RT Journal Article
T1 Relative adrenal insufficiency and hemodynamic status in cardiopulmonary bypass surgery patients. A prospective cohort study
A1 Iribarren, José L.
A1 Jiménez, Juan J.
A1 Hernández, Domingo
A1 Lorenzo, Lisset
A1 Brouard, Maitane
A1 Milena, Antonio
A1 Mora, María L.
A1 Martínez, Rafael
K1 Insuficiencia Suprarrenal
K1 Anestésicos Intravenoso
K1 Procedimientos Quirúrgicos Cardíaco
K1 Puente Cardiopulmonar
K1 Cosintropina
K1 Etomidato
K1 Hidrocortisona
K1 Cuidados Postoperatorios
K1 Vasoconstrictores
AB BACKGROUND: The objectives of this study were to determine the risk factors for relative adrenal insufficiency in cardiopulmonary bypass patients and the impact on postoperative vasopressor requirements.METHODS: Prospective cohort study on cardiopulmonary bypass patients who received etomidate or not during anesthetic induction. Relative adrenal insufficiency was defined as a rise in serum cortisol <or= 9 microg/dl after the administration of 250 microg of consyntropin. Plasma cortisol levels were measured preoperatively, immediately before, 30, 60, and 90 minutes after the administration of cosyntropin, and at 24 hours after surgery. RESULTS: 120 elective cardiopulmonary bypass patients were included. Relative adrenal insufficiency (Deltacortisol <or=9 microg/dl) incidence was 77.5%. 78 patients received etomidate and 69 (88%) of them developed relative adrenal insufficiency, (P < 0.001). Controlling for clinical characteristics with a propensity analysis, etomidate was the only independent risk factor associated with relative adrenal insufficiency (OR 6.55, CI 95%: 2.47-17.4; P < 0.001). Relative adrenal insufficiency patients showed more vasopressor requirements just after surgery (P = 0.04), and at 4 hours after surgery (P = 0.01). Pre and post-test plasma cortisol levels were inversely associated with maximum norepinephrine dose (rho = -0.22, P = 0.02; rho = -0.18, P = 0.05; rho = -0.21, P = 0.02; and rho = -0.22, P = 0.02, respectively). CONCLUSIONS: Relative adrenal insufficiency in elective cardiopulmonary bypass patients may induce postoperative vasopressor dependency. Use of etomidate in these patients is a modifiable risk factor for the development of relative adrenal insufficiency that should be avoided.
PB BioMed Central
SN 1749-8090
YR 2010
FD 2010-04
LK http://hdl.handle.net/10668/396
UL http://hdl.handle.net/10668/396
LA en
NO Iribarren JL, Jiménez JJ, Hernández D, Lorenzo L, Brouard M, Milena A, et al. Relative adrenal insufficiency and hemodynamic status in cardiopulmonary bypass surgery patients. A prospective cohort study. J Cardiothorac Surg. 2010;5:26.
NO Research article
DS RISalud
RD Apr 8, 2025