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E Ruokonen

Publications and source records attributed to E Ruokonen.

At least 19 recordsLinked to original sources
PubMed2003

Cardiac arrest after interscalene brachial plexus block with ropivacaine and lidocaine.

Serious adverse reactions to ropivacaine and lidocaine are rare. In this report, we describe a case of sudden cardiac arrest after an interscalene brachial plexus block with a mixture of 150 mg of ropivacaine and 360 mg of lidocaine in a previously healthy, 34-year-old, 97-kg man. Severe hypotension occurred after successful resuscitation, necessitating an infusion of epinephrine. The patient developed pulmonary oedema, and was mechanically ventilated for 22 h. He eventually made a good recovery. We conclude that although ropivacaine and lidocaine are often considered relatively safe local anesthetics, serious cardiovascular complications can occur after the use of these drugs.

Adult↗
PubMed2002

High-dose thiopental in the treatment of refractory status epilepticus in intensive care unit.

The authors studied prospectively the effects of thiopental anesthesia on seizure control, hemodynamics, and the course of intensive care in 10 patients with refractory status epilepticus. Clinical and electrophysiological seizures were terminated in every patient. Hemodynamically, thiopental was well tolerated, but slow recovery from anesthesia prolonged the need for intensive care.

Adolescent↗
PubMed2002

Procalcitonin and neopterin as indicators of infection in critically ill patients.

BACKGROUND: : In critically ill patients, severe infection and systemic inflammation due to non-infectious causes produce very similar clinical presentations, and traditional infection markers do not always differentiate these two conditions. Both procalcitonin and neopterin have been suggested to aid in the early diagnosis of bacterial infections and in differentiating bacterial infections from systemic inflammatory, non-infectious diseases or from viral infections. METHODS: : Procalcitonin (PCT) and neopterin were analyzed in 208 ICU patients who developed acute fever or septic shock. Blood samples were taken every 8th h within 48 h of the onset of fever or septic shock. RESULTS: : A total 162/208 of patients had infection, the most common location being the respiratory tract. Mortality was higher in infected patients (31.4% vs. 10.9%; P < 0.01). The optimum cut-off levels in identifying patients with infection of daily peak PCT were 0.8 microg/L on day 1 and 0.9 microg/L on day 2, and both sensitivity (67.7% and 60.9%, respectively) and specificity (47.8% and 63%) were poor. Accordingly, the optimum cut-off values of peak neopterin were 18 and 16 pg/L. The sensitivity was 62.7% on day 1 and 69.3% on day 2, while specificity was correspondingly 78.3% and 67.9%. There were no significant differences between the markers in discriminating between patients with infection or inflammation. Both PCT and neopterin increased with the severity of infection. They were higher in non-survivors. CONCLUSION: : PCT and neopterin were equally effective, although not very accurate in differentiating between infection and inflammation in critically ill patients. Neopterin was more specific than PCT, suggesting that neopterin is related to the activity of inflammatory response.

Adult↗
PubMed2002

Paramedic helicopter emergency service in rural Finland - do benefits justify the cost?

BACKGROUND: The benefit of the Helicopter Emergency Medical Service (HEMS) is not well documented. The aim of our study was to investigate the potential health benefits of HEMS, and their relation to cost of the service in a rural area in Finland. We also evaluated whether the patient benefit is due to early Advanced Life Support (ALS) procedures performed on-scene, or due to rapid transport of patients to definitive care. METHODS: We reviewed all helicopter missions during 1 year (1999). Based on given prehospital care, we divided these missions into various categories. At the time of discharge, in-hospital records were reviewed for patients who received prehospital ALS care in order to estimate the potential benefit of HEMS. RESULTS: There were 588 missions. In 40% (n = 233/588), the mission was aborted. ALS care was given on-scene to 206 patients. It was estimated that in this group lives of three patients (1.5%) were saved, and 42 (20%) patients, mostly with cardiovascular disease, otherwise benefited from the service. The majority (84%) of the patients benefited from on-scene ALS procedures only. The cost for beneficial mission was euro 28 444. CONCLUSION: A minority of all patients did benefit from HEMS. Benefit was related to early ALS care and the cost per beneficial mission was 28 444.

