Corticoids and ACTH test in septic shock: a prospective study over 15 months
© Biomed central limited 2001
Published: 1 March 2002
Inflammatory and vascular manifestations have a considerable physiological role during septic shock. The place of corticoids is discussed since 30 years.
To determine the interest of the use of corticoids in septic shock.
Patients and methods
During a period of 15 months (June 2000–August 2001), are enrolled all the patients presenting a septic shock requiring high and/or increasing doses of vaso-active agents because of the obstinacy of a low blood pressure in spite of a satisfactory colloid infusion. A test with ACTH is realized in all patients, then treatment with 300 mg daily Hydrocortisone (3×100) is administered.
Twenty-one patients are enrolled. Their mean age is 46 ± 17 years. The mean severity score (IGSII) is 42 ± 14. The etiology is pneumonia in 62% of cases. Nosocomial infection is found 13 times (62%). The administration of corticoids is begun at the 10th hour on average. Evolution is favorable in 17 patients (81%), judged on the increase of blood pressure, the beginning of weaning or the stabilization of necessities in vaso-active agents. This occurs in 21 ± 16 H.
The result of the ACTH test allowed to distinguish three groups of patients.
Six patients have adequate adrenal response: high basal serum cortisol level which increase after ACTH's injection. Hydrocortisone is stopped. Evolution in this group is always favorable (100%).
Thirteen patients have a relative adrenal insufficiency: normal or high serum cortisol level but with a weak increase after the test. Hydrocortisone is maintained for 5 days. Evolution is favorable in nine patients (69%).
Two patients with very high serum cortisol level, had quickly fatal evolution.
The ACTH test must be realized at the patients in state of septic shock to discover those that can benefit from a contribution of corticoids.