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Intensive Care Med. 2008 Feb;34(2):344-9. Epub 2007 Sep 29.

Stress doses of hydrocortisone in septic shock: beneficial effects on opsonization-dependent neutrophil functions.

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1
Ludwig Maximilians University, Klinikum Grosshadern, Clinic of Anesthesiology, 81377 Munich, Germany.

Abstract

OBJECTIVE:

To assess the effects of stress doses of hydrocortisone (HC) on clinical parameters and neutrophil functions in patients with septic shock.

DESIGN:

Prospective, double-blind, randomized, placebo-controlled study.

SETTING:

Intensive care units of a university hospital.

PATIENTS AND PARTICIPANTS:

30 adult patients with septic shock.

INTERVENTIONS:

Patients were allocated to receive either HC (intravenous bolus of 100 mg preceding a continuous infusion 10 mg/h, n = 15) or placebo (n = 15), respectively. The effects of HC were assessed at baseline and after 24 h.

MEASUREMENTS AND RESULTS:

As compared with placebo-treated patients, administration of HC significantly decreased norepinephrine requirements (from 1.5 to 0.8 mg/h; p < 0.001), interleukin-6 serum concentrations (from 388.8 to 88.8 pg/ml; p < 0.02), and the spontaneous release of hydrogen peroxide (H2O2) by neutrophils (-33.0%; p < 0.05). Additionally, HC treatment preserved the autologous plasma-induced amplification of phagocytosis of zymosan particles [factor of opsonin-induced amplification of phagocytosis of unopsonized particles: 1.80 for placebo vs. 1.75 for HC at baseline (not significant between groups) and 0.50 for placebo vs. 1.75 for HC after 24 h of treatment (p < 0.05)]. These effects were paralleled by respective changes in the phagocytosis-associated H2O2 production.

CONCLUSIONS:

In patients with septic shock stress doses of HC exert beneficial effects in terms of improvements in hemodynamics, decrease in pro-inflammatory mediators, and oxidative stress without the compromise of opsonization-dependent phagocytic neutrophil functions; thus, HC treatment does not aggravate non-specific immunosuppression but instead improves innate immunity in the early stage of septic shock.

PMID:
17906853
DOI:
10.1007/s00134-007-0868-8
[Indexed for MEDLINE]
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