Abstract
IntroductionThe aim of this study was to assess the effect of low-dose corticosteroid therapy in reducing shock duration after severe burn.MethodsA placebo-controlled, double-blind, randomized clinical trial (RCT) was performed on two parallel groups in the burn intensive care unit (ICU). Patients were randomized to receive either low-dose corticosteroid therapy or placebo for seven days. A corticotropin test was performed at the time of randomization, before the administration of the treatment dose. Thirty-two severely burned patients with refractory shock (>0.5 μg/kg/min of norepinephrine) were prospectively included in the study.ResultsWe included 12 patients in the hydrocortisone-treated group and 15 patients in the placebo group in the final analysis. Among these patients, 21 were nonresponders to the corticotropin test. Median norepinephrine treatment duration (primary objective) was significantly lower in the corticosteroid-treated versus the placebo group (57 hours versus 120 hours, P = 0.035). The number of patients without norepinephrine 72 hours after inclusion was significantly lower in the treated group (P = 0.003, log-rank test analysis). The total quantities of norepinephrine administered to patients were lower in the hydrocortisone-treated versus the placebo group (1,205 μg/kg (1,079 to 2,167) versus 1,971 μg/kg (1,535 to 3,893), P = 0.067). There was no difference in terms of ICU or hospital length of stay, sepsis incidence, cicatrization or mortality.ConclusionsIn this placebo-controlled, randomized, double-blind clinical trial, we show for the first time that the administration of low-dose hydrocortisone in burn patients with severe shock reduces vasopressor administration.Trial registrationClinicaltrial.gov NCT00149123. Registered 6 September 2005.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0740-0) contains supplementary material, which is available to authorized users.
Highlights
The aim of this study was to assess the effect of low-dose corticosteroid therapy in reducing shock duration after severe burn
Whether this effect may occur in the particular context of burn patients remains to be investigated. Considering these limitations, we want to emphasize that results presented in this study are only preliminary and need to be confirmed through an intention-to-treat, multicentric randomized clinical trial (RCT) including a larger cohort of patients. In this placebo-controlled, double-blind RCT we show for the first time that the administration of low-dose hydrocortisone in burn patients with severe shock reduces vasopressor administration
In the treated group of patients, we observed a significant withdrawal of vasopressor therapy within the first 72 hours after inclusion. This effect was present in burn patients with or without relative adrenal insufficiency (RAI)
Summary
The aim of this study was to assess the effect of low-dose corticosteroid therapy in reducing shock duration after severe burn. Major burn triggers a systemic inflammatory response syndrome associated with the release of circulating mediators such as histamine or cytokines. These inflammatory mediators induce similar consequences as those seen in septic shock. After an initial hypovolemic phase, In septic shock, the use of low-dose corticosteroids has been proposed as an adjunctive therapy to reduce mortality and improve shock reversal. While debate still exists regarding the impact of this treatment on septic shock-induced mortality, low-dose corticosteroids have been shown to improve systemic hemodynamics and reduce the time on vasopressor treatment in septic patients [5,6]. Stress-dose hydrocortisone was suggested as a means of improving outcome in the specific subpopulation of septic patients presenting with critical-illness-related corticosteroid insufficiency [7]
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