Adult↗
PubMed2002

Classification for coding procedures in the intensive care unit.

BACKGROUND: There is no commonly accepted coding system for non-operative procedures in general, including intensive care unit (ICU) procedures. In order to create a classification of codes for ICU procedures, a system developed at the University Hospital of Bergen was evaluated in four Nordic countries. METHODS: Classification codes were constructed using seven main groups of related procedures that were given a letter from A to G. Within each group major procedures were given a number from 00 to 99, with the possibility of up to 10 subclassifications within each procedure. A simple questionnaire regarding the use of coding general ICU procedures and some specific procedures was sent to 171 ICUs in Sweden, Finland, Denmark, and Norway. They were also asked to give their comments on the new classification coding system, which was attached. RESULTS: One hundred and fifty-four questionnaires were returned (response rate 90%). Some or most of the ICU procedures were registered in the ICUs (82.2%). However 38% did not use any coding system and 24% used a specific internal system. The new classification coding system was well received, and was given a mean value of 7.5 using a VAS scale from 0 to 10 (best). Most ICUs would consider using this system if introduced at a national level. CONCLUSION: Most Nordic ICUs do register some or most of the procedures performed. Such procedures are however, registered in very different ways, using several different systems, and are often home-made. The new classification system of ICU procedures was well rated.

Critical Care↗
PubMed2001

Gastric mucosal systemic partial pressure of carbon dioxide (PCO(2)) gradient in experimental endotoxin shock in swine--comparison of two methods.

OBJECTIVES: Clinically applicable methods for continuous monitoring of visceral perfusion/metabolism do not exist. Gastric mucosal end-tidal partial pressure of carbon dioxide (PCO(2)) gradient has been used, but it has limitations, especially in patients with lung injury and increased dead space ventilation. We studied the agreement between gastric mucosal end-tidal (DPCO(2gas)) and gastric mucosal arterial PCO(2) (D((t-a))PCO(2)) gradients, and especially the effect of dead space ventilation (V(d)/V(t) ratio) on the agreement. We hypothesized that DPCO(2gas) can be used as a semi-continuous indicator of mucosal arterial PCO(2) gradient in sepsis. DESIGN: A randomized, controlled animal experiment. SETTING: National laboratory animal center. INTERVENTIONS: Twelvehour infusion of endotoxin in landrace pigs. MEASUREMENTS AND RESULTS: We measured end-tidal PCO(2) continuously, gastric mucosal PCO(2) every 10 min (gas tonometry) and arterial PCO(2) every 120 min. Carbon dioxide production and the V(d)/V(t) ratio were determined by indirect calorimetry. In the endotoxin group ( n=7) cardiac index increased and systemic vascular resistance decreased. Endotoxemia increased dead space ventilation by 27% ( p=0.001). Both DPCO(2gas) and D((t-a))PCO(2)increased significantly in the endotoxin group ( p<0.0001 and p=0.049, respectively). Control animals remained stable throughout the experiment. When we compared DPCO(2gas) and D((t-a))PCO(2)(Bland-Altman analysis), the bias and precision were 0.9 and 0.9 kPa in the control group and 2.0 and 2.2 kPa in the endotoxin group, respectively. The disagreement between DPCO(2gas) and D((t-a))PCO(2) increased as the V(d)/V(t) ratio increased. CONCLUSIONS: DPCO(2gas) is a clinically applicable method for continuous monitoring of visceral perfusion/metabolism. Septic lung injury and increased dead space ventilation decrease the accuracy of the method, but this may not be clinically important.

Animals↗
PubMed2001

Nitrogen sparing effect of structured triglycerides containing both medium-and long-chain fatty acids in critically ill patients; a double blind randomized controlled trial.

