Iribarren, José L.Jiménez, Juan J.Hernández, DomingoLorenzo, LissetBrouard, MaitaneMilena, AntonioMora, María L.Martínez, Rafael2012-05-142012-05-142010-04Iribarren 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;5:26.1749-8090http://hdl.handle.net/10668/396Research articleBACKGROUND: 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.enInsuficiencia SuprarrenalAnestésicos IntravenosoProcedimientos Quirúrgicos CardíacoPuente CardiopulmonarCosintropinaEtomidatoHidrocortisonaCuidados PostoperatoriosVasoconstrictoresMedical Subject Headings::Diseases::Endocrine System Diseases::Adrenal Gland Diseases::Adrenal InsufficiencyMedical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Central Nervous System Depressants::Anesthetics::Anesthetics, General::Anesthetics, IntravenousMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Cardiac Surgical ProceduresMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Extracorporeal Circulation::Cardiopulmonary BypassMedical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Neuropeptides::Hypothalamic Hormones::Pro-Opiomelanocortin::Melanocortins::Adrenocorticotropic Hormone::CosyntropinMedical Subject Headings::Chemicals and Drugs::Heterocyclic Compounds::Heterocyclic Compounds, 1-Ring::Azoles::Imidazoles::EtomidateMedical Subject Headings::Chemicals and Drugs::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones::Hydroxycorticosteroids::11-Hydroxycorticosteroids::HydrocortisoneMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Perioperative Care::Postoperative CareMedical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Postoperative ComplicationsMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk FactorsMedical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Cardiovascular Agents::Vasoconstrictor AgentsMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studiesresearch article20403156open access10.1186/1749-8090-5-26PMC2867788