Reposição de corticoesteróides em crianças com choque séptico

Detalhes bibliográficos
Autor(a) principal: Amoretti, Carolina Friedrich
Data de Publicação: 2012
Tipo de documento: Tese
Idioma: por
Título da fonte: Repositório Institucional PUCRS
Texto Completo: http://hdl.handle.net/10923/4632
Resumo: Objectives: To evaluate hydrocortisone treatment and response to ACTH adrenal stimulation test, with or without respect to basal cortisol, in children with volume refractory septic shock. Method: Randomized placebo controlled clinical trial, including children admitted to the Pediatric Intensive Care Unit at São Lucas Hospital (HSL-PUCRS, Brazil) with a diagnosis of volume refractory septic shock, between Jun/2008 and Sep/2012. Basal cortisol level was determined and, then, ACTH test (1mcg/1,73m2) was performed. Then, patients were randomized to hydrocortisone or placebo treatment groups. Study protocol was approved by the HSL´s ethics committee. Results: Fifty six patients were analyzed. Median age was 5 months old, and mortality was 17. 8%. Mortality rate was higher in patients that failed to respond to ACTH test, regardless of treatment (36% versus 6%; p=0. 01). There was no difference between treatment groups regarding time and dose of vasoactive drugs, PICU length of stay and mortality, even when those who fail to respond to ACTH test were analyzed separately. Conclusion: Mortality was higher among patients who failed to respond to ACTH stimulation test, regardless of group of treatment. In our study, steroid replacement in children with volume refractory septic shock failed to improve mortality or any other studied outcome. More studies are needed to confirm these results.
id PUCR_96654ea15ee0e00bf34ee6e099dbf17c
oai_identifier_str oai:meriva.pucrs.br:10923/4632
network_acronym_str PUCR
network_name_str Repositório Institucional PUCRS
repository_id_str 2753
spelling Amoretti, Carolina FriedrichGarcia, Pedro Celiny Ramos2013-08-07T19:06:23Z2013-08-07T19:06:23Z2012http://hdl.handle.net/10923/4632Objectives: To evaluate hydrocortisone treatment and response to ACTH adrenal stimulation test, with or without respect to basal cortisol, in children with volume refractory septic shock. Method: Randomized placebo controlled clinical trial, including children admitted to the Pediatric Intensive Care Unit at São Lucas Hospital (HSL-PUCRS, Brazil) with a diagnosis of volume refractory septic shock, between Jun/2008 and Sep/2012. Basal cortisol level was determined and, then, ACTH test (1mcg/1,73m2) was performed. Then, patients were randomized to hydrocortisone or placebo treatment groups. Study protocol was approved by the HSL´s ethics committee. Results: Fifty six patients were analyzed. Median age was 5 months old, and mortality was 17. 8%. Mortality rate was higher in patients that failed to respond to ACTH test, regardless of treatment (36% versus 6%; p=0. 01). There was no difference between treatment groups regarding time and dose of vasoactive drugs, PICU length of stay and mortality, even when those who fail to respond to ACTH test were analyzed separately. Conclusion: Mortality was higher among patients who failed to respond to ACTH stimulation test, regardless of group of treatment. In our study, steroid replacement in children with volume refractory septic shock failed to improve mortality or any other studied outcome. More studies are needed to confirm these results.Objetivo: Avaliar o efeito do tratamento com hidrocortisona e da resposta ao teste de estimulação adrenal com ACTH, com e sem relação ao cortisol basal, em pacientes pediátricos com choque séptico refratário a volume.Método: Ensaio clínico randomizado, duplo cego, placebo