BACKGROUND AND AIMS: Patients with sepsis and trauma are characterised by hypermetabolism, insulin resistance and protein catabolism. Fat emulsions containing medium chain triglycerides have been suggested to be beneficial for these patients since medium chain fatty acids are a more readily available source of energy when compared to long chain fatty acids. The aim of this study was to compare a medium and long chain triglyceride emulsion consisting of structured triglycerides (ST) with a long chain triglyceride (LCT) emulsion in terms of effects on nitrogen balance, energy metabolism and safety. METHODS: 30 ICU patients with sepsis or multiple injury received a fat emulsion with ST or 20% LCT (1.5 g triglycerides/kg body weight/day) as a component of total parenteral nutrition (TPN), for 5 days in a double blind randomised parallel group design. The main analysis was made on the 3 day per protocol population due to lack of patients at day 5. RESULTS: There were no differences in baseline characteristics of the two groups receiving either the LCT or the ST emulsion. The efficacy analysis was performed on the per protocol population (n=9 ST, n=11 LCT). There was a significant difference between the two treatments regarding daily nitrogen balances when the first 3 days were analysed P=0.0038). This resulted in an amelioration of the nitrogen balance on day 3 in the group on ST as compared to those on LCT (0.1+/-2.4 g vs -9.9+/-2.1 g P=0.01). The 3 day cumulative nitrogen balance was significantly better in the group receiving ST compared to those on LCT (-0.7+/-6.0 vs -16.7+/-3.9 P=0.03). This better cumulative nitrogen balance on day 3 was also preserved as a tendency (P=0.061) in the analysis of the intention to treat population, but on day 5 there was no significant difference (P=0.08). The ST emulsion was well tolerated and no difference was found compared to the LCT emulsion regarding respiratory quotient, energy expenditure, glucose or triglyceride levels during infusion. CONCLUSION: Administration of a structured triglyceride emulsion resulted in an amelioration of nitrogen balance despite no effect on energy expenditure in short term administration over 3 days to ICU patients when compared to a long chain triglyceride emulsion. No side effects linked to medium chain triglycerides were noted.

Adult↗
PubMed2001

Splanchnic perfusion during hemodialysis: evidence for marginal tissue perfusion.

OBJECTIVE: Splanchnic perfusion may be compromised during hemodialysis because of hypovolemia, inflammatory response, and blood flow redistribution. The aim of this study was to assess the response of splanchnic blood flow and oxygen transport to hemodialysis. DESIGN: A prospective clinical study. SETTING: A mixed medical-surgical intensive care unit in a university hospital. PATIENTS: Nine patients with acute renal failure. INTERVENTIONS: A 4-hr period of hemodialysis. MEASUREMENTS AND MAIN RESULTS: Systemic (via a pulmonary artery catheter), hepatosplanchnic, and femoral (via dye dilution) blood flow and gastric mucosal Pco2 were measured before, during, and 2 hrs after hemodialysis. During hemodialysis, despite unchanged arterial blood pressure, cardiac output and stroke volume decreased from 3.0 +/- 1.0 L/m2/min (mean +/- sd) to 2.3 +/- 0.7 L/m2/min (p =.02), and from 38 +/- 16 mL/m2/min to 28 +/- 12 mL/m2/min (p =.01), respectively. Splanchnic but not femoral blood flow decreased from 0.9 +/- 0.3 L/m2/min to 0.7 +/- 0.2 L/m2/min (p =.02). The blood flows returned to baseline values after dialysis without need for therapeutic interventions. Gastric mucosal-arterial Pco2 gradients were high before dialysis (35 +/- 23 torr [4.6 +/- 3.1 kPa]) and did not change. Renin but not atrial natriuretic peptide concentration increased during hemodialysis from 13 +/- 13 microg/L to 35 +/- 40 microg/L and decreased afterward to baseline values (13 +/- 13 microg/L; p =.01). Whereas interleukin 6 tended to decrease, tumor necrosis factor alpha increased during hemodialysis from 74 +/- 24 pg/mL to 86 +/- 31 pg/mL and continued to increase after hemodialysis to 108 +/- 66 pg/mL (p =.022). CONCLUSION: Hemodialysis and fluid removal in normotensive patients with acute renal failure may result in a reduction of systemic and splanchnic blood flow that is undetectable using traditional clinical signs. In contrast to what is observed in hypovolemia, the changes in regional blood flow are rapidly reversible after hemodialysis.

