Safety, efficacy and response to a hydrocortisone rescue therapy protocol in children with refractory hypotension after cardiopulmonal bypass.
Little is known about which paediatric patients respond to hydrocortisone rescue therapy (HRT) with improvement of haemodynamic stability in refractory hypotension after cardiopulmonal bypass. Data were gathered retrospectively from children who received HRT in refractory hypotension after cardiopulmonary bypass in the period from 2000 to 2010. One hundred and sixty-six out of 1,273 children, 150 <1 year and 16 >1 year were enrolled. HRT improved haemodynamics significantly, increased blood pressure, decreased the vasoactive-inotropic score and plasma lactate concentrations in all children >1 year and in 82 % (123 out of 150) of the infants <1 year. Non-responders <1 year were significantly younger, lighter, mostly male infants and had longer cardiopulmonary bypass support time. Serum lactate and paediatric risk of mortality score were significantly higher in non-responders at time of initiation of HRT. Mortality was significantly higher in non-responders versus responders (2.44 vs. 13.5 %; p = 0.0008). HRT caused no adverse effects like electrolyte disturbances or hyperglycaemia. HRT in refractory hypotension after paediatric cardiac surgery is safe but not all infants <1 year show haemodynamic response to HRT. Non-response to HRT is associated with significantly higher mortality.
Department of Paediatric Cardiology, Pulmology and Paediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany, felix.neunhoeffer@gmx.de.
F
F
Neunhoeffer
H
H
Renk
M
M
Hofbeck
Ch
Ch
Grenz
Ch
Ch
Haller
E
E
Heimberg
I
I
Gerbig
Ch
Ch
Schlensak
M
M
Kumpf
D000293:Adolescent; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D006943:Hyperglycemia / Q000139:chemically induced; D007022:Hypotension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007223:Infant; D019344:Lactic Acid / Q000097:blood; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000187:drug effects
D013256:Steroids; D019344:Lactic Acid; D006854:Hydrocortisone