Please use this identifier to cite or link to this item: http://hdl.handle.net/10668/396
Title: Relative adrenal insufficiency and hemodynamic status in cardiopulmonary bypass surgery patients. A prospective cohort study
Authors: Iribarren, José L.
Jiménez, Juan J.
Hernández, Domingo
Lorenzo, Lisset
Brouard, Maitane
Milena, Antonio
Mora, María L.
Martínez, Rafael
metadata.dc.contributor.authoraffiliation: [Iribarren,JL; Jiménez,JJ; Lorenzo,L; Mora,ML]. Critical Care Department. Hospital Universitario de Canarias,La Laguna. Tenerife. España. [Hernández, D] Nephrology Department. Hospital Universitario Carlos Haya. Málaga. España. [Milena,A] Biochemistry Laboratory. Hospital Universitario de Canarias.La Laguna. Tenerife. España. [Martínez, R] Cardiac Surgery Department. Hospital Universitario de Canarias. La Laguna. Tenerife. España.
Keywords: Insuficiencia Suprarrenal;Anestésicos Intravenoso;Procedimientos Quirúrgicos Cardíaco;Puente Cardiopulmonar;Cosintropina;Etomidato;Hidrocortisona;Cuidados Postoperatorios;Vasoconstrictores
metadata.dc.subject.mesh: Medical Subject Headings::Diseases::Endocrine System Diseases::Adrenal Gland Diseases::Adrenal Insufficiency
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Central Nervous System Depressants::Anesthetics::Anesthetics, General::Anesthetics, Intravenous
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Cardiac Surgical Procedures
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Extracorporeal Circulation::Cardiopulmonary Bypass
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Neuropeptides::Hypothalamic Hormones::Pro-Opiomelanocortin::Melanocortins::Adrenocorticotropic Hormone::Cosyntropin
Medical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 1-Ring::Azoles::Imidazoles::Etomidate
Medical Subject Headings::Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones::Hydroxycorticosteroids::11-Hydroxycorticosteroids::Hydrocortisone
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Perioperative Care::Postoperative Care
Medical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative Complications
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Cardiovascular Agents::Vasoconstrictor Agents
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies
Issue Date: Apr-2010
Publisher: BioMed Central
Citation: Iribarren JL, Jiménez JJ, Hernández D, Lorenzo L, Brouard M, Milena A, et al. Relative adrenal insufficiency and hemodynamic status in cardiopulmonary bypass surgery patients. A prospective cohort study. J Cardiothorac Surg. 2010;5:26.
Abstract: BACKGROUND: The objectives of this study were to determine the risk factors for relative adrenal insufficiency in cardiopulmonary bypass patients and the impact on postoperative vasopressor requirements. METHODS: Prospective cohort study on cardiopulmonary bypass patients who received etomidate or not during anesthetic induction. Relative adrenal insufficiency was defined as a rise in serum cortisol <or= 9 microg/dl after the administration of 250 microg of consyntropin. Plasma cortisol levels were measured preoperatively, immediately before, 30, 60, and 90 minutes after the administration of cosyntropin, and at 24 hours after surgery. RESULTS: 120 elective cardiopulmonary bypass patients were included. Relative adrenal insufficiency (Deltacortisol <or=9 microg/dl) incidence was 77.5%. 78 patients received etomidate and 69 (88%) of them developed relative adrenal insufficiency, (P < 0.001). Controlling for clinical characteristics with a propensity analysis, etomidate was the only independent risk factor associated with relative adrenal insufficiency (OR 6.55, CI 95%: 2.47-17.4; P < 0.001). Relative adrenal insufficiency patients showed more vasopressor requirements just after surgery (P = 0.04), and at 4 hours after surgery (P = 0.01). Pre and post-test plasma cortisol levels were inversely associated with maximum norepinephrine dose (rho = -0.22, P = 0.02; rho = -0.18, P = 0.05; rho = -0.21, P = 0.02; and rho = -0.22, P = 0.02, respectively). CONCLUSIONS: Relative adrenal insufficiency in elective cardiopulmonary bypass patients may induce postoperative vasopressor dependency. Use of etomidate in these patients is a modifiable risk factor for the development of relative adrenal insufficiency that should be avoided.
Description: Research article
URI: http://hdl.handle.net/10668/396
metadata.dc.relation.publisherversion: http://www.cardiothoracicsurgery.org/content/5/1/26
metadata.dc.identifier.doi: 10.1186/1749-8090-5-26
ISSN: 1749-8090
Appears in Collections:01- Artículos - Hospital Regional de Málaga

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