Freund Yonathan, Jabre Patricia, Mourad Jerome, Lapostolle Frederic, Reuter Paul-Georges, Woimant Maguy, Javaud Nicolas, Adnet Frederic
Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France; Université Pierre et Marie Curie Paris 6 (Sorbonne Université), Paris, France.
Urgences-Samu 93, hôpital Avicenne, APHP, 93000 Bobigny, France; SAMU de Paris, Hôpital Necker-Enfants Malades, APHP, Paris, France; INSERM Unité 970, Centre de Recherche Cardiovasculaire de Paris, Université Paris Descartes, Paris, France.
J Crit Care. 2014 Jun;29(3):386-9. doi: 10.1016/j.jcrc.2013.12.018. Epub 2014 Jan 3.
Relative adrenal insufficiency (RAI) has been reported as a predictor of mortality in septic patient; however, its effects on mortality and outcomes for critically ill patients remain debatable. The objective of this study was to assess the effect of RAI on prognostic outcomes in patients after out-of-hospital rapid sequence intubation (RSI) and factors associated with the onset of RAI.
A prespecified ancillary study of KETASED, a randomized prospective multicenter trial, was conducted. Three hundred ten patients who underwent RSI in an out-of-hospital setting had baseline cortisol and adrenocorticotropic hormone response test measurements within 24 hours of intensive care unit admission and were included.
The mean (SD) age was 55 (19) years, with a mean (SD) Sequential Organ Failure Assessment score of 9 (4). Two hundred forty-seven (69%) patients presented with RAI. Baseline characteristics were similar between patients with and without RAI, except for the use of etomidate as a sedative agent (63% of patients with RAI vs 21%, P<.001), and history of chronic kidney disease. There was no difference in terms of 28-day mortality between the 2 groups (21% vs 19%, P=.65) and in terms of other 28-day prognosis end points.
In critically ill patients who require RSI, RAI is common and is not associated with worsened outcomes in our cohort.
相对肾上腺皮质功能不全（RAI）已被报道为脓毒症患者死亡率的预测指标；然而，其对危重症患者死亡率和预后的影响仍存在争议。本研究的目的是评估RAI对院外快速顺序插管（RSI）后患者预后结局的影响以及与RAI发生相关的因素。
进行了一项预先设定的KETASED辅助研究，这是一项随机前瞻性多中心试验。310例在院外接受RSI的患者在重症监护病房入院后24小时内进行了基线皮质醇和促肾上腺皮质激素反应测试测量，并被纳入研究。
平均（标准差）年龄为55（19）岁，序贯器官衰竭评估平均（标准差）评分为9（4）。247例（69%）患者出现RAI。有RAI和无RAI的患者基线特征相似，但使用依托咪酯作为镇静剂的情况（有RAI的患者为63%，无RAI的患者为21%，P<0.001）以及慢性肾病病史除外。两组在28天死亡率方面（21%对19%，P=0.65）以及其他28天预后终点方面没有差异。
在需要RSI的危重症患者中,RAI很常见，且在我们的队列中与预后恶化无关。
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