Reposi??o de corticoester?ides em crian?as com choque s?ptico
Ano de defesa: | 2012 |
---|---|
Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | |
Tipo de documento: | Tese |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Pontif?cia Universidade Cat?lica do Rio Grande do Sul
|
Programa de Pós-Graduação: |
Programa de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?a
|
Departamento: |
Faculdade de Medicina
|
País: |
BR
|
Palavras-chave em Português: | |
Área do conhecimento CNPq: | |
Link de acesso: | http://tede2.pucrs.br/tede2/handle/tede/1407 |
Resumo: | Objectives: To evaluate hydrocortisone treatment and response to ACTH adrenal stimulation test, with or without respect to basal cortisol, in children with volume refractory septic shock.Method: Randomized placebo controlled clinical trial, including children admitted to the Pediatric Intensive Care Unit at S?o Lucas Hospital (HSL-PUCRS, Brazil) with a diagnosis of volume refractory septic shock, between Jun/2008 and Sep/2012. Basal cortisol level was determined and, then, ACTH test (1mcg/1,73m2) was performed. Then, patients were randomized to hydrocortisone or placebo treatment groups. Study protocol was approved by the HSL?s ethics committee.Results: Fifty six patients were analyzed. Median age was 5 months old, and mortality was 17.8%. Mortality rate was higher in patients that failed to respond to ACTH test, regardless of treatment (36% versus 6%; p=0.01). There was no difference between treatment groups regarding time and dose of vasoactive drugs, PICU length of stay and mortality, even when those who fail to respond to ACTH test were analyzed separately.Conclusion: Mortality was higher among patients who failed to respond to ACTH stimulation test, regardless of group of treatment. In our study, steroid replacement in children with volume refractory septic shock failed to improve mortality or any other studied outcome. More studies are needed to confirm these results |
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Garcia, Pedro Celiny RamosCPF:11423714091http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4787221J8CPF:94556334004http://lattes.cnpq.br/7445910422999371Amoretti, Carolina Friedrich2015-04-14T13:33:01Z2013-03-082012-12-17AMORETTI, Carolina Friedrich. Reposi??o de corticoester?ides em crian?as com choque s?ptico. 2012. 85 f. Tese (Doutorado em Pediatria e Sa?de da Crian?a) - Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Porto Alegre, 2012.http://tede2.pucrs.br/tede2/handle/tede/1407Objectives: To evaluate hydrocortisone treatment and response to ACTH adrenal stimulation test, with or without respect to basal cortisol, in children with volume refractory septic shock.Method: Randomized placebo controlled clinical trial, including children admitted to the Pediatric Intensive Care Unit at S?o Lucas Hospital (HSL-PUCRS, Brazil) with a diagnosis of volume refractory septic shock, between Jun/2008 and Sep/2012. Basal cortisol level was determined and, then, ACTH test (1mcg/1,73m2) was performed. Then, patients were randomized to hydrocortisone or placebo treatment groups. Study protocol was approved by the HSL?s ethics committee.Results: Fifty six patients were analyzed. Median age was 5 months old, and mortality was 17.8%. Mortality rate was higher in patients that failed to respond to ACTH test, regardless of treatment (36% versus 6%; p=0.01). There was no difference between treatment groups regarding time and dose of vasoactive drugs, PICU length of stay and mortality, even when those who fail to respond to ACTH test were analyzed separately.Conclusion: Mortality was higher among patients who failed to respond to ACTH stimulation test, regardless of group of treatment. In our study, steroid replacement in children with volume refractory septic shock failed to improve mortality or any other studied