Evaluation of beneficial effects of steroids in head trauma

Road traffic crashes account for most serious head injuries, and the global burden of head injury can be expected to rise with the increasing use of vehicles in Asia and Africa. The overall incidence of adrenal insufficiency in critically ill patients approximates 30%, with an incidence as high as 50 to 60% in patients with septic shock. To re-evaluate the beneficial effects of I.V. steroids [dexamethasone], for 48 hours in the critically ill head trauma patients; to assess the prevalence of adrenal insufficiency in the critically ill head trauma patients, its relation to the seventy of the lesion and outcome. Prospective randomized controlled study, included 19 cases [patients who received I.V. steroids 8mg dexamethasone within 8 hours of injury, every 8 hours for 48 hours and 22 controls [patients who did not receive steroids]. 10.53% of cases died compared to 18.18%. of controls, the difference was not statistically significant, impaired circadian rhythm defined as p.m./a.m. cortisol >0.5 was found in 84% of mild head trauma, 80% moderate head trauma and 66.67% of severe head trauma, a.m. and p.m. cortisol levels were higher in moderate than mild TBI and the difference was statistically significant p-values 0.006 and 0.023 respectively. Altered circadian rhythm and adrenal insufficiency is common among critically ill head trauma patients, steroids resulted in decreased mortality among patients who received steroids and among patients with adrenal insufficiency who received steroids, however, the difference was