Acute Kidney Injury↗
PubMed2000

Sampling rate causes bias in APACHE II and SAPS II scores.

OBJECTIVE: To study the effect of sampling rate of laboratory and haemodynamic data on severity scorings and predicted risk of hospital death. DESIGN: Prospective study. SETTING: Medical-surgical intensive care unit (ICU) with 23 beds in a university hospital. PATIENTS: Sixty-nine consecutive emergency admission patients. INTERVENTIONS: Blood samples were drawn from indwelling arterial lines for the laboratory tests of all variables contained in the APACHE II and SAPS II scores at 2-hourly intervals from the time of admission up to 24 h or earlier discharge or death of the patient. Haemodynamic data and temperature were collected either manually by the attending nurse once an hour or as 2-min median values automatically using a Clinical Information Management System (CIMS, Clinisoft, Datex-Ohmeda, Helsinki, Finland). Three sets of severity scores were obtained. (1) "Traditional" scores (haemodynamic data from manual records and laboratory values from tests taken at admission and subsequently on clinical basis only). (2) "CIMS" scores (haemodynamic data from 2-min median values and laboratory values prescribed on clinical indication) and (3) "High rate" scores (haemodynamic data from 2-min median values and laboratory values at 2-hourly intervals). Probability of hospital death was calculated using the SAPS II and APACHE II scores, respectively. RESULTS: Increasing the sampling rate of haemodynamic monitoring interval to 2-min from once per hour resulted in 7.8 % and 11.5 % increases (p < 0.001) in the APACHE II and SAPS II scores, respectively. The combined effect of increased sampling rate of haemodynamic and laboratory tests on the APACHE II and SAPS II scores was 14.4 % and 14.5 % compared to traditional scores (p < 0.001), respectively. The probability of hospital death increased from 0.23 and 0.21 ("traditional" SAPS II and APACHE II) to 0.31 and 0.25 ("high rate" SAPS II and APACHE II), respectively, and, because eight patients died, standardised mortality ratio (SMR) decreased from 0.53 to 0.41 (SAPS II) and from 0.60 to 0.50 (APACHE II). CONCLUSIONS: Increased sampling rate results in higher scores and lower SMR. Comparisons between hospitals using severity scores are biased due to differences in the sampling rates.

APACHE↗
PubMed2000

Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care.

OBJECTIVE: To assess (1) the long-term outcome of patients requiring renal replacement therapy (RRT) in terms of 6-month and 5-year mortality, (2) quality of life and (3) costs of the intensive care. DESIGN: A retrospective observational cohort study. SETTING: Twenty-three-bed multidisciplinary intensive care unit (ICU) in a tertiary care center. PATIENTS AND PARTICIPANTS: Out of 3,447 intensive care patients admitted, 62 patients with no end-stage renal failure required RRT. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The incidence rate of acute renal failure (ARF) was 8/100,000 inhabitants/ year. The majority of patients (71%) had ARF in conjunction with multiple organ failure. The mortality in the ICU and in the hospital was 34 % and 45%, respectively. Mortality was 55% at 6 months and 65 % at 5 years. Renal function recovered in 82 % of the survivors during hospitalization. Loss of energy and limitations of physical mobility assessed by Nottingham Health Profile were the most frequently reported complaints at 6 months. Functional ability, as assessed by the Activities of Daily Living score was fairly good at 6 months. The cost per ARF 6-month survivor was $80,000. CONCLUSIONS: There was only a minor increase in mortality after discharge from hospital among patients treated for ARF in intensive care. The costs related to ARF in intensive care are high, but the almost complete physical and functional recovery seen in ARF survivors should be noted in cost-effective analyses.

