinical data, changes of arterial blood gas, hemodynamics and respiratory mechanics were observed and recorded at admission and at 7 days after treatment. Ventilator-free and shock-free days, ICU stay within 28 days after admission were recorded and 28-day mortality was used as judge prognosis index.
  
  
  RESULTS
  CIRCI rate in 45 early ARDS patients was 57.8% (26 patients), and the shock rate was markedly higher in ARDS patients with CIRCI than patients without CIRCI (46.2% vs 5/19). There were no significant differences in baseline parameters, oxygenation and illness severity between the treatment and control groups, except for markedly lower lactic level in the treatment group [2.7(1.2, 3.9) mmol/L vs 4.6(2.5, 6.3) mmol/L, P < 0.05]. After 7 days of treatment, PaO2/FiO2 markedly increased, while heart rate obviously decreased in the both groups. Compared with the control group, survival time of patients was significantly longer and shock rate of the patients was markedly lower in treatment group within 28 days (5/12 vs 10/14, P < 0.05). The 28-day mortality, which were adjusted by baseline arterial lactic, was lower in the treatment group (2.6/12) than in the control group (5.8/14) while with no significant difference (P > 0.05). There was no significant difference in complication incidence between the two groups.
  
  
  CONCLUSIONS
  Stress dose glucocorticoid could reduce shock incidence and prolong survival time, and has a tendency of lower 28-day mortality in early ARDS patients combined with CIRCI.
authors.affiliation: Department of Critical Medicine, Southeast University, Nanjing, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Liu
authors.forename: Jia
authors.initials: J
authors.lastname: Li
authors.forename: Ying-zi
authors.initials: YZ
authors.lastname: Huang
authors.forename: Song-qiao
authors.initials: SQ
authors.lastname: Liu
authors.forename: Cong-shan
authors.initials: CS
authors.lastname: Yang
authors.forename: Feng-mei
authors.initials: FM
authors.lastname: Guo
authors.forename: Hai-bo
authors.initials: HB
authors.lastname: Qiu
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000097:blood; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000097:blood; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone