Interest of low-dose hydrocortisone therapy during brain-dead organ donor resuscitation: the CORTICOME study

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• 作者：Michel Pinsard (69)
  St茅phanie Ragot (70)
  Paul Michel Mertes (71)
  Jean Paul Bleichner (72)
  Samira Zitouni (73)
  Fabrice Cook (74)
  Marc Pierrot (75)
  Laurent Dube (76)
  Edgard Menguy (77)
  Laurent Martin Lef猫vre (78)
  Laurence Escaravage (79)
  Pierre-Fran莽ois Dequin (80)
  Philippe Vignon (81)
  Nicolas Pichon (82)
  
  69. Intensive Care Unit ; Inserm U 1082 ; University Hospital Mil茅trie ; Poitiers ; 86000 ; France
  70. Center of Clinical Investigation ; Inserm 0802 ; Poitiers ; 86000 ; France
  71. Department of Anesthesiology ; Inserm U 1116 ; University Hospital of Strasbourg ; Nancy ; 54000 ; France
  72. Intensive Care Unit ; University Hospital Pontchaillou ; Rennes ; 35000 ; France
  73. Intensive Care Unit ; University Hospital C么te de Nacre ; Caen ; 14000 ; France
  74. Intensive Care Unit ; University Hospital Henri Mondor ; Cr茅teil ; 94010 ; France
  75. Critical Care Department ; University Hospital of Angers ; Angers ; 49100 ; France
  76. Intensive Care Unit ; University Hospital of Angers ; Angers ; 49100 ; France
  77. Intensive Care Unit ; University Hospital of Rouen ; Rouen ; 76000 ; France
  78. Intensive Care Unit ; Hospital Les Oudairies ; La Roche-sur-Yon ; 85925 ; France
  79. Department of Anesthesiology ; University Hospital of Clermont-Ferrand ; Clermont-Ferrand ; 63000 ; France
  80. Critical Care Department ; University Hospital Bretonneau ; Tours ; 37000 ; France
  81. Intensive Care Unit ; University Hospital of Limoges ; Limoges ; 87042 ; France
  82. Center of Clinical Investigation ; INSERM 1435 ; CHU Dupuytren ; 2 Avenue Martin Luther King ; Limoges ; 87042 ; France
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：18
• 期：4
• 全文大小：382 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Circulatory failure during brain death organ donor resuscitation is a problem that compromises recovery of organs. Combined administration of steroid, thyroxine and vasopressin has been proposed to optimize the management of brain deceased donors before recovery of organs. However the single administration of hydrocortisone has not been rigorously evaluated in any trial. Methods In this prospective multicenter cluster study, 259 subjects were included. Administration of low-dose steroids composed the steroid group (n鈥?鈥?02). Results Although there were more patients in the steroid group who received norepinephrine before brain death (80% vs. 66%: P鈥?鈥?.03), mean dose of vasopressor administered after brain death was significantly lower than in the control group (1.18鈥壜扁€?.92聽mg/H vs. 1.49鈥壜扁€?.29聽mg/H: P鈥?鈥?.03), duration of vasopressor support use was shorter (874聽min vs. 1160聽min: P鈥?鈥?.0001) and norepinephrine weaning before aortic clamping was more frequent (33.8% vs. 9.5%: P鈥?鈥?.0001). Using a survival approach, probability of norepinephrine weaning was significantly different between the two groups (P鈥?鈥?.0001) with a probability of weaning 4.67 times higher in the steroid group than in the control group (95% CI: 2.30 鈥?9.49). Conclusions Despite no observed benefits of the steroid administration on primary function recovery of transplanted grafts, administration of glucocorticoids should be a part of the resuscitation management of deceased donors with hemodynamic instability.