Background Adrenal dysfunction is associated with increased inotrope requirement and worse clinical outcome in children with sepsis. In children after bypass surgery a very low incidence of adrenal dysfunction is reported. However, use of hydrocortisone has been shown to improve hemodynamics of children requiring catecholamine after cardiac surgery. We aimed to evaluate the adrenal function of this subgroup of children requiring catecholamines after cardiac surgery.
Methods Retrospective analysis of adrenal function testing of children requiring catecholamine after cardiac surgery at the Royal Brompton Hospital from 2006 to 2011. Adrenal function was assessed using a 250µg/1.73m2 ACTH stimulation test. Two definitions of adrenal dysfunction were used: physiological (peak cortisol after ACTH stimulation < 500nmol/L) and critical care (difference between cortisol post-stimulation and baseline cortisol < 250nmol/L). Children that received corticosteroids or etomidate, and children with known endocrine dysfunction were excluded.
Results 62 children were included in the study. Median (interquartile range) age was 3.2(0.9–6.5)months and weight 3.9(3.3–7.2)Kg. The mean RACHS was 2.5±0.7 and median catecholamine score 0.11(0.06–0.18). Seven (11.3%) children had adrenal dysfunction according to the physiological definition and 9 (14.5%) according to the critical care definition. Children with physiological adrenal dysfunction had significantly higher catecholamine requirement than children with normal adrenal function (p<0.01). There was no difference in catecholamine requirement in children with normal or abnormal adrenal function according to critical care definition.
Conclusions In children requiring catecholamines after cardiac surgery, adrenal dysfunction according to a physiological definition (but not critical care definition) is associated with higher catecholamine requirement.