Article
Impact of the initial cortisol value on cardiopulmonary stress within the first 24 hours after non-traumatic subarachnoid hemorrhage
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Authors
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Michael Bender
- Department of Neurosurgery, Justus-Liebig University, Giessen, Germany
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Marco Stein
- Department of Neurosurgery, Justus-Liebig University, Giessen, Germany
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Malgorzata Kolodziej
- Department of Neurosurgery, Justus-Liebig University, Giessen, Germany
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Eberhard Uhl
- Department of Neurosurgery, Justus-Liebig University, Giessen, Germany
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Marcus H. T. Reinges
- Department of Neurosurgery, Justus-Liebig University, Giessen, Germany
| Published: | June 2, 2015 |
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Outline
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Objective: Cardiopulmonary stress (CPS) in patients with non-traumatic subarachnoid hemorrhage (ntSAH) is a well-known phenomenon. An acute elevation of the initial serum cortisol value (CV) based on a stress situation could imply CPS. The impact of elevated CV on CPS within the first 24 hours after ntSAH is still unknown. Therefore, the present study was conducted to investigate the association between CV and CPS in patients with ntSAH within the first 24 hours of intensive care unit (ICU) treatment.
Method: From February 2008 to December 2013 we retrospectively reviewed all patients with ntSAH admitted to our emergency department. Patients were excluded with acute cardiac decompensation (n=1), long-term medication of cortisol (n=1) as well as patients with no measuring of CV in the initial blood samples. Furthermore, we collected data on demographics, average arterenol application rate in μg/kg/min (AAR) and inspiratory oxygen fraction (OF) within the first 24 hours. Requiring arterenol application and OF >0.21 was defined as CPS. The target values of systolic blood pressure were 100 to 130 mmHg for patients with ntSAH before clipping or coiling. After neurosurgical or neuroradiological treatment of ruptured aneurysms the target values of systolic blood pressure were 140 to 160 mmHg. The target value of oxygen saturation was ≥95%, measured by a pulse oximeter. Circardian measurements of serum cortisol were not considered based on the acute stress situation. We selected two cohorts of patients. The first group was defined by a CV value >20 μg/dl (eCV), the second group by a CV value ≤20 μg/dl (nCV). Mann-Whitney-U-Test was used for statistical evaluation. P<0.05 was the level of significance.
Results: Data from 55 patients with a mean age (SD) of 56.4 (12.1) years were analyzed. There were 22 male and 33 female. An eCV value was found in 30 patients. We observed no significant difference in the average AAR (p=0.32) and OF (p=0.59) within the first 24 hours of ICU treatment between both groups. In a subgroup-assay with the Spearman correlation for the cohort eCV, a negative trend between eCV and AAR (r= -0,25; p=0.18) was found. For OF no correlation was found (r=0,07; p=0.72).
Conclusions: We observed no difference between both groups regarding CPS within the first 24 hours after ntSAH. Therefore the impact of eCV on CPS is negligible. However, to confirm these preliminary data a prospective study with a large number of patients should be performed.