outcome. More studies are needed to confirm these resultsObjetivo: Avaliar o efeito do tratamento com hidrocortisona e da resposta ao teste de estimula??o adrenal com ACTH, com e sem rela??o ao cortisol basal, em pacientes pedi?tricos com choque s?ptico refrat?rio a volume.M?todo: Ensaio cl?nico randomizado, duplo cego, placebo controlado, incluindo crian?as admitidas na Unidade de Terapia Intensiva Pedi?trica do Hospital S?o Lucas, entre junho/2008 e setembro/2012. Os pacientes tinham diagn?stico de choque s?ptico refrat?rio a volume. Foi dosado cortisol basal e ap?s, realizado o teste de estimula??o com ACTH (1mcg/1,73m2). O paciente era ent?o randomizado para tratamento com hidrocortisona ou placebo. O protocolo de estudo foi aprovado pelo Comit? de ?tica do referido hospital.Resultados: Foram analisadas 56 crian?as. A mediana de idade foi de 5 meses, e a mortalidade foi de 17,8%. A mortalidade foi mais alta entre pacientes que n?o responderam ao teste com ACTH, independente do tratamento recebido (36% versus 6%; p=0,01). N?o houve diferen?a estat?stica entre os pacientes tratados ou n?o com hidrocortisona, com rela??o ? mortalidade, horas e quantidade de drogas vasoativas e tempo de interna??o em UTIP. Este resultado se mant?m, mesmo quando analisados separadamente os pacientes que responderam ou n?o ao teste do ACTH.Conclus?o: Pacientes que n?o respondem a est?mulo com ACTH apresentaram mortalidade aumentada, independente do tratamento recebido. A reposi??o de corticoester?ides em crian?as com choque s?ptico refrat?rio a volume n?o mostrou melhora de mortalidade, ou dos outros desfechos avaliados neste estudo. Novos estudos s?o necess?rios para confirmar estes achadosMade available in DSpace on 2015-04-14T13:33:01Z (GMT). No. of bitstreams: 1 446168.pdf: 819347 bytes, checksum: df8fbcb39a3bf3cd0e2b8587e38200b8 (MD5) Previous issue date: 2012-12-17application/pdfhttp://tede2.pucrs.br:80/tede2/retrieve/8621/446168.pdf.jpgporPontif?cia Universidade Cat?lica do Rio Grande do SulPrograma de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?aPUCRSBRFaculdade de MedicinaMEDICINAPEDIATRIAHIDROCORTISONACORTICOSTER?IDESHORM?NIO ADRENOCORTICOTR?PICOCHOQUE S?PTICOCRIAN?ASLACTENTEUNIDADES DE TERAPIA INTENSIVA PEDI?TRICACNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::PEDIATRIAReposi??o de corticoester?ides em crian?as com choque s?pticoinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesis3098206005268432148500600-8624664729441623247info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_RSinstname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSTHUMBNAIL446168.pdf.jpg446168.pdf.jpgimage/jpeg3051http://tede2.pucrs.br/tede2/bitstream/tede/1407/3/446168.pdf.jpg01a0bf50778535ea10e90c794eb10de4MD53TEXT446168.pdf.txt446168.pdf.txttext/plain110003http://tede2.pucrs.br/tede2/bitstream/tede/1407/2/446168.pdf.txtdbd20a2150a6ba42f866c81343cb59e9MD52ORIGINAL446168.pdfapplication/pdf819347http://tede2.pucrs.br/tede2/bitstream/tede/1407/1/446168.pdfdf8fbcb39a3bf3cd0e2b8587e38200b8MD51tede/14072015-04-17 17:09:44.981oai:tede2.pucrs.br:tede/1407Biblioteca Digital de Teses e Dissertaçõeshttp://tede2.pucrs.br/tede2/PRIhttps://tede2.pucrs.br/oai/requestbiblioteca.central@pucrs.br||opendoar:2015-04-17T20:09:44Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false |
dc.title.por.fl_str_mv |
Reposi??o de corticoester?ides em crian?as com choque s?ptico |
title |
Reposi??o de corticoester?ides em crian?as com choque s?ptico |
spellingShingle |
Reposi??o de corticoester?ides em crian?as com choque s?ptico Amoretti, Carolina Friedrich MEDICINA PEDIATRIA HIDROCORTISONA CORTICOSTER?IDES HORM?NIO ADRENOCORTICOTR?PICO CHOQUE S?PTICO CRIAN?AS LACTENTE UNIDADES DE TERAPIA INTENSIVA PEDI?TRICA CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::PEDIATRIA |
title_short |
