Adrenal Dysfunction in Severe Community-Acquired Pneumonia Requiring VenoVenous Extracorporeal Membrane Oxygenation
https://doi.org/10.23934/2223-9022-2024-13-1-150-155
Abstract
The article presents a clinical case of adrenal dysfunction in a patient with severe communityacquired pneumonia requiring extracorporeal membrane oxygenation. We discuss the lack of diagnostic criteria for adrenal dysfunction in critical conditions; the tactics of hydrocortisone treatment: initiation of use, its duration, dose titration and withdrawal conditions.
About the Authors
N. E. AltshulerRussian Federation
Natavan E. Altshuler - Candidate of Medical Sciences, Assistant of the Department of Anesthesiology, Reanimatology and Intensive Care, Medical and Biological University of Innovation and Continuing Education, A.I. Burnasyan FMBC.
23, Marshala Novikova Str., Moscow 123098
N. M. Kruglyakov
Russian Federation
Nikolay M. Kruglyakov - AnesthesiologistResuscitator, Head of the Department of Resuscitation and Intensive Care.
23, Marshala Novikova Str., Moscow 123098
G. I. Bagzhanov
Russian Federation
German I. Bagzhanov - Assistant of the Department of Anesthesiology, Reanimatology and Intensive Care, Medical and Biological University of Innovation and Continuing Education.
23, Marshala Novikova Str., Moscow 123098
A. A. Dokukin
Russian Federation
Aleksey A. Dokukin - AnesthesiologistResuscitator, European Medical Center.
3, Shepkina Str., Moscow 129090
K. K. Gubarev
Russian Federation
Konstantin K. Gubarev - Candidate of Medical Sciences, Head of the ECMO Center; Head of the Surgical Department for Coordination of Organ and (or) Human Tissue Donation, A.I. Burnasyan FMBC.
23, Marshala Novikova Str., Moscow 123098
M. B. Kutsyi
Russian Federation
Mikhail B. Kutsyi - Candidate of Medical Sciences, Head of the Surgical Center, European Medical Center.
3, Shepkina Str., Moscow 129090
K. A. Popugaev
Russian Federation
Konstantin A. Popugaev - Doctor of Medical Sciences, Professor of the Russian Academy of Sciences, Deputy DirectorHead of the Regional Vascular Center of the N.V. Sklifosovsky RI for Emergency Medicine; Head of the Department of Anesthesiology, Reanimatology and Intensive Care, Medical and BU of Innovation and Continuing Education, A.I. Burnasyan FMBC.
23, Marshala Novikova Str., Moscow 123098; 3, Bolshaya Sukharevskaya Sq., Moscow 129090
References
1. Krishnan S, Schmidt GA. Hemodynamic monitoring in the extracorporeal membrane oxygenation patient. Curr Opin Crit Care. 2019;25(3):285–291. PMID: 30865613 https://doi.org/10.1097/MCC.0000000000000602
2. Annane D, Pastores SM, Rochwerg B, Arlt W, Balk RA, Beishuizen A, et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in Critically Ill Patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM). Crit Care Med. 2017;45(12):2078–2088. PMID: 28940011 https://doi.org/10.1097/CCM.0000000000002737
3. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–1247. PMID: 34599691 https://doi.org/10.1007/s00134-021-06506-y
4. Töpfer L, Menk M, Weber-Carstens S, Spies C, Wernecke KD, Uhrig A, et al. Influenza A (H1N1) vs non-H1N1 ARDS: analysis of clinical course. J Crit Care. 2014;29(3):340–346. PMID: 24508203 https://doi.org/10.1016/j.jcrc.2013.12.013
5. Marik PE, Pastores SM, Annane D, Meduri GU, Sprung CL, Arlt W, et al. Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: consensus statements from an international task force by the American College of Critical Care Medicine. Crit Care Med. 2008;36(6):1937–1949. PMID: 18496365 https://doi.org/10.1097/ccm.0b013e31817603ba
6. Téblick A, Peeters B, Langouche L, den Berghe GV. Adrenal function and dysfunction in critically ill patients. Nat Rev Endocrinol. 2019;15(7):417– 427. PMID: 30850749 https://doi.org/10.1038/s41574-019-0185-7
7. Dhillo WS, Kong WM, Le Roux CW, Alaghband-Zadeh J, Jones J, Carter G, et al. Cortisol-binding globulin is important in the interpretation of dynamic tests of the hypothalamic-pituitary-adrenal axis. Eur J Endocrinol. 2002;146(2):231–235. PMID: 11834433 https://doi.org/10.1530/eje.0.1460231
8. Combes A, Peek GJ, Hajage D, Hardy P, Abrams D, Schmidt M, et al. ECMO for severe ARDS: systematic review and individual patient data meta-analysis. Intensive Care Med. 2020;46(11):2048–2057. PMID: 33021684 https://doi.org/10.1007/s00134-020-06248-3
9. Ho JT, Al-Musalhi H, Chapman MJ, Quach T, Thomas PD, Bagley CJ, et al. Septic shock and sepsis: a comparison of total and free plasma cortisol levels. J Clin Endocrinol Metab. 2006;91(1):105–114. PMID: 16263835 https://doi.org/10.1210/jc.2005-0265
10. Loisa P, Uusaro A, Ruokonen E. A single adrenocorticotropic hormone stimulation test does not reveal adrenal insufficiency in septic shock. Anesth Analg. 2005;101(6):1792–1798. PMID: 16301260 https://doi.org/10.1213/01.ane.0000184042.91452.48
11. Bouachour G, Roy PM, Guiraud MP. The repetitive short corticotropin stimulation test in patients with septic shock. Ann Intern Med. 1995;123(12):962–963. PMID: 7486498 https://doi.org/10.7326/00034819-123-12-199512150-00018
Review
For citations:
Altshuler N.E., Kruglyakov N.M., Bagzhanov G.I., Dokukin A.A., Gubarev K.K., Kutsyi M.B., Popugaev K.A. Adrenal Dysfunction in Severe Community-Acquired Pneumonia Requiring VenoVenous Extracorporeal Membrane Oxygenation. Russian Sklifosovsky Journal "Emergency Medical Care". 2024;13(1):150-155. https://doi.org/10.23934/2223-9022-2024-13-1-150-155