The use of a low dose hydrocortisone to prevent pulmonary embolism in patients with multiple trauma.

Abstract

BACKGROUND:

Venous thromboembolism events are common in trauma patients. Immediate acute inflammation following injury triggers coagulation cascade and may increase the risk of pulmonary embolism (PE) in this population.

OBJECTIVE:

We aimed to evaluate whether early low-dose steroids prevent symptomatic PE onset in multiple trauma patients.

SETTING:

The medical surgical intensive care unit of Habib Bourguiba University Hospital (Sfax--Tunisia).

METHODS:

Comparative study of two cohorts: a retrospective cohort of patients who didn't receive early low-dose steroids (steroid (-) group) and a prospective cohort of patients who received hydrocortisone with a dose of 100 mg/8 h for a scheduled period of 7 days (steroid (+) group). All adult patients admitted in our intensive care unit (ICU) for multiple trauma with predicted duration of mechanical ventilation over 48 h were included.

MAIN OUTCOME MEASURE:

Evaluation of the impact of low-dose steroids on the incidence of symptomatic PE.

RESULTS:

We included 175 patients: 92 in the steroids (-) group and 83 in the steroids (+) group. PE was diagnosed in 15 patients (8.5 %). The incidence of PE was significantly lower in steroid (+) group (3.6 vs 13 %; p = 0.013). In multivariate analysis, independent factors predicting PE onset were meningeal hemorrhage [OR = 14.7; 95 % CI (2.2-96.3); p = 0.013] and pelvic ring trauma [OR = 8; 95 % CI (1.8-36.4); p = 0.007] whereas low-dose steroids were significantly associated with a protective effect [OR = 0.2; 95 % CI (0.05-0.77); p = 0.019]. There was no significant difference between steroids (+) and steroids (-) groups neither in terms of mean ICU length of stay (LOS) (respectively 11 ± 9.7 and 12.3 ± 10.7 days; p = 0.372) nor in terms of ICU mortality (respectively 29.3 and 24.1 %; p = 0.434).

CONCLUSION:

Steroids are effective in reducing the incidence of PE in multiple trauma patients. However, no significant benefice was found on ICU mortality.

• Authors: Anis Chaari, Hatem Ghadhoune, Olfa Chakroune, Hanen Abid, Olfa Turki, Mabrouk Bahloul, Mounir Bouaziz
• Journal: International journal of clinical pharmacy (Int J Clin Pharm) Vol. 35 Issue 4 Pg. 593-9 (Aug 2013) ISSN: 2210-7711 [Electronic] Netherlands
• PMID: 23605143 (Publication Type: Journal Article)

Chemical References

• Glucocorticoids
• Hydrocortisone

Topics

• Adult
• Dose-Response Relationship, Drug
• Female
• Glucocorticoids (administration & dosage, therapeutic use)
• Hospital Mortality
• Hospitals, University
• Humans
• Hydrocortisone (administration & dosage, therapeutic use)
• Incidence
• Intensive Care Units
• Length of Stay
• Male
• Middle Aged
• Multiple Trauma (complications, drug therapy)
• Multivariate Analysis
• Prospective Studies
• Pulmonary Embolism (etiology, prevention & control)
• Retrospective Studies
• Tunisia
• Young Adult