metabolism Archives - Critical Care Science (CCS)
, , Abstract
Rev Bras Ter Intensiva. 2020;32(4):514-520
DOI 10.5935/0103-507X.20200088
, , Low levels of thyroid hormones have been associated with poor clinical outcomes. This metabolic situation, designated euthyroid sick syndrome, has been interpreted as a state of adaptation to different pathological processes, characterized by the decrease in plasma triiodothyronine. The present study seeks to determine the incidence of this disorder in patients with septic shock and its relationship with other severity indices and clinical outcomes.
This prospective analytical study evaluated patients admitted to the intensive care unit with septic shock between April 2018 and July 2019. Variables associated with septic shock and thyroid profile were recorded at the time of the septic shock diagnosis and 7, 14, and 21 days later.
A total of 27 patients who met the inclusion criteria were analyzed. The incidence of an altered thyroid axis was 96.3%, with a mortality at 28 days of 36.7%. Patients without hormonal alteration did not present negative outcomes. Among those with low triiodothyronine, 42.3% recovered their thyroid function within 28 days, in whom mortality was 0%; 57.7% did not recover their thyroid function, in whom mortality was 66.7%. Those whose thyroid axis was altered and who did not normalize its function required more doses of vasoactives and had deteriorated lactate clearance.
Patients with septic shock have a high incidence of alteration of the thyroid axis, and this dysfunction is associated with higher mortality.
Abstract
Rev Bras Ter Intensiva. 2020;32(4):514-520
DOI 10.5935/0103-507X.20200088
, , Low levels of thyroid hormones have been associated with poor clinical outcomes. This metabolic situation, designated euthyroid sick syndrome, has been interpreted as a state of adaptation to different pathological processes, characterized by the decrease in plasma triiodothyronine. The present study seeks to determine the incidence of this disorder in patients with septic shock and its relationship with other severity indices and clinical outcomes.
This prospective analytical study evaluated patients admitted to the intensive care unit with septic shock between April 2018 and July 2019. Variables associated with septic shock and thyroid profile were recorded at the time of the septic shock diagnosis and 7, 14, and 21 days later.
A total of 27 patients who met the inclusion criteria were analyzed. The incidence of an altered thyroid axis was 96.3%, with a mortality at 28 days of 36.7%. Patients without hormonal alteration did not present negative outcomes. Among those with low triiodothyronine, 42.3% recovered their thyroid function within 28 days, in whom mortality was 0%; 57.7% did not recover their thyroid function, in whom mortality was 66.7%. Those whose thyroid axis was altered and who did not normalize its function required more doses of vasoactives and had deteriorated lactate clearance.
Patients with septic shock have a high incidence of alteration of the thyroid axis, and this dysfunction is associated with higher mortality.
Abstract
Rev Bras Ter Intensiva. 2006;18(2):200-203
DOI 10.1590/S0103-507X2006000200015
BACKGROUND AND OBJECTIVES: To assess the use of recombinant human growth hormone (rhGH) in pediatric patients with hypercatabolic state in the pediatric intensive care unit. METHODS: We searched the databases of MedLine (1990 to 2005), LILACS (1990 to 2005), OVID (1990 to 2006) and EMBASE (1990 to 2005). Randomized controlled trials in pediatric patients using rhGH for hypercatabolic state (burns, sepsis) were selected. Intervention included rhGH therapy versus placebo. Data were extracted in duplicate and independently. Meta-analyses were performed using the software Review Manager statistic tools, with Mantel-Haenzel method for dichotomous outcomes and inverse variance method for continuous. RESULTS: There were evidences that rhGH in burned pediatric patients can reduce exogenous albumin requirement, with a improvement in Lean Body Mass, and accelerate site-donor wound healing, with no effects on mortality. Possibly can reduce the length of hospital stay. Hyperglycemia was the most frequently reported adverse event. CONCLUSIONS: This review suggests that the early application of rhGH to standard treatment in pediatric severe burned patients has the potential to improve some aspects from outcome. At this time, although the literature does not support routine rhGH for pediatric burn patients, consideration should be given to its use in this group, at least as an aim for further research. For use in septic patients, no proper statement can be done.
Abstract
Rev Bras Ter Intensiva. 2006;18(2):200-203
DOI 10.1590/S0103-507X2006000200015
BACKGROUND AND OBJECTIVES: To assess the use of recombinant human growth hormone (rhGH) in pediatric patients with hypercatabolic state in the pediatric intensive care unit. METHODS: We searched the databases of MedLine (1990 to 2005), LILACS (1990 to 2005), OVID (1990 to 2006) and EMBASE (1990 to 2005). Randomized controlled trials in pediatric patients using rhGH for hypercatabolic state (burns, sepsis) were selected. Intervention included rhGH therapy versus placebo. Data were extracted in duplicate and independently. Meta-analyses were performed using the software Review Manager statistic tools, with Mantel-Haenzel method for dichotomous outcomes and inverse variance method for continuous. RESULTS: There were evidences that rhGH in burned pediatric patients can reduce exogenous albumin requirement, with a improvement in Lean Body Mass, and accelerate site-donor wound healing, with no effects on mortality. Possibly can reduce the length of hospital stay. Hyperglycemia was the most frequently reported adverse event. CONCLUSIONS: This review suggests that the early application of rhGH to standard treatment in pediatric severe burned patients has the potential to improve some aspects from outcome. At this time, although the literature does not support routine rhGH for pediatric burn patients, consideration should be given to its use in this group, at least as an aim for further research. For use in septic patients, no proper statement can be done.