controlado, incluindo crianças admitidas na Unidade de Terapia Intensiva Pediátrica do Hospital São Lucas, entre junho/2008 e setembro/2012. Os pacientes tinham diagnóstico de choque séptico refratário a volume. Foi dosado cortisol basal e após, realizado o teste de estimulação com ACTH (1mcg/1,73m2). O paciente era então randomizado para tratamento com hidrocortisona ou placebo. O protocolo de estudo foi aprovado pelo Comitê de Ética do referido hospital. Resultados: Foram analisadas 56 crianças. A mediana de idade foi de 5 meses, e a mortalidade foi de 17,8%. A mortalidade foi mais alta entre pacientes que não responderam ao teste com ACTH, independente do tratamento recebido (36% versus 6%; p=0,01). Não houve diferença estatística entre os pacientes tratados ou não com hidrocortisona, com relação à mortalidade, horas e quantidade de drogas vasoativas e tempo de internação em UTIP. Este resultado se mantém, mesmo quando analisados separadamente os pacientes que responderam ou não ao teste do ACTH. Conclusão: Pacientes que não respondem a estímulo com ACTH apresentaram mortalidade aumentada, independente do tratamento recebido. A reposição de corticoesteróides em crianças com choque séptico refratário a volume não mostrou melhora de mortalidade, ou dos outros desfechos avaliados neste estudo. Novos estudos são necessários para confirmar estes achados.Made available in DSpace on 2013-08-07T19:06:23Z (GMT). No. of bitstreams: 1 000446168-Texto+Completo-0.pdf: 819347 bytes, checksum: df8fbcb39a3bf3cd0e2b8587e38200b8 (MD5) Previous issue date: 2012Pontifícia Universidade Católica do Rio Grande do SulPorto AlegreMEDICINAPEDIATRIAHIDROCORTISONACORTICOSTERÓIDESHORMÔNIO ADRENOCORTICOTRÓPICOCHOQUE SÉPTICOCRIANÇASLACTENTEUNIDADES DE TERAPIA INTENSIVA PEDIÁTRICAReposição de corticoesteróides em crianças com choque sépticoinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisPontifícia Universidade Católica do Rio Grande do SulFaculdade de MedicinaPrograma de Pós-Graduação em Pediatria e Saúde da CriançaDoutorado2012porreponame:Repositório Institucional PUCRSinstname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSinfo:eu-repo/semantics/openAccessTEXT000446168-Texto+Completo-0.pdf.txt000446168-Texto+Completo-0.pdf.txtExtracted texttext/plain113370http://meriva.pucrs.br:8080/jspui/bitstream/10923/4632/3/000446168-Texto%2BCompleto-0.pdf.txtbd9b3aa4c1f234ebe358484594c84318MD53ORIGINAL000446168-Texto+Completo-0.pdfTexto Completoapplication/pdf819347http://meriva.pucrs.br:8080/jspui/bitstream/10923/4632/1/000446168-Texto%2BCompleto-0.pdfdf8fbcb39a3bf3cd0e2b8587e38200b8MD51LICENSElicense.txttext/plain601http://meriva.pucrs.br:8080/jspui/bitstream/10923/4632/2/license.txt3d470ad030ca6782c9f44a1fb7650ec0MD5210923/46322017-09-28 11:05:35.98oai:meriva.pucrs.br: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Repositório InstitucionalPRIhttp://repositorio.pucrs.br/oai/request?verb=Identifyopendoar:27532017-09-28T14:05:35Repositório Institucional PUCRS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false
dc.title.pt_BR.fl_str_mv Reposição de corticoesteróides em crianças com choque séptico
title Reposição de corticoesteróides em crianças com choque séptico
spellingShingle Reposição de corticoesteróides em crianças com choque séptico
Amoretti, Carolina Friedrich
MEDICINA
PEDIATRIA
HIDROCORTISONA
CORTICOSTERÓIDES
HORMÔNIO ADRENOCORTICOTRÓPICO
CHOQUE SÉPTICO
CRIANÇAS
LACTENTE
UNIDADES DE TERAPIA INTENSIVA PEDIÁTRICA
title_short Reposição de corticoesteróides em crianças com choque séptico
title_full Reposição de corticoesteróides em crianças com choque séptico
title_fullStr Reposição de corticoesteróides em crianças com choque séptico
