[Hydrocortisone for the treatment of refractory hypotension: a randomized controlled trial]

Abstract

Introduction: Systemic hypotension is a common sign in critically sick infants. Several studies have suggested that the use of short series of corticosteroids increases arterial blood pressure and reduces the inotropic support needs in preterm neonates with hypotension. There are a small number of reports on the use of hydrocortisone (HC) for the treatment of refractory hypotension in infants.

Material and methods: To assess the effectiveness of hydrocortisone in the reduction of inotropic support in infants with refractory hypotension.

Population: infants who required dopamine ≥ 14 μg/kg/min and/or epinephrine.

Design: prospective, controlled, randomized, double blind trial with placebo.

Intervention hc: 2.5mg/kg every 12 hours, for 48 hours intravenously (intervention group [IG]); placebo: isotonic saline 1.25 ml/kg/doses intravenously (placebo group [PG]) every 12 hours, for 48 hours. Randomization was performed in blocks with blind assignment.

Results: A total of 50 infants with refractory systemic hypotension were prospectively recruited. Patient characteristics were similar in both groups. Requirements for inotropic support at 48 hrs were achieved in 60%, of the IG versus 24% of the PG (P=.009, RR: 2.5, 95% CI, 1.16-5.38). A significant association was observed between the administration of HC in infants treated with epinephrine and the presence of hyperglycemia (P =.008).

Conclusion: In patients with refractory hypotension hydrocortisone administration reduced the need for inotropic support. Further studies with a greater number of patients are needed to confirm the effectiveness of HC as a therapeutic tool in these infants.

Keywords: Dopamina; Dopamine; Epinefrina; Epinephrine; Esteroides; Hidrocortisona; Hipotensión; Hydrocortisone; Hypotension; Inotropes; Inotrópicos; Steroids.