کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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3010444 | 1181515 | 2008 | 8 صفحه PDF | دانلود رایگان |
![عکس صفحه اول مقاله: The pituitary–adrenal axis is activated more in non-survivors than in survivors of cardiac arrest, irrespective of therapeutic hypothermia The pituitary–adrenal axis is activated more in non-survivors than in survivors of cardiac arrest, irrespective of therapeutic hypothermia](/preview/png/3010444.png)
SummaryObjectiveTo investigate the effect of therapeutic hypothermia in the prognostic value of the pituitary–adrenal axis in comatose patients after cardiac arrest.DesignProspective observational study in intensive care units (ICU) of a university and an affiliated regional hospital.PatientsTwenty-nine consecutive patients, in coma after cardiac arrest, admitted to the ICU and treated by hypothermia.MeasurementsOn ICU-admission (T = 1), at reaching the target of 32–33 °C during therapeutic hypothermia (T = 2), at the end of hypothermia (T = 3) and 48 h later (T = 4), plasma adrenocorticotrophic hormone (ACTH), serum cortisol, albumin and corticosteroid-binding globulin (CBG) were measured. A short 250 μg ACTH test was performed at each time-point, except at T = 1. The free cortisol index (FCI) and free cortisol calculated by Coolens method were also evaluated.ResultsThe ICU mortality was 59%, including withdrawal of life-sustaining treatment in 45% because of negative somatosensory evoked potentials. ACTH and (free) cortisol levels (mean 13.1 pmol/L vs. 6.0 pmol/L and 1250 nmol/L vs. 596 nmol/L, respectively) were higher in non-survivors than in survivors. Levels decreased in time, but the relative difference between outcome groups was maintained until T = 4. The cortisol response to ACTH was lower in non-survivors at T = 3 (P = 0.047) only.ConclusionsIn comatose patients resuscitated from cardiac arrest, the pituitary–adrenal axis is activated particularly in those dying in the ICU, irrespective of therapeutic hypothermia. Hence, activation of the axis may be a marker of fatal cerebral damage. There is no firm evidence for relative adrenal insufficiency associated with death and a transiently blunted cortisol response to ACTH in non-survivors may be attributed to higher baseline values.
Journal: Resuscitation - Volume 78, Issue 3, September 2008, Pages 281–288