State Of Adrenocortical Function In Patients With Mechanical Ventilation Effects On Ventilator Weaning

Objective: To explore the adrenal function of critically ill patients received mechanical ventilation,study the function of adrenal’s effective for ventilator weaning and the significance of prognosis.Methods: Critically ill patients who were mechanically ventilated over 48 hours were enrolled in this study from ICU of Harison Internation Peace Hospital in Heng Shui. Following parameters were recorded including age、sex、APACHE II and diseases lead to respiratory failure and complications. Every patient was given one shot of ACTH 250μg intravenously on the first day of receiving mechanical ventilation to evaluate their adrenal function[ACTH stimulating test: record the plasma cortisol concentration when ACTH 250 μg intravenous injection before and after 30 minutes,the difference between notes as △cortisol, we define △cortisol≤9 μg/d L(248.76 nmol/L,1nmol/L=27.64×μg/d L) as adrenocortical insufficiency].A total of 127 mechanically ventilated patients were enrolled in the ventilator weaning trial, finally there have 56 patients with adrenal insufficiency enrolled as objects of study after screening. Patients with adrenal insufficiency using the random number table method were randomized to the treatment group(hydrocortisone 100 mg intravenous every 8h) and the placebo group(0.9%normal saline same volume intravenous every 8h),in order to analysis the relationship between adrenal insufficiency and ventilator weaning.The same time we need record many statistics,such as the mechanical ventilation time of patients with,△cortisol when start to breath without mechanical ventilation, ICU length of stay, in-hospital mortality and mortality were followed up for 28 days.Explain the differences between patients with adrenocortical insufficiency after receved hormone replacement therapy on ventilator weaning △cortisol, ICU length of stay, in-hospital mortality and mortality were followed up for 28 days with the adrenal insufficiency patients receved placebo group. Furthermore,Compared the adrenal function before and afterof the treatment group after hormone replacement therapy.Results: The adrenal insufficiency accepted treatment group and the placebo group have no significant differency in age、APACHE II score、rapid-shallow-breathing index(RSI)、PO2/Fi O2、△cortisol(P=0.494, 0.105, 0.138,0.908,0.931);The main causes of disease leading to respiratory failure and complications which result in mechanical ventilation,such as pneumonia、cerebrovascular disease、chronic lung disease、diabetes and so on. The results show that they have no difference statistically(P>0.05). The treatment group have significant differency in mechanical ventilation time of patients with、ICU length of stay and ventilator weaning after accepted hydrocortisone treatments compared with placebo group(P=0.000, 0.022,0.023). Moreover,the adrenal function receved improvement obviously(P=0.000).But the two groups have no have no significant differency in in- hospital mortality and mortality were followed up for 28 days(P=0.556, 0.279).Conclusions: The occurrence of CIRCI is common in critically ill patients with mechanical ventilation. Patients with adrenal insufficiency may influence the mechanical ventilation time, We should early evaluate adrenal function for critically ill patients, especially patients with mechanical ventilation,and identify adrenal insufficiency to provide appropriate treatment with stress dose hydrocortisone to cut the weaning period and increase the success of ventilator weaning necessary.