This Article Full Text Full Text (PDF) All Versions of this Article: 200504-545OCv1 173/3/276    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Huang, C.-J. Articles by Lin, H.-C. Search for Related Content PubMed PubMed Citation Articles by Huang, C.-J. Articles by Lin, H.-C.

Association between Adrenal Insufficiency and Ventilator Weaning

Department of Thoracic Medicine II, Chang Gung Memorial Hospital, Taipei, Taiwan

Correspondence and requests for reprints should be addressed to Horng-Chyuan Lin, M.D., Department of Thoracic Medicine II, Chang Gung Memorial Hospital, 5 Fushing Street, Gueishan Shiang, Taoyuan, Taiwan. E-mail: lin53424{at}ms13.hinet.net

Rationale: Adrenal insufficiency is a common disorder in critically ill patients with mechanical ventilation and is usually associated with higher mortality and poor clinical outcome.

Objectives: To determine whether stress dose corticosteroid supplementation can improve ventilator weaning and clinical outcome in patients with adrenal insufficiency.

Methods: A prospective, randomized, placebo controlled, double-blinded study was conducted in the intensive care unit of a tertiary teaching hospital. A total of 93 mechanically ventilated patients were enrolled in the ventilator weaning trial. Adrenal function was assessed in all patients. Patients with adrenal insufficiency were randomized to the treatment group (50 mg intravenous hydrocortisone every 6 h) and the placebo group.

Measurements and Main Results: The successful ventilator weaning percentage was significantly higher in the adequate adrenal reserve group (88.4%) and in the stress dose hydrocortisone treatment group (91.4%) than in the placebo group (68.6%). The weaning period was shorter in the hydrocortisone treatment group than in the placebo group. No significant adverse effects were observed in the corticosteroid treatment group.

Conclusions: For patients with respiratory failure, early identification of adrenal insufficiency and appropriate supplementation with stress dose hydrocortisone increase the success of ventilator weaning and shortens the weaning period.

Key Words: adrenal insufficiency • hypothalamic-pituitary-adrenal axis • stress dose hydrocortisone • ventilator weaning

This article has been cited by other articles:

				S. R. Bornstein Predisposing Factors for Adrenal Insufficiency N. Engl. J. Med., May 28, 2009; 360(22): 2328 - 2339. [Full Text] [PDF]

				C. N. Sessler Mechanical Ventilatory Support ACCP Pulmonary Med Brd Rev, January 1, 2009; 25(0): 457 - 478. [Full Text] [PDF]

				S. K. Epstein Weaning From Ventilatory Support ACCP Crit Care Med Brd Rev, January 1, 2009; 20(0): 213 - 226. [Full Text] [PDF]

				P. E. Marik Critical Illness-Related Corticosteroid Insufficiency Chest, January 1, 2009; 135(1): 181 - 193. [Abstract] [Full Text] [PDF]

				N. MacIntyre Discontinuing Mechanical Ventilatory Support Chest, September 1, 2007; 132(3): 1049 - 1056. [Abstract] [Full Text] [PDF]

				E. B. Milbrandt, A. Ishizaka, and D. C. Angus Update in Critical Care 2006 Am. J. Respir. Crit. Care Med., April 1, 2007; 175(7): 638 - 648. [Full Text] [PDF]

				D. Annane, V. Maxime, F. Ibrahim, J. C. Alvarez, E. Abe, and P. Boudou Diagnosis of Adrenal Insufficiency in Severe Sepsis and Septic Shock Am. J. Respir. Crit. Care Med., December 15, 2006; 174(12): 1319 - 1326. [Abstract] [Full Text] [PDF]

				B. M. Arafah Hypothalamic Pituitary Adrenal Function during Critical Illness: Limitations of Current Assessment Methods J. Clin. Endocrinol. Metab., October 1, 2006; 91(10): 3725 - 3745. [Abstract] [Full Text] [PDF]

				P. E. Marik, D. Annane, C. L. Sprung, W. Arlt, D. Keh, and for the International Task Force on the Diagnoses Using Corticosteroids in Intensive Care Arch Surg, September 1, 2006; 141(9): 946 - 947. [Full Text] [PDF]

				W. H. Marx Steroids and the Intensive Care Unit Arch Surg, September 1, 2006; 141(9): 945 - 946. [Full Text] [PDF]

				W. L. Jackson Jr. Adrenal insufficiency and ventilator weaning: additional study is required. Am. J. Respir. Crit. Care Med., May 15, 2006; 173(10): 1176 - 1176. [Full Text] [PDF]

				C.-J. Huang and H.-C. Lin Adrenal Insufficiency and Ventilator Weaning: Additional Study Is Required Am. J. Respir. Crit. Care Med., May 15, 2006; 173(10): 1176a - 1176a. [Full Text] [PDF]

				I. Dimopoulou Association between Adrenal Insufficiency and Ventilator Weaning. Am. J. Respir. Crit. Care Med., April 15, 2006; 173(8): 934 - 934. [Full Text] [PDF]

				H.-C. Lin and C.-J. Huang Association between Adrenal Insufficiency and Ventilator Weaning Am. J. Respir. Crit. Care Med., April 15, 2006; 173(8): 934a - 935. [Full Text] [PDF]

				Steroid Therapy to Facilitate Ventilator Weaning in the ICU? Journal Watch (General), February 28, 2006; 2006(228): 2 - 2. [Full Text]