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document
Immunologic and hemodynamic effects of " low-dose " hydrocortisone in septic shock : a double-blind , randomized , placebo-controlled , crossover study . Within the last few years , increasing evidence of relative adrenal insufficiency in septic shock evoked a reassessment of hydrocortisone therapy . To evaluate the effects of hydrocortisone on the balance between proinflammatory and antiinflammation , 40 patients with septic shock were randomized in a double-blind crossover study to receive either the first 100 mg of hydrocortisone as a loading dose and 10 mg per hour until Day 3 ( n = 20 ) or placebo ( n = 20 ) , followed by the opposite medication until Day 6 . Hydrocortisone infusion induced an increase of mean arterial pressure , systemic vascular resistance , and a decline of heart rate , cardiac index , and norepinephrine requirement . A reduction of plasma nitrite/nitrate indicated inhibition of nitric oxide formation and correlated with a reduction of vasopressor support . The inflammatory response ( interleukin-6 and interleukin-8 ) , endothelial ( soluble E-selectin ) and neutrophil activation ( expression of CD11b , CD64 ) , and antiinflammatory response ( soluble tumor necrosis factor receptors I and II and interleukin-10 ) were attenuated . In peripheral blood monocytes , human leukocyte antigen-DR expression was only slightly depressed , whereas in vitro phagocytosis and the monocyte-activating cytokine interleukin-12 increased . Hydrocortisone withdrawal induced hemodynamic and immunologic rebound effects . In conclusion , hydrocortisone therapy restored hemodynamic stability and differentially modulated the immunologic response to stress in a way of antiinflammation rather than immunosuppression .
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Intervention_Pharmacological
" low-dose " hydrocortisone
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Intervention_Control
placebo-controlled
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Intervention_Pharmacological
hydrocortisone
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Intervention_Pharmacological
hydrocortisone
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Intervention_Pharmacological
hydrocortisone
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Intervention_Control
placebo
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Intervention_Pharmacological
Hydrocortisone
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Intervention_Pharmacological
Hydrocortisone
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Intervention_Pharmacological
hydrocortisone
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Outcome_Physical
mean arterial pressure , systemic vascular resistance
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Outcome_Physical
heart rate
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Outcome_Physical
cardiac index
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Outcome_Other
norepinephrine requirement
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Outcome_Physical
plasma nitrite/nitrate
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Outcome_Physical
nitric oxide formation
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Outcome_Physical
reduction of vasopressor support
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Outcome_Physical
inflammatory response ( interleukin-6 and interleukin-8 )
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Outcome_Physical
endothelial ( soluble E-selectin )
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Outcome_Physical
neutrophil activation
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Outcome_Physical
antiinflammatory response
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Outcome_Physical
soluble tumor necrosis factor receptors I and II and interleukin-10
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Outcome_Physical
human leukocyte antigen-DR expression
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Outcome_Physical
in vitro phagocytosis
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Outcome_Physical
monocyte-activating cytokine interleukin-12
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Outcome_Adverse-effects
hemodynamic and immunologic rebound effects .
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Outcome_Physical
hemodynamic stability
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Outcome_Physical
immunologic response to stress
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Participant_Condition
septic shock :
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Participant_Condition
adrenal insufficiency
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Participant_Condition
septic shock
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Participant_Sample-size
40
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Participant_Condition
septic shock