ADP-Ribosylation Factor 6↗
PubMed2000

Ranitidine or dobutamine alone or combined has no effect on gastric intramucosal-arterial PCO(2) difference after cardiac surgery.

OBJECTIVE: To test the hypothesis that ranitidine, either alone or in combination with dobutamine, modifies the gastric intramucosal-arterial PCO(2) difference. DESIGN: Full factorial design (double-blinded for ranitidine). SETTING: Intensive Care Unit of a university hospital. PATIENTS: Sixty-four haemodynamically stable coronary artery bypass surgery patients. INTERVENTIONS: Ranitidine (150 mg preoperatively per os and 50 mg intravenously postoperatively) and dobutamine (4 micro g. kg(-1). min(-1) for 3 h postoperatively) were administered in four randomised groups of patients: preoperative and postoperative ranitidine, either alone (n = 15) or in combination with dobutamine (n = 17), dobutamine alone (n = 15) or neither ranitidine nor dobutamine (n = 17). MEASUREMENTS AND RESULTS: Gastric intramucosal-arterial PCO(2) difference was measured during the first 5 postoperative hours. No differences in the postoperative pattern of gastric intramucosal-arterial PCO(2) difference were found among the groups. CONCLUSIONS: Ranitidine and dobutamine have no effect on the gastric tonometry results on intramucosal-arterial PCO(2) difference after uncomplicated cardiac surgery. Hence, the routine use of H(2)-antagonists for gastrointestinal tonometry is not warranted. Our results must be limited to results obtained by tonometry; they do not allow any conclusions on the effects of these drugs on splanchnic blood flow or its distribution.

Adrenergic beta-Agonists↗
PubMed2000

Detection of artifacts in monitored trends in intensive care.

In intensive care, decision-making is often based on trend analysis of physiological parameters. Artifact detection is a pre-requisite for interpretation of trends both for clinical and research purposes. In this study, we developed and tested three methods of artifact detection in physiological data (systolic, mean and diastolic artery and pulmonary artery pressures, central venous pressure, and peripheral temperature) using pre-filtered physiological signals (2-min median filtering) from 41 patients after cardiac surgery. These methods were: (1) the Rosner statistic; (2) slope detection with rules; and (3) comparison with a running median (median detection). After tuning the methods using data from 20 randomly chosen patients, the methods were tested using the data from the remaining patients. The results were compared with those obtained by manual identification of artifacts by three senior intensive care unit physicians. Out of an average of 22,480 data points for each variable, the three observers labelled 0.98% (220 data points) as artifacts. The inter-observer agreement was good. The average (range) sensitivity for artifact detection in all variables in the test database was 66% (33-92%) for the Rosner statistic, 64% (24-98%) for slope detection and 72% (41-98%) for median detection. All methods had a high specificity (> or = 94%). Slope detection had the highest mean positive prediction rate (53%; 21-85%). When the performance was measured by the cost function, slope detection and running median performed equally well and were superior to Rosner statistics for systemic arterial and central venous pressure and peripheral temperature. None of the methods produced acceptable results for pulmonary artery pressures. We conclude that median filtering of physiological variables is effective in removing artifacts. In post-operative cardiac surgery patients, the remaining artifacts are difficult to detect among physiological and pathophysiological changes. This makes large databases for tuning artifact algorithms mandatory. Despite these limitations, the performance of running median and slope detection were good in selected physiological variables.

Algorithms↗
PubMed2000

Assessment of the adequacy of systemic and regional perfusion after cardiac surgery.

