49-50 International Abstracts_49-50 International Abstracts

49 HYDROCORTISONE IMPROVED HAEMODYNAMICS AND FLUID REQUIREMENT IN SURVIVING BUT NOT NONSURVIVING OF SEVERELY BURNED PATIENTS The administration of hydrocortisone can lead to a reduction of catecholamines and improved outcome in septic patients. However, no data exist regarding the use of hydrocortisone in burn patients although, in such patients, the reduction of vasopressors may be even more crucial for outcome, owing to improved skin perfusion. This study is the first to present results of the impact of hydrocortisone administration in severely burned norepinephrine-dependent patients. In our prospective cohort study, 14 consecutive severely burned patients, 12 h after norepinephrine dependency, received a 100-mg hydrocortisone bolus followed by 0.18 mg/kg/h hydrocortisone. The course of the necessary norepinephrine dose and of fluid balance was documented 12 h before and after the first dosage of hydrocortisone. Statistical analysis showed an unexpected increase in the norepinephrine dosage. A statistical post hoc evaluation of surviving and non-surviving patients indicated a significant increase of norepinephrine in non-survivors, whereas in survivors it was possible to reduce norepinephrine significantly. Also, it was possible to significantly reduce median fluid requirements in surviving patients, whereas in the non-survivor group no change of volume was needed. Our data suggest that hydrocortisone could be useful in selected patients with severe burn injuries. However, patients not responding to hydrocortisone administration seem to have a poor prognosis. Our findings contrast with previously published data on septic patients, in whom hydrocortisone administration caused in a reduction in norepinephrine. Further prospective controlled studies will be necessary to establish hydrocortisone in the routine therapy of severely burned patients.