Accepted Manuscript Title: Adrenal response after trauma is affected by time after trauma and sedative/analgesic drugs Author: Camilla Brorsson Per Dahlqvist Leif Nilsson Johan Thunberg Anders Sylvan Silvana Naredi PII: DOI: Reference:
S0020-1383(14)00072-2 http://dx.doi.org/doi:10.1016/j.injury.2014.02.001 JINJ 5633
To appear in:
Injury, Int. J. Care Injured
Received date: Revised date: Accepted date:
23-5-2013 21-1-2014 6-2-2014
Please cite this article as: Camilla BrorssonPer DahlqvistLeif NilssonJohan ThunbergAnders SylvanSilvana Naredi Adrenal response after trauma is affected by time after trauma and sedative/analgesic drugs (2014), http://dx.doi.org/10.1016/j.injury.2014.02.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Title Adrenal response after trauma is affected by time after trauma and sedative/analgesic drugs
Authors:
cr
ip t
Camilla Brorsson1 (corresponding author) Per Dahlqvist2 Leif Nilsson3 Johan Thunberg1 Anders Sylvan4 Silvana Naredi1
an
Department of Anaesthesia and Intensive Care Institution of Surgery and Perioperative Sciences Umeå University 901 87 Umeå Sweden
us
1
2
M
Department of medicine Institution of Public Health and Clinical Medicine Umeå University 901 87 Umeå Sweden
3
te
4
d
Department of Mathematics and Mathematical Statistics Umeå University 901 87 Umeå Sweden
Ac ce p
Department of surgery Institution of Surgery and Perioperative Sciences Umeå University 901 87 Umeå Sweden
Corresponding author:
Camilla Brorsson Department of Anaesthesia and Intensive Care Institution of Surgery and Perioperative Sciences Umeå University 901 87 Umeå Sweden Email: [email protected] Telephone: +46-90-7850000 Fax: +46-90-131388 Mobile: +46706680967 Key words: multiple trauma, adrenal insufficiency, sedatives
1
Page 1 of 29
Abstract Background: The adrenal response in critically ill patients, including trauma victims, has been debated over the last decade. The aim of this study was to assess the early adrenal
ip t
response after trauma.
Methods: Prospective, observational study of 50 trauma patients admitted to a level-1-trauma
cr
centre. Serum and saliva cortisol were followed from the accident site up to five days after
us
trauma. Corticosteroid binding globulin (CBG), dehydroepiandrosterone (DHEA) and sulphated dehydroepiandrosterone (DHEAS) were obtained twice during the first five days
an
after trauma. The effect of time and associations between cortisol levels and; severity of trauma, infusion of sedative/analgesic drugs, cardiovascular dysfunction and other
M
adrenocorticotropic hormone (ACTH) dependent hormones (DHEA/DHEAS) were studied. Results: There was a significant decrease over time in serum cortisol both during the initial
d
24 hours, and from the 2nd to the 5th morning after trauma. A significant decrease over time
te
was also observed in calculated free cortisol, DHEA, and DHEAS. No significant association
Ac ce p
was found between an Injury Severity Score ≥16 (severe injury) and a low (
S0020-1383(14)00072-2 http://dx.doi.org/doi:10.1016/j.injury.2014.02.001 JINJ 5633
To appear in:
Injury, Int. J. Care Injured
Received date: Revised date: Accepted date:
23-5-2013 21-1-2014 6-2-2014
Please cite this article as: Camilla BrorssonPer DahlqvistLeif NilssonJohan ThunbergAnders SylvanSilvana Naredi Adrenal response after trauma is affected by time after trauma and sedative/analgesic drugs (2014), http://dx.doi.org/10.1016/j.injury.2014.02.001 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Title Adrenal response after trauma is affected by time after trauma and sedative/analgesic drugs
Authors:
cr
ip t
Camilla Brorsson1 (corresponding author) Per Dahlqvist2 Leif Nilsson3 Johan Thunberg1 Anders Sylvan4 Silvana Naredi1
an
Department of Anaesthesia and Intensive Care Institution of Surgery and Perioperative Sciences Umeå University 901 87 Umeå Sweden
us
1
2
M
Department of medicine Institution of Public Health and Clinical Medicine Umeå University 901 87 Umeå Sweden
3
te
4
d
Department of Mathematics and Mathematical Statistics Umeå University 901 87 Umeå Sweden
Ac ce p
Department of surgery Institution of Surgery and Perioperative Sciences Umeå University 901 87 Umeå Sweden
Corresponding author:
Camilla Brorsson Department of Anaesthesia and Intensive Care Institution of Surgery and Perioperative Sciences Umeå University 901 87 Umeå Sweden Email: [email protected] Telephone: +46-90-7850000 Fax: +46-90-131388 Mobile: +46706680967 Key words: multiple trauma, adrenal insufficiency, sedatives
1
Page 1 of 29
Abstract Background: The adrenal response in critically ill patients, including trauma victims, has been debated over the last decade. The aim of this study was to assess the early adrenal
ip t
response after trauma.
Methods: Prospective, observational study of 50 trauma patients admitted to a level-1-trauma
cr
centre. Serum and saliva cortisol were followed from the accident site up to five days after
us
trauma. Corticosteroid binding globulin (CBG), dehydroepiandrosterone (DHEA) and sulphated dehydroepiandrosterone (DHEAS) were obtained twice during the first five days
an
after trauma. The effect of time and associations between cortisol levels and; severity of trauma, infusion of sedative/analgesic drugs, cardiovascular dysfunction and other
M
adrenocorticotropic hormone (ACTH) dependent hormones (DHEA/DHEAS) were studied. Results: There was a significant decrease over time in serum cortisol both during the initial
d
24 hours, and from the 2nd to the 5th morning after trauma. A significant decrease over time
te
was also observed in calculated free cortisol, DHEA, and DHEAS. No significant association
Ac ce p
was found between an Injury Severity Score ≥16 (severe injury) and a low (