Changes in systemic, hepatosplanchnic and femoral blood flow and liver function after cardiac surgery were studied in 17 patients from April to October 1995. Blood flows were measured every 3 h and gastric mucosal PCO2 (by tonometry) every hour from arrival in the intensive care unit until extubation. Cardiac output and systemic oxygen consumption increased from 2.83 (0.68) litres min-1 m-2 to 3.17 (0.57) litres min-1 m-2 and from 126 (18) ml min-1 m-2 to 135 (44) ml min-1 m-2, respectively (mean (SD), P = 0.028 and P = 0.019, respectively, baseline vs 6 h). The fraction of cardiac output distributed to the splanchnic region decreased from 0.25 (0.06) to 0.20 (0.04) (P = 0.004) while splanchnic oxygen extraction increased from 0.43 (0.15) to 0.50 (0.12) (P = 0.019). Femoral blood flow increased from 0.18 (0.07) litres min-1 m-2 to 0.23 (0.09) litres min-1 m-2, (P = 0.006, baseline vs 3 h) but femoral oxygen consumption did not change. Changes in blood flow were not reflected by venous-arterial PCO2 gradients. Initially high glutathione transferase alpha concentrations decreased and indocyanine green extraction was well preserved. We conclude that the predominant increase in peripheral blood flow and the increased oxygen uptake in certain regions of the body may increase the risk of a mismatch between splanchnic perfusion and metabolic demands. This mismatch was not associated with impaired liver function or cellular integrity.

Aged↗
PubMed2000

A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients.

UNLABELLED: Organ dysfunction and multiple organ failure are the main causes of prolonged hospital stay after cardiac surgery, which increases resource use and health care costs. Increased levels of oxygen delivery and consumption are associated with improved outcome in different groups of postoperative patients. Cardiac surgical patients are at risk of inadequate perioperative oxygen delivery caused by extracorporeal circulation and limited cardiovascular reserves. The purpose of our study was to test whether increasing oxygen delivery immediately after cardiac surgery would shorten hospital and intensive care unit (ICU) stay. Four hundred three elective cardiac surgical patients were enrolled in the study and randomly assigned to either the control or the protocol group. Goals of the protocol group were to maintain SvO(2) >70% and lactate concentration < or =2.0 mmol/L from admission to the ICU and up to 8 h thereafter. Hemodynamics, oxygen transport data, and organ dysfunctions were recorded. The median hospital stay was shorter in the protocol group (6 vs 7 days, P < 0.05), and patients were discharged faster from the hospital than those in the control group (P < 0.05). Discharge from the ICU was similar between groups (P = 0. 8). Morbidity was less frequent at the time of hospital discharge in the protocol group (1.1% vs 6.1%, P < 0.01). Increasing oxygen delivery to achieve normal SvO(2) values and lactate concentration during the immediate postoperative period after cardiac surgery can shorten the length of hospital stay. IMPLICATIONS: Health care economics has challenged clinicians to reduce costs and improve resource use in cardiac surgery and anesthesia in a patient population increasing in age and in severity of disease. Optimizing cardiovascular function to maintain adequate oxygen delivery during the immediate postoperative period after cardiac surgery can decrease morbidity and reduce length of hospital stay.

Cardiac Surgical Procedures↗
PubMed2000

Time-pattern of lactate and lactate to pyruvate ratio in the first 24 hours of intensive care emergency admissions.

