Evaluation of hydrocortisone therapy in burn ICU patients with hemodynamic instability Ashley Weiss; Rita Gayed;Rachael Williams, Juvonda Hodge, Walter Ingram Grady Health System - Atlanta, GA
Background/Purpose: Hemodynamic instability is a common complication in critically ill patients with burns and or inhalation injury. Despite appropriate measures to manage shock in the critically ill patient in the burn intensive care unit, including adequate fluid resuscitation, antibiotic and infection source control management when applicable, blood product administration when appropriate, hemodynamic instability may still persist, necessitating increased doses of vasopressors. Relative adrenal insufficiency is then suspected with burn size, age and presence of inhalation injury all as independent risk factors for critical illness related adrenal insufficiency, and management with hydrocortisone may be employed. However, steroids pose risk to the burn population as they have also been shown to decrease tensile strength and impede wound contraction along with increasing blood glucose levels which also affect wound healing. The primary objective of the study is to investigate the relationship between hydrocortisone and restoring hemodynamic stability in patients admitted to the burn intensive care unit.
Methodology: This was a retrospective chart review of patients 18 years of age or older admitted to the burn intensive care unit who received hydrocortisone for hemodynamic instability after adequate fluid resuscitation. Patients were excluded if they are pregnant, less than 18 years old, prisoners, were prescribed outpatient corticosteroids within 7 days of hospital admission, or treated for Stevens Johnson Syndrome or Toxic Epidermal Necrolysis. Secondary objectives include evaluating current steroid prescribing patterns, the utility of random cortisol levels in diagnosis relative adrenal insufficiency, onset of relative adrenal insufficiency relative to etomidate exposure and adverse effects associated with steroid use.
Presentation Objective: To investigate the relationship between hydrocortisone use and restoring hemodynamic stability in patients admitted to the burn ICU.
Self-Assessment: True or False: There is clear evidence to support the use of hydrocortisone in restoring hemodynamic stability in IBU burn patients.
