The Effects Of Adrenal Function On The Weaning Of Mechanical Ventilation For Critically Ill Patients

Objective:To examine the incidence of relative adrenal insufficiency(RAI)in critically ill patients with Mechanical ventilation and explore the relationship between the occurrence of RAI and weaning outcome, and then investigate the guide value of adrenal function in ventilator weaning.Methods:Critically ill patients who were mechanically ventilated over 48 hours were enrolled in this study. Every patient was given one shot of corticotrophin 250ug intravenously at the first day,the first Spontaneous-breathing-trial day, plasma contisol level was detected by radio-immunoassay before the shot (TO) and 30 minutes (T30) after. And meanwhile the following parameters in the patients were recorded:age, APACHEⅡ, age and cause of disease,et al。Relative adrenal insufficiency was defined as the difference between TO and T30≤9μg/dl。Using receiver operating characteristic curve (ROC) to evaluate the accuracy of the indicators towards the weaning outcome。Results:(1) A total of 45 patients with mechanical ventilation were enrolled in this study, when admitted ICU,51%(23/45) were diagnosed RAI.(2)The successful weaning group were 29 cases which inclued 11 RAI(37.93%),unsuccessful weaning group were 16 cases which inclued 12 RAI(75%); (3) When admitted ICU,there were no significant difference ofΔCOR between successful weaning group and The failure weaning group(10.3±5.7μg/dl vs7.5±4.5μg/dl, P=0.100), At the first Spontaneous-breathing-trial day,ΔCOR of the successful weaning group was significantly higher than The failure weaning group(10.9±5.1μg/dl vs4.9±2.9μg/dl, P=0.043); Logistic regression analysis showed thatΔCOR is the independent risk factors on the weaning of the mechanically ventilated patients; (4) By using receiver operating characteristic analysis, At the first Spontaneous-breathing-trial day, the area under the curve was 0.872, If ACOR≤6.95μg/dl, the sensitivity and the specificity of accurate judgment were 81.3% and 82.8%.Conclution:Adrenal function can be one of the factors for predicting the prognosis of weaning in Critically ill patients with Mechanical ventilation。...