The August issue of Anesthesiology is now available online and features studies as well as editorials that provide new insights into the use of steroids to treat septic patients as well as lipids used to minimize heart damage in heart attack patients.
Steroid Treatment May Help Some Patients Recover From Septic Shock
A recent study found improvement in septic shock patients who were treated with steroid (eg, cortisone) therapy and identified a potential measurement tool to determine in which patients the treatment will work most effectively.
“This study found that measuring adrenal gland volume and using imaging testing was helpful in predicting a patient’s outcome and may help to determine success potential with steroid treatment,” said Boris Jung, M.D., the study’s lead investigator.
Several risk factors have been described for predicting mortality in patients with septic shock. The current study used computed tomography to determine the prognostic value of adrenal gland volumes in predicting mortality in patients with or without septic shock. Total adrenal gland volume below 10cm3 was associated with mortality above 70 percent in the intensive care unit compared with mortality lower than 20 percent when total adrenal gland volume was above 10cm3.
“Steroid treatments can cause complications such as gastrointestinal bleeding, muscular weakness, and viral infection, so it is important to determine which patients will have the best outcomes from the drug,” said Dr. Jung.
An accompanying editorial in the Journal provided a comprehensive overview on the adrenal gland’s anatomy and physiology that are critical for the body to respond to physiologic stress.
“The examination of the stress reaction helps researchers better understand the rationale for steroid treatment in septic shock patients,” said Matthais Eikermann, M.D., Ph.D., co-author of the editorial.
Good Fats May Limit Damage for Heart Attack Victims
A fat (Intralipid) used to treat local anesthetic toxicity may have protective value for patients suffering a heart attack, according to another study in Anesthesiology. During a heart attack, blood flow to tissues other than the heart may decline, leading to blood flow that is inadequate to keep those tissues performing optimally. When the blood from those tissues returns to the heart, the blood may be altered in ways that directly harm the heart.
“This study in animals showed that use of lipid emulsion during the return of blood flow to the heart can prevent extensive damage to the heart muscle and can preserve heart function immediately following a heart attack,” said Siamak Rahman, M.D., lead author of the study.
“The impact of lipid emulsion therapy on cell membranes integrity and function during stress has implications for developing future therapeutics,” said Yoshitaka Kawaraguchi, M.D., co-author of an editorial examining the study.
For more information on the study, visit the Anesthesiology website at www.anesthesiology.org.