Intensive care unit physicians can increase the success of mechanical ventilation weaning and shorten the weaning period by identifying critically ill patients who have adrenal insufficiency and treating them with the hormone hydrocortisone (cortisol).
These study results appear in the first issue for February 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Horng-Chyuan Lin, M.D., of the Department of Thoracic Medicine II at Chang Gung Memorial Hospital in Taipei, Taiwan, and an associate studied 93 critically ill patients who were receiving mechanical ventilation. In an initial evaluation, 23 individuals exhibited normal adrenal function and 70 were diagnosed with adrenal insufficiency.
Because of the high percentage of adrenal insufficiency detected within the study cohort, the authors recommend that all mechanically ventilated patients undergo an adrenal function test before weaning.
The adrenal gland, which plays an important role in stress response, is situated atop the kidney and secrets various hormones essential to the function of many organ systems in the body. Cortisol (hydrocortisone) is an adrenal-cortex hormone used in the treatment of rheumatoid arthritis and other inflammatory conditions.
According to the authors, adrenal insufficiency is a common disorder in critically ill patients who have been mechanically ventilated. For these patients, the problem is usually associated with higher mortality and a poor clinical outcome.
To determine whether corticosteroid supplementation could improve ventilator weaning in those patients with renal insufficiency, the investigators divided the 70 patients into two groups by random computer selection. Thirty-five individuals were treated with hydrocortisone intravenously, while 35 controls received a saline solution.