Document Type: Original Article
Anesthesiology and Critical Care Department, Trauma and Injury Research Center, Rasool-e-Akram Complex Hospital, Iran University of Medical Sciences, Tehran, Iran
Trauma and Injury Research Center, Critical Care Department, Iran University of Medical Sciences, Tehran, Iran
Background: Systematic inflammatory syndrome causes death in many conditions. Inflammation and anti-inflammation parameters variation monitoring were done by different clinical and lab methods, however, determining the progression of inflammation is very important for on time interference, gaining best results, and cost controlling. In this condition, adrenal insufficiency’s variation causes water and electrolyte disorders, circulatory failure, and uncontrolled progression of inflammatory response, which is very important. Routine serum total cortisol level monitoring for SIRS is not advised as yet, and corticosteroid was used blindly according to hemodynamic condition and physician diagnosis.
Objectives: In this pilot study, the ability of first three days monitoring serum total cortisol level in SIRS of burned ICU traumatic patients was studied for outcoming improvement.
Methods: A total of 60 patients, 15 - 70 years old, < 80% burn, with systemic inflammatory response syndrome, during first three days of admission in the ICU, that weren’t included in the exclusion criteria (patients with history of clinical adrenal insufficiency or corton usage, or recent drug history of etomidate or ketoconazole), were divided randomly between two groups with 30 patients. The first group considered under the routine clinical treatment and in the second group, besides the routine methods cortisol daily measurement at 8 o’clock, was done during three days to find the cortisol level under 15 ug/dL, and replacement therapy with 50 mg hydrocortisone IV, four times a day.
Results: None of the patients had a cortisol drop during their first three days. Among patients with cortisol more than normal, 20% (6 patients) died.
Conclusions: Despite the fact that total serum cortisol drop during systemic inflammatory response syndrome may happen, it is not prevalent, however, it is wise to consider it as an effective parameter on monitoring of treatment measures.