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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Appropriateness of Adrenocorticotropic Hormone Stimulation Test for Critically III Patients
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Appropriateness of Adrenocorticotropic Hormone Stimulation Test for Critically III Patients

机译：严重III类患者的促肾上腺皮质激素刺激试验的适当性

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Background: In earlier work, it was shown that patients with septic shock who also have adrenal insufficiency experience a benefit in terms of lower mortality rates with hydrocortisone supplementation. As such, the adrenocorticotropic hormone (ACTH) stimulation test has been used frequently to identify these patients. However, recent evidence has suggested that the identification and treatment of adrenal insufficiency in patients with septic shock does not reduce mortality. These results call into question the utility of the ACTH stimulation test in this patient population.Objectives: To determine the indications for ordering the ACTH stimulation test for critically ill patients at a tertiary care hospital and to classify the indications as either appropriate (e.g., primary adrenal insufficiency or medication-induced suppression of the hypothalamus-pituitary-adrenal axis) or inappropriate (e.g., patients with septic shock, prior etomidate exposure, or absence of steroid use).Methods: A retrospective analysis of health care records was conducted for all patients who had been admitted to the intensive care unit and who had undergone an ACTH stimulation test during 2007. For each patient, the indication for the test was identified and classified as appropriate or inappropriate.Results: A total of 35 ACTH stimulation tests were performed during the study period, of which 8 (23%) were classified as having an appropriate indication and 27 (77%) as having an inappropriate indication. Of the tests with an inappropriate indication, 15 (56%) were ordered for patients with septic shock. However, the number of ACTH tests ordered for this indication declined as the year progressed.Conclusions: The ACTH stimulation test was often used inappropriately for patients with septic shock. Over time, there appeared to be a trend away from use of this test in this patient population, perhaps reflecting increasing awareness of the lack of benefit.
机译：背景：在较早的工作中，已经证明，患有肾上腺功能不全的败血性休克患者可以通过补充氢化可的松来降低死亡率，从而受益。因此，促肾上腺皮质激素（ACTH）刺激测试已经常用于识别这些患者。但是，最近的证据表明，败血性休克患者的肾上腺功能不全的识别和治疗并不能降低死亡率。这些结果令人质疑ACTH刺激测试在该患者人群中的效用。目的：确定在三级医院对危重患者订购ACTH刺激测试的适应症，并对适应症进行适当分类（例如，原发性肾上腺皮质功能不全或药物引起的下丘脑-垂体-肾上腺轴抑制或不适当（例如感染性休克，先前依托咪酯暴露或未使用类固醇的患者）方法：对所有患者的医疗记录进行回顾性分析在2007年期间接受过重症监护病房并接受过ACTH刺激测试的患者。对于每位患者，该检查的适应症均已确定并归类为适当或不适当。结果：总共进行了35次ACTH刺激测试在研究期间，其中8（23％）被归为具有适当适应症，27（77％）被归为具有ina适当的指示。在指示不适当的测试中，有15例（56％）被订购用于败血性休克患者。然而，随着这一年的发展，为该适应症订购的ACTH测试数量有所下降。结论：ACTH刺激测试通常不适用于败血性休克患者。随着时间的流逝，在该患者人群中似乎有远离使用该测试的趋势，这可能反映出人们越来越意识到缺乏益处。

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