Blood lactate elevation in critically ill patients commonly is taken as a sign of impaired tissue perfusion. Simultaneous elevation of lactate to pyruvate ratio (L/P ratio) may be helpful in discriminating between different mechanisms of hyperlactatemia and thus in determining the relevance of the finding. We studied prospectively the prevalence and the time pattern of hyperlactatemia and simultaneous L/P ratio elevation in 98 consecutive emergency admission patients in a 23-bed surgical-medical University Hospital intensive care unit. Blood lactate, L/P ratio, and blood gases were measured at 2-h intervals during the initial 24 h of intensive care unit admission. Hyperlactatemia (blood lactate over 2 mmol/L) was found in 48 (49%) patients, and the median peak value of the non-survivors was higher than that of the survivors [5.3 (interquartile range 1.9-7.5) vs. 1.9 (1.3-2.9) mmol/L, respectively, p = 0.003]. Hyperlactatemia at admission (n = 31) was associated with a higher hospital mortality than hyperlactatemia developing later (n = 17) (29.0% vs. 5.9%, P = 0.003). Sustained admission hyperlactatemia (>6 h) was associated with higher mortality than short-lasting hyperlactatemia (36.8% vs. 0%, P = 0.008). Simultaneously elevated L/P ratio (L/P ratio > 18; n = 16) was associated with higher mortality than hyperlactatemia with normal L/P ratio (n = 32; 37.5% vs. 12.5%, respectively, P = 0.03) and was found mainly in patients who had severe circulatory failure. The hyperlactatemia of patients with sepsis was not associated with L/P ratio elevation. We conclude that hyperlactatemia is common in emergency admission patients. Hyperlactatemia with L/P ratio elevation and lactic acidosis is likely to be associated with inadequate tissue perfusion. Hyperlactatemia persisting more than 6 h and simultaneous elevation of L/P ratio are associated with increased mortality.

APACHE↗
PubMed2000

Dangers of growth hormone therapy in critically ill patients.

Prolonged stay of patients is the major challenge for modern intensive care because of its effects on morbidity and resource utilization. Severe trauma or infection are associated with the catabolic response, characterized by increased protein turnover and negative nitrogen balance. Severe catabolism leads to end-organ dysfunction and muscular weakness prolonging the need for mechanical ventilation. Catabolism cannot be prevented with standard parenteral or enteral nutritional formulas. In order to prevent the complications of catabolism in intensive care patients, recombinant growth hormone (rhGH) has been applied during two decades as an experimental therapy for patients requiring parenteral nutrition and for those with respiratory failure. Administration of rhGH has resulted in positive nitrogen balance, and studies in mechanically ventilated patients suggest that it may shorten the need for ventilatory support. In contrast to the results of these relatively small studies, a recent multinational randomized controlled trial revealed that the administration of rhGH (with doses 10-20 times higher than those used for replacement therapy) increases the mortality of critically ill patients. This excessive mortality in patients treated with rhGH was related to infections and development of multiple organ failure. Administration of high doses of rhGH to critically ill patients cannot thus be recommended.

APACHE↗
PubMed1999

Increased mortality associated with growth hormone treatment in critically ill adults.

BACKGROUND: The administration of growth hormone can attenuate the catabolic response to injury, surgery, and sepsis. However, the effect of high doses of growth hormone on the length of stay in intensive care and in the hospital, the duration of mechanical ventilation, and the outcome in critically ill adults who are hospitalized for long periods is not known. METHODS: We carried out two prospective, multicenter, double-blind, randomized, placebo-controlled trials in parallel involving 247 Finnish patients and 285 patients in other European countries who had been in an intensive care unit for 5 to 7 days and who were expected to require intensive care for at least 10 days. The patients had had cardiac surgery, abdominal surgery, multiple trauma, or acute respiratory failure. The patients received either growth hormone (mean [+/-SD] daily dose, 0.10 +/- 0.02 mg per kilogram of body weight) or placebo until discharge from intensive care or for a maximum of 21 days. RESULTS: The in-hospital mortality rate was higher in the patients who received growth hormone than in those who did not (P<0.001 for both studies). In the Finnish study, the mortality rate was 39 percent in the growth hormone group, as compared with 20 percent in the placebo group. The respective rates in the multinational study were 44 percent and 18 percent. The relative risk of death for patients receiving growth hormone was 1.9 (95 percent confidence interval, 1.3 to 2.9) in the Finnish study and 2.4 (95 percent confidence interval, 1.6 to 3.5) in the multinational study. Among the survivors, the length of stay in intensive care and in the hospital and the duration of mechanical ventilation were prolonged in the growth hormone group. CONCLUSIONS: In patients with prolonged critical illness, high doses of growth hormone are associated with increased morbidity and mortality.

Adolescent↗