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TY - THES AU - Johnen, Daniel TI - Die funktionelle Nebennierenrindeninsuffizienz nach schwerem Verbrennungstrauma : Physiologie und therapeutische Optionen CY - Aachen PB - Publikationsserver der RWTH Aachen University M1 - RWTH-CONV-113720 SP - 107 S. : graph. Darst. PY - 2009 N1 - Aachen, Techn. Hochsch., Diss., 2009 AB - Hydrocortisone may have a beneficial effect in patients with septic shock. Septic shock after severe burn trauma shows specific complexity because of the impairment of the skin. In a retrospective study a group of ten patients with septic shock after severe burn trauma, who were treated with hydrocortisone 200mg/24h, were compared with a control group of nine persons. The study hypothesized a benefit of the substitution therapy. The course of catecholamines, hemodynamic parameters, the sequential organ failure assessment (SOFA)-score and mortality were analysed. The study showed an improvement of the SOFA-score after hydrocortisone substitution, as well as a lower catecholamine level and an improvement of the systemic vascular resistance index (SVRI). Mortality was notable – but not significant - lower in the therapy group. In a prospective design the second part of the study investigated the hypothalamus-pituitary-adrenal(hpa)-axis of 20 patients with severe burn trauma. A CRH-test was performed on day one after hospitalisation. The study hypothesized that functional adrenal insufficiency is common in this certain entity of a systemic inflammatory response syndrome (SIRS). The idea is based on the similarity of sepsis and SIRS after burn trauma. In seven patients a disturbance of the hpa-axis occurred, four of these were classified as an absolute adrenal insufficiency, three as an impaired stress reaction. Patients with an absolute adrenal insufficiency all showed high scores in the abbreviated burn severity index, a more distinctive development of edema and a higher mortality. A single primary, secondary or tertiary adrenal insufficiency could be ruled out. A disturbance on several levels seems to be likely. Since further testing after seven days offered physiologic results, functional adrenal insufficiency after severe burn trauma could be shown as a transient event. Comparable to the first part of the study the results support the hypothesis. However the results have to be interpreted with caution because of the small number of patients. Further studies may be promising. KW - Sepsis (SWD) KW - Septischer Schock (SWD) KW - Verbrennung (SWD) KW - Verbrennungskrankheit (SWD) KW - Glucocorticosteroide (SWD) KW - Hydrocortison (SWD) KW - Nebennierenrindeninsuffizienz (SWD) KW - Allgemeine Entzündungsreaktion (SWD) LB - PUB:(DE-HGF)11 UR - https://publications.rwth-aachen.de/record/51429 ER -