Scientific paperThe adrenal response after severe trauma
Section snippets
Methods
Between June 1, 1999, and February 28, 2000, a convenience sample of severely injured adult patients admitted to the surgical intensive care unit at Denver Health Medical Center, a regional level 1 trauma center, was prospectively identified and studied. Patients were followed until death or discharge. Demographic and outcome data were tabulated. Selection of patients to be studied was determined by the trauma attending and was based on assessement of injury severity using anatomic and
Results
Over the 18-month study period, 22 severely injured patients were identified and followed. The mean age was 35 ± 4 years and 14 (62%) were male. Blunt mechanism of injury was present in 15 patients (68%). Despite the severe nature of the injuries (mean ISS: 33 ± 3), overall mortality was only 9% (2 of 22). Mean admission cortisol levels were elevated (35 ± 3 μg/dL) and declined significantly over the following 10 days (Fig. 1). Admission cortisol levels did not correlate with injury severity (
Comments
Critical illness results in a stress response that is characterized by activation of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system [11]. This coordinated reaction generally initiates metabolic and cardiovascular responses designed to maintain homeostasis. Cortisol is the major stress response hormone mediating many of these effects. In response to critical illness, enhanced corticotropin-releasing factor release from the hypothalamus stimulates an increase in ACTH
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