title_full_unstemmed Reposição de corticoesteróides em crianças com choque séptico
title_sort Reposição de corticoesteróides em crianças com choque séptico
author Amoretti, Carolina Friedrich
author_facet Amoretti, Carolina Friedrich
author_role author
dc.contributor.author.fl_str_mv Amoretti, Carolina Friedrich
dc.contributor.advisor1.fl_str_mv Garcia, Pedro Celiny Ramos
contributor_str_mv Garcia, Pedro Celiny Ramos
dc.subject.por.fl_str_mv MEDICINA
PEDIATRIA
HIDROCORTISONA
CORTICOSTERÓIDES
HORMÔNIO ADRENOCORTICOTRÓPICO
CHOQUE SÉPTICO
CRIANÇAS
LACTENTE
UNIDADES DE TERAPIA INTENSIVA PEDIÁTRICA
topic MEDICINA
PEDIATRIA
HIDROCORTISONA
CORTICOSTERÓIDES
HORMÔNIO ADRENOCORTICOTRÓPICO
CHOQUE SÉPTICO
CRIANÇAS
LACTENTE
UNIDADES DE TERAPIA INTENSIVA PEDIÁTRICA
description Objectives: To evaluate hydrocortisone treatment and response to ACTH adrenal stimulation test, with or without respect to basal cortisol, in children with volume refractory septic shock. Method: Randomized placebo controlled clinical trial, including children admitted to the Pediatric Intensive Care Unit at São Lucas Hospital (HSL-PUCRS, Brazil) with a diagnosis of volume refractory septic shock, between Jun/2008 and Sep/2012. Basal cortisol level was determined and, then, ACTH test (1mcg/1,73m2) was performed. Then, patients were randomized to hydrocortisone or placebo treatment groups. Study protocol was approved by the HSL´s ethics committee. Results: Fifty six patients were analyzed. Median age was 5 months old, and mortality was 17. 8%. Mortality rate was higher in patients that failed to respond to ACTH test, regardless of treatment (36% versus 6%; p=0. 01). There was no difference between treatment groups regarding time and dose of vasoactive drugs, PICU length of stay and mortality, even when those who fail to respond to ACTH test were analyzed separately. Conclusion: Mortality was higher among patients who failed to respond to ACTH stimulation test, regardless of group of treatment. In our study, steroid replacement in children with volume refractory septic shock failed to improve mortality or any other studied outcome. More studies are needed to confirm these results.
publishDate 2012
dc.date.issued.fl_str_mv 2012
dc.date.accessioned.fl_str_mv 2013-08-07T19:06:23Z
dc.date.available.fl_str_mv 2013-08-07T19:06:23Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/doctoralThesis
format doctoralThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10923/4632
url http://hdl.handle.net/10923/4632
dc.language.iso.fl_str_mv por
language por
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Pontifícia Universidade Católica do Rio Grande do Sul
Porto Alegre
publisher.none.fl_str_mv Pontifícia Universidade Católica do Rio Grande do Sul
Porto Alegre
dc.source.none.fl_str_mv reponame:Repositório Institucional PUCRS
instname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
instacron:PUC_RS
instname_str Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
instacron_str PUC_RS
institution PUC_RS
reponame_str Repositório Institucional PUCRS
collection Repositório Institucional PUCRS
bitstream.url.fl_str_mv http://meriva.pucrs.br:8080/jspui/bitstream/10923/4632/3/000446168-Texto%2BCompleto-0.pdf.txt
http://meriva.pucrs.br:8080/jspui/bitstream/10923/4632/1/000446168-Texto%2BCompleto-0.pdf
http://meriva.pucrs.br:8080/jspui/bitstream/10923/4632/2/license.txt
bitstream.checksum.fl_str_mv bd9b3aa4c1f234ebe358484594c84318
df8fbcb39a3bf3cd0e2b8587e38200b8
3d470ad030ca6782c9f44a1fb7650ec0
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
repository.name.fl_str_mv Repositório Institucional PUCRS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)
repository.mail.fl_str_mv
_version_ 1817559047355760640