Dexamethasone therapy and endogenous cortisol production in severe pediatric head injury.

Détails

ID Serval
serval:BIB_4CA09FE53890
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Dexamethasone therapy and endogenous cortisol production in severe pediatric head injury.
Périodique
Intensive care medicine
Auteur(s)
Fanconi S., Klöti J., Meuli M., Zaugg H., Zachmann M.
ISSN
0342-4642
Statut éditorial
Publié
Date de publication
1988
Peer-reviewed
Oui
Volume
14
Numéro
2
Pages
163-6
Langue
anglais
Notes
Publication types: Clinical Trial ; Journal Article ; Randomized Controlled Trial - Publication Status: ppublish
Résumé
A prospective randomised study was performed on 25 children aged 1.4 to 15.8 years with severe head injury (Glasgow Coma Scale less than or equal to 7) to determine the clinical effectiveness and the impact on endogenous cortisol production of high-dose steroid therapy. Thirteen patients (group 1) received dexamethasone 1 mg/kg/day during the first 3 days and 12 (group 2) not. All patients were treated with a standardized regimen. Urinary free cortisol was measured by radioimmunoassay, and the clinical data were recorded at hourly intervals. Outcome was assessed 6 months later using the Glasgow Outcome Scale. We found a higher frequency of bacterial pneumonias in the dexamethasone-treated patients (7/13 versus 2/12). Group 1 showed a suppression of endogenous cortisol production from day 1 to day 6. In group 2, mean free cortisol was up to 5-fold higher than under basal conditions. The results in group 2 showed that the endogenous steroid production reacts adequately to the stress of severe head injury. It probably is sufficient to elicit maximum glucocorticoid effects. There was no other statistically significant difference in the clinical and laboratory data between the two groups. We conclude that dexamethasone in high doses suppresses endogenous cortisol production up to 6 days and may increase the risk of bacterial infection without affecting the outcome or the clinical and laboratory data.
Mots-clé
Adolescent, Child, Child, Preschool, Craniocerebral Trauma, Dexamethasone, Humans, Hydrocortisone, Infant, Pneumonia, Prospective Studies, Random Allocation
Pubmed
Web of science
Création de la notice
25/01/2008 10:07
Dernière modification de la notice
20/08/2019 14:01
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