Reposi??o de corticoester?ides em crian?as com choque s?ptico |
title_full |
Reposi??o de corticoester?ides em crian?as com choque s?ptico |
title_fullStr |
Reposi??o de corticoester?ides em crian?as com choque s?ptico |
title_full_unstemmed |
Reposi??o de corticoester?ides em crian?as com choque s?ptico |
title_sort |
Reposi??o de corticoester?ides em crian?as com choque s?ptico |
author |
Amoretti, Carolina Friedrich |
author_facet |
Amoretti, Carolina Friedrich |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Garcia, Pedro Celiny Ramos |
dc.contributor.advisor1ID.fl_str_mv |
CPF:11423714091 |
dc.contributor.advisor1Lattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4787221J8 |
dc.contributor.authorID.fl_str_mv |
CPF:94556334004 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/7445910422999371 |
dc.contributor.author.fl_str_mv |
Amoretti, Carolina Friedrich |
contributor_str_mv |
Garcia, Pedro Celiny Ramos |
dc.subject.por.fl_str_mv |
MEDICINA PEDIATRIA HIDROCORTISONA CORTICOSTER?IDES HORM?NIO ADRENOCORTICOTR?PICO CHOQUE S?PTICO CRIAN?AS LACTENTE UNIDADES DE TERAPIA INTENSIVA PEDI?TRICA |
topic |
MEDICINA PEDIATRIA HIDROCORTISONA CORTICOSTER?IDES HORM?NIO ADRENOCORTICOTR?PICO CHOQUE S?PTICO CRIAN?AS LACTENTE UNIDADES DE TERAPIA INTENSIVA PEDI?TRICA CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::PEDIATRIA |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::PEDIATRIA |
description |
Objectives: To evaluate hydrocortisone treatment and response to ACTH adrenal stimulation test, with or without respect to basal cortisol, in children with volume refractory septic shock.Method: Randomized placebo controlled clinical trial, including children admitted to the Pediatric Intensive Care Unit at S?o Lucas Hospital (HSL-PUCRS, Brazil) with a diagnosis of volume refractory septic shock, between Jun/2008 and Sep/2012. Basal cortisol level was determined and, then, ACTH test (1mcg/1,73m2) was performed. Then, patients were randomized to hydrocortisone or placebo treatment groups. Study protocol was approved by the HSL?s ethics committee.Results: Fifty six patients were analyzed. Median age was 5 months old, and mortality was 17.8%. Mortality rate was higher in patients that failed to respond to ACTH test, regardless of treatment (36% versus 6%; p=0.01). There was no difference between treatment groups regarding time and dose of vasoactive drugs, PICU length of stay and mortality, even when those who fail to respond to ACTH test were analyzed separately.Conclusion: Mortality was higher among patients who failed to respond to ACTH stimulation test, regardless of group of treatment. In our study, steroid replacement in children with volume refractory septic shock failed to improve mortality or any other studied outcome. More studies are needed to confirm these results |
publishDate |
2012 |
dc.date.issued.fl_str_mv |
2012-12-17 |
dc.date.available.fl_str_mv |
2013-03-08 |
dc.date.accessioned.fl_str_mv |
2015-04-14T13:33:01Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/doctoralThesis |
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doctoralThesis |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
AMORETTI, Carolina Friedrich. Reposi??o de corticoester?ides em crian?as com choque s?ptico. 2012. 85 f. Tese (Doutorado em Pediatria e Sa?de da Crian?a) - Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Porto Alegre, 2012. |
dc.identifier.uri.fl_str_mv |
http://tede2.pucrs.br/tede2/handle/tede/1407 |
identifier_str_mv |
AMORETTI, Carolina Friedrich. Reposi??o de corticoester?ides em crian?as com choque s?ptico. 2012. 85 f. Tese (Doutorado em Pediatria e Sa?de da Crian?a) - Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Porto Alegre, 2012. |
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http://tede2.pucrs.br/tede2/handle/tede/1407 |
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