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Adrenal insufficiency in septic shock
M Hatherill1, S M Tibby, T Hilliard
1Paediatric Intensive Care Unit, Guy's Hospital, London, UK. m.hatherill@umds.ac.uk
Insights
Adrenal insufficiency affects over half of children with septic shock, increasing vasopressor needs and shock duration. Early identification is crucial for managing pediatric critical illness.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Endocrinology
- Pediatric Infectious Diseases
Background:
- Functional adrenal insufficiency is recognized in critically ill adults.
- Septic shock in children presents unique physiological challenges.
- Understanding adrenal function is vital for pediatric intensive care.
Purpose of the Study:
- To determine the incidence of adrenal insufficiency in pediatric septic shock.
- To assess the impact of adrenal insufficiency on treatment and outcomes.
- To evaluate the relationship between adrenal status and mortality in children with septic shock.
Main Methods:
- A study involving 33 children with septic shock in a pediatric intensive care unit.
- Adrenal function assessed via short Synacthen test, defining insufficiency as < 200 nmol/l cortisol increment.
- Analysis of vasopressor requirements, intensive care duration, and mortality.
Main Results:
- Adrenal insufficiency occurred in 52% of children, associated with older age and higher risk scores.
- Children with adrenal insufficiency required higher vasopressor doses and longer inotropic support.
- Mortality rates were similar between groups, but shock duration was prolonged in those with adrenal insufficiency.
Conclusions:
- Adrenal insufficiency is highly prevalent in pediatric septic shock.
- It is linked to increased vasopressor dependency and prolonged shock.
- This highlights the importance of monitoring adrenal function in critically ill children.
Background:
Functional adrenal insufficiency has been documented in critically ill adults.
Objective:
To document the incidence of adrenal insufficiency in children with septic shock, and to evaluate its effect on catecholamine requirements, duration of intensive care, and mortality.
Setting:
Sixteen-bed paediatric intensive care unit in a university hospital.
Methods:
Thirty three children with septic shock were enrolled. Adrenal function was assessed by the maximum cortisol response after synthetic adrenocorticotropin stimulation (short Synacthen test). Insufficiency was defined as a post-Synacthen cortisol increment < 200 nmol/l.
Results:
Overall mortality was 33%. The incidence of adrenal insufficiency was 52% and children with adrenal insufficiency were significantly older and tended to have higher paediatric risk of mortality scores. They also required higher dose vasopressors for haemodynamic stability. In the survivor group, those with adrenal insufficiency needed a longer period of inotropic support than those with normal function (median, 3 v 2 days), but there was no significant difference in duration of ventilation (median, 4 days for each group) or length of stay (median, 5 v 4 days). Mortality was not significantly greater in children with adrenal insufficiency than in those with adequate adrenal function (6 of 17 v 5 of 16, respectively).
Conclusion:
Adrenal insufficiency is common in children with septic shock. It is associated with an increased vasopressor requirement and duration of shock.