PURPOSE: 1.To determine whether adrenal insufficiency in the perioperative cardiac surgery patients would be predicted by preoperative cortisol level.2.To evaluate the effectiveness of perioperative hydrocortisone therapy in this patients poplations in reducing the duration of postoperative pressors in patients identified as being adrenal insufficiency.
METHODS: Forty-four patients were prospectively studied from December 1st 2005 to February 28th 2006, with an average age of 65 years, 31 (70%) patients were male. No patients in cardiogenic shock included in the study.Patients with history of adrenal insufficiency or on steroid therapy as outpatient prior to hospitalization were excluded. All patients had serum morning cortisol obtained on the day of surgery. We define the adrenal insufficiency if morning cortisol was < 15mcg/dl. Sixteen patients (group 1), with cortisol <15 mcg/dl placed on hydrocortisone. Eleven patients (group 2), with cortisol level <15 mcg/dl, and 17 patients (group3), with cortisol level >15mcg/dl, were not placed on hydrocortisone. Post-surgery Cardiac index, pulmonary diastolic pressure, central venous pressure, CBC, and fluid balance in 24 hr post-surgery were obtained.
RESULTS: Postoperative cardiac index, CVP, PAD, CBC, and fluid balance were not significant different between test groups.The duration of vasopressors needs in postoperative hypotension (Systolic blood pressure <100 mmHg), were significantly lower in group 1 than group 2 and 3, respectively ((8.4hr vs. 16.8hr, p <0.033), (8.4hr vs. 21.5hr, p <0.002)).
CONCLUSION: 1.Preoperative cortisol levels consistently and predictably identified patients with perioperative adrenal insufficiency. 2.Treating this group of patients with hydrocortisone, reduce in a statistically significant manner; the duration of pressors reduced postoperatively. 3.Patients with preoperative adrenal insufficiency have longer period of pressors requirement and hypotension if not treated.
CLINICAL IMPLICATIONS: 1.The early ascertainment of perioperative adrenal insufficiency in open-heart surgery patients will improve postoperative management decision regarding predictability for pressors requirement.2.A better understanding of the physiology of the normal adrenal response in setting of coronary artery bypass is needed.
DISCLOSURE: N. Mansuroglu, None.