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Critical care involves the care of the sickest patients in the hospital. Critically ill patients have usually been through a significant insult to their body (such as trauma, infection, burn) and have developed organ failure and require life-support. Critical Care is the largest theme bringing together clinicians and scientists from diverse backgrounds and includes collaborative research from hospitals throughout north-west London. Investigations range from evaluating biological mechanisms of organ failure through to the development of innovative technologies which allow the short-term and long-term support and recovery of organs.
Many people are exposed to the environment of an Intensive care unit (ICU) either personally or through a family member. It is often a life-changing event and our work aims to reduce this impact facilitating post-ICU recovery.
@article{Gordon:2014:10.1097/CCM.0000000000000212,
author = {Gordon, AC and Mason, AJ and Perkins, GD and Stotz, M and Terblanche, M and Ashby, D and Brett, SJ},
doi = {10.1097/CCM.0000000000000212},
journal = {Critical Care Medicine},
pages = {1325--1333},
title = {The interaction of vasopressin and corticosteroids in septic shock: A pilot randomized controlled trial},
url = {http://dx.doi.org/10.1097/CCM.0000000000000212},
volume = {42},
year = {2014}
}
TY - JOUR
AB - OBJECTIVES: Vasopressin and corticosteroids are both commonly used adjunctive therapies in septic shock. Retrospective analyses have suggested that there may be an interaction between these drugs, with higher circulating vasopressin levels and improved outcomes in patients treated with both vasopressin and corticosteroids. We aimed to test for an interaction between vasopressin and corticosteroids in septic shock. DESIGN: Prospective open-label randomized controlled pilot trial. SETTING: Four adult ICUs in London teaching hospitals. PATIENTS: Sixty-one adult patients who had septic shock. INTERVENTIONS: Initial vasopressin IV infusion titrated up to 0.06 U/min and then IV hydrocortisone (50 mg 6 hourly) or placebo. Plasma vasopressin levels were measured at 6-12 and 24-36 hours after hydrocortisone/placebo administration. MEASUREMENTS AND MAIN RESULTS: Thirty-one patients were allocated to vasopressin + hydrocortisone and 30 patients to vasopressin + placebo. The hydrocortisone group required a shorter duration of vasopressin therapy (3.1 d; 95% CI, 1.1-5.1; shorter in hydrocortisone group) and required a lower total dose of vasopressin (ratio, 0.47; 95% CI, 0.32-0.71) compared with the placebo group. Plasma vasopressin levels were not higher in the hydrocortisone group compared with the placebo group (64 pmol/L difference at 6- to 12-hour time point; 95% CI, -32 to 160 pmol/L). Early vasopressin use was well tolerated with only one serious adverse event possibly related to study drug administration reported. There were no differences in mortality rates (23% 28-day mortality in both groups) or organ failure assessments between the two treatment groups. CONCLUSIONS: Hydrocortisone spared vasopressin requirements, reduced duration, and reduced dose, when used together in the treatment of septic shock, but it did not alter plasma vasopressin levels. Further trials are needed to assess the clinical effectiveness of vasopressin as the initial vasopressor therapy with or
AU - Gordon,AC
AU - Mason,AJ
AU - Perkins,GD
AU - Stotz,M
AU - Terblanche,M
AU - Ashby,D
AU - Brett,SJ
DO - 10.1097/CCM.0000000000000212
EP - 1333
PY - 2014///
SN - 0090-3493
SP - 1325
TI - The interaction of vasopressin and corticosteroids in septic shock: A pilot randomized controlled trial
T2 - Critical Care Medicine
UR - http://dx.doi.org/10.1097/CCM.0000000000000212
UR - http://hdl.handle.net/10044/1/21257
VL - 42
ER -