ADRENAL DYSFUNCTION AND ITS CORRECTION DURING EXTRACORPOREAL MEMBRANE OXYGENATION: A PROSPECTIVE COHORT STUDY

The aim of the research. Evaluation of the effect of hydrocortisone on the need for vasopressors in dynamics and on the survival of patients during ECMO.

Materials and methods. The prospective cohort study was performed in the intensive care unit (47 patients during ECMO). Patients were divided into: Ia (with vascular insufficiency and hyponatremia and Ib (with isolated vascular insufficiency without hyponatremia); group II (n18) - patients without vascular insufficiency. The appointment of intravenous therapy with hydrocortisone was carried out in patients with a need for norepinephrine of 0.25 µg/kg/min and above.

Results. In group Ia, there is a high mortality of patients due to: the obvious clinical symptoms of adrenal dysfunction against the background of low cortisol levels, the duration of the underlying disease, the transfer of patients from the primary hospitalization clinic. Patients of subgroup Ib showed a positive trend in the resolution of organ dysfunction. The best survival rate in Ib is associated with the development of an early stage of adrenal dysfunction, when the depletion of the adrenal medulla is already of clinical importance, but the compensatory abilities of the cortical layer have not yet exhausted themselves, which manifested itself in the absence of hyponatremia. At the same time, the appointment of hydrocortisone in this situation made it possible to compensate for progressive adrenal dysfunction. The main effect of the hormone therapy used was precisely the absence of differences in mortality between patients of group II and subgroup Ib, although the severity of the condition of patients in subgroup Ib was significantly higher. It should also be taken into account that ECMO is an aggressive treatment method that carries independent risks of developing complications that increase mortality in the study groups. Thus, patients who initially had clinical and laboratory signs of adrenal dysfunction (Ia) despite ongoing therapy with hydrocortisone and sodium compensation showed the highest mortality compared to subgroup Ib and II group.

Conclusion. The appointment of hydrocortisone can reduce the need for norepinephrine. The use of hydrocortisone during ECMO increases the survival rate of patients.

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