Erschienen in:
01.02.2008 | Brief Report
Stress doses of hydrocortisone in septic shock: beneficial effects on opsonization-dependent neutrophil functions
verfasst von:
Ines Kaufmann, Josef Briegel, Florian Schliephake, Alwin Hoelzl, Alexander Chouker, Theresia Hummel, Gustav Schelling, Manfred Thiel
Erschienen in:
Intensive Care Medicine
|
Ausgabe 2/2008
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Abstract
Objective
To assess the effects of stress doses of hydrocortisone (HC) on clinical parameters and neutrophil functions in patients with septic shock.
Design
Prospective, double-blind, randomized, placebo-controlled study.
Setting
Intensive care units of a university hospital.
Patients and participants
30 adult patients with septic shock.
Interventions
Patients were allocated to receive either HC (intravenous bolus of 100 mg preceding a continuous infusion 10 mg/h, n = 15) or placebo (n = 15), respectively. The effects of HC were assessed at baseline and after 24 h.
Measurements and results
As compared with placebo-treated patients, administration of HC significantly decreased norepinephrine requirements (from 1.5 to 0.8 mg/h; p < 0.001), interleukin-6 serum concentrations (from 388.8 to 88.8 pg/ml; p < 0.02), and the spontaneous release of hydrogen peroxide (H2O2) by neutrophils (−33.0%; p < 0.05). Additionally, HC treatment preserved the autologous plasma-induced amplification of phagocytosis of zymosan particles [factor of opsonin-induced amplification of phagocytosis of unopsonized particles: 1.80 for placebo vs. 1.75 for HC at baseline (not significant between groups) and 0.50 for placebo vs. 1.75 for HC after 24 h of treatment (p < 0.05)]. These effects were paralleled by respective changes in the phagocytosis-associated H2O2 production.
Conclusions
In patients with septic shock stress doses of HC exert beneficial effects in terms of improvements in hemodynamics, decrease in pro-inflammatory mediators, and oxidative stress without the compromise of opsonization-dependent phagocytic neutrophil functions; thus, HC treatment does not aggravate non-specific immunosuppression but instead improves innate immunity in the early stage of septic shock.