Dünser, Martin

Lorenz, Ingo

Luckner, Günter

Schmittinger, Christian

Schröder, Daniel

Torgersen, Christian

RERO DOC Digital Library

Christian A. SchmittingerChristian TorgersenGu¨nter LucknerDaniel C. H. Schro¨derIngo LorenzMartin W. Du¨nserResponse to Salvadori et al.:adverse cardiac eventsduring catecholamine therapy:a role for hydrocortisone?Accepted: 1 July 2012Published online: 7 August 2012 Copyright jointly held by Springer andESICM 2012This reply refers to the comment availableat: doi:10.1007/s00134-012-2663-4.Dear Editor,We thank Dr. Salvadori and his col-leagues for their interest in our work[1] and the constructive comments. Inview of the evolving controversyregarding the effects of hydrocorti-sone therapy in sepsis during thestudy period (January to December2009), the use of hydrocortisone wasstrictly reserved for patients withseptic shock requiring escalatingnorepinephrine doses. This explainswhy only one patient suffering fromseptic shock received hydrocortisone(continuous infusion of 200 mg/day)at study enrollment. Unfortunately,this precludes evaluation of theinfluence of hydrocortisone on thebinary occurrence of adverse cardiacevents in our study population. At theoccurrence of an adverse cardiacevent, 15 of 21 septic shock patients(71.4 %) received a continuoushydrocortisone infusion at a median(interquartile range, IQR) daily doseof 192 (192–288) mg. The absolutenumber of adverse cardiac events didnot differ between septic shockpatients with or without hydrocorti-sone therapy [4 (2.5–6) versus 3(2–7)] in both an unadjusted(p = 0.64) and adjusted (p = 0.12)model (model adjustment for Simpli-fied Acute Physiology Score II, needfor renal replacement therapy, pres-ence of chronic liver diseases).Interestingly, however, patients onhydrocortisone developed adversecardiac events at higher medianvasopressor load [0.48(0.36–0.54) lg/kg/min] than patientswho did not receive hydrocortisone[0.18 (0.06–0.43) lg/kg/min] in bothan unadjusted (p = 0.005) andadjusted model (p = 0.006). The typeof adverse cardiac event had noinfluence on this association(p = 0.17 and p = 0.13, respec-tively). Carrying the hypothesis ofSalvadori and colleagues on a poten-tially protective effect ofhydrocortisone on the occurrence ofadverse cardiac events during cate-cholamine vasopressor therapyfurther, one may speculate thathydrocortisone raised the individualthreshold at which catecholaminevasopressors may induce adversecardiac events in our study patientswith septic shock. Taking the post -hoc character of this analysis and thelow number of septic shock patientsdeveloping adverse cardiac events(n = 21) into consideration, thesedata must be regarded as purelyhypothesis-generating. Further stud-ies are, therefore, needed to evaluatethe influence of a hydrocortisonetherapy on the occurrence of adverse(cardiac) events during catecholaminevasopressor therapy in septic shock.Reference1. Schmittinger CA, Torgersen C, LucknerG, Schro¨der DCH, Lorenz I, Du¨nser MW(2012) Adverse cardiac events duringcatecholamine vasopressor therapy: aprospective observational study.Intensive Care Med 38:950–958.doi:10.1007/s00134-012-2531-2C. A. Schmittinger  C. TorgersenDepartment of Intensive Care Medicine,Inselspital, Bern University Hospital andUniversity of Bern, Bern, SwitzerlandC. A. Schmittinger ())Department of Anaesthesiology, SurgicalIntensive Care Medicine, and RescueMedicine, Lucerne Cantonal Hospital,Lucerne, Switzerlande-mail: christian.schmittinger@luks.chTel.: ?41-41-2054901C. Torgersen  G. Luckner D. C. H. Schro¨der  I. LorenzDepartment of Anaesthesiology and CriticalCare Medicine, Innsbruck MedicalUniversity, Innsbruck, AustriaM. W. Du¨nserDepartment of Anaesthesiology,Perioperative and Intensive Care Medicine,Salzburg General Hospital and ParacelsusPrivate Medical University,Salzburg, AustriaIntensive Care Med (2012) 38:1726DOI 10.1007/s00134-012-2665-2 CORRESPONDENCE

Response to Salvadori et al.: adverse cardiac events during catecholamine therapy: a role for hydrocortisone?

http://doc.rero.ch/record/312933/files/134_2012_Article_2665.pdf

Response to Salvadori et al.: adverse cardiac events during catecholamine therapy: a role for hydrocortisone?

Abstract

Similar works

Full text

Available Versions

RERO DOC Digital Library