Samransamruajkit Rujipat, Jitchaiwat Siriwan, Deerojanawong Jitladda, Sritippayawan Suchada, Praphal Nuanchan
Respiratory and Critical Care unit, Faculty of Medicine, Department of Pediatrics, Chulalongkorn University, Bangkok 10330, Thailand.
J Crit Care. 2007 Dec;22(4):314-8. doi: 10.1016/j.jcrc.2007.03.003. Epub 2007 Jul 5.
Adequate adrenal function is essential to survive critical illness. Several recent articles have reported the significant effect of adrenal insufficiency (AI) in patients with sepsis. However, the prevalence of AI in pediatric acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is so far still scanty. Thus, we elected to study its prevalence and its clinical outcome.
This is a cross-sectional observational study. We enrolled eligible infants and children aged between 1 month and 15 years who were admitted to our tertiary pediatric intensive care unit from February 1, 2005, to December 31, 2005, with ALI or ARDS diagnosed by the American-European Consensus criteria. A short corticotropin stimulation test (250 microg) was done within 24 hours of enrollment, and all clinical data were also recorded. Cortisol levels were measured at baseline, 30 minutes, and 60 minutes posttest. Adrenal insufficiency was defined as a baseline cortisol level of less than 15.1 microg/dL or an increment of cortisol level of less than 9 microg/dL after the adrenocorticotropic hormone stimulation test.
Of 507 patients admitted to the pediatric intensive care unit, there were 20 diagnosed with ALI/ARDS. Of 20 children, 16 met the inclusion criteria and had none of the exclusion criteria. Of 16, there were 9 (56%) with ARDS, and 7 (44%) of 12 had ALI. The prevalence of AI was observed in 37.5% (6/16), diagnosed by baseline level criteria in 25% (4/16) and by incremental criteria in 12.5% (2/16). The Baseline level of the adrenocorticotropic hormone was 7.8 +/- 5 (nmol/L). The median age in the AI group was 2 months. Of 6 children, 5 (83.3%) were in the ARDS group. Pediatric Risk of Mortality III score was significantly higher in the AI group compared with that in the non-AI (P < .05). Initial Pao(2)/fraction of inspired oxygen ratio tended to be lower in the AI group (123.2 +/- 62.2) compared with that in the non-AI group (183.8 +/- 79.1), although not statistically significant (P = .1). The mortality was also not statistically different between the AI (1/6, 16.7%) and the non-AI groups (1/10, 10%).
Our study demonstrated that the prevalence of AI was common in pediatric ALI/ARDS. These results would be an initial step to further study the impact of AI on clinical outcomes of these children in a larger scale.
充足的肾上腺功能对于危重病患者的生存至关重要。最近的几篇文章报道了肾上腺功能不全（AI）在脓毒症患者中的显著影响。然而，迄今为止，AI在小儿急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）中的患病率仍然知之甚少。因此，我们选择研究其患病率及其临床结局。
这是一项横断面观察性研究。我们纳入了2005年2月1日至2005年12月31日期间入住我们三级儿科重症监护病房的年龄在1个月至15岁之间符合条件的婴儿和儿童，他们根据欧美共识标准被诊断为ALI或ARDS。在入组后24小时内进行短促肾上腺皮质激素刺激试验（250微克），并记录所有临床数据。在基线、试验后30分钟和60分钟测量皮质醇水平。肾上腺功能不全定义为促肾上腺皮质激素刺激试验后基线皮质醇水平低于15.1微克/分升或皮质醇水平增量低于9微克/分升。
在入住儿科重症监护病房的507例患者中，有20例被诊断为ALI/ARDS。在这20名儿童中，16名符合纳入标准且无排除标准。在这16名患者中，9名（56%）患有ARDS，12名中的7名（44%）患有ALI。观察到AI的患病率为37.5%（6/16），根据基线水平标准诊断的占25%（4/16），根据增量标准诊断的占12.5%（2/16）。促肾上腺皮质激素的基线水平为7.8±5（纳摩尔/升）。AI组的中位年龄为2个月。在6名儿童中，5名（83.3%）在ARDS组。与非AI组相比，AI组的小儿死亡风险III评分显著更高（P<0.05）。AI组的初始动脉血氧分压/吸入氧分数比值（123.2±62.2）与非AI组（183.8±79.1）相比有降低趋势，尽管差异无统计学意义（P = 0.1）。AI组（1/6，16.7%）和非AI组（1/10，10%）之间的死亡率差异也无统计学意义。
我们的研究表明，AI在小儿ALI/ARDS中很常见。这些结果将是进一步大规模研究AI对这些儿童临床结局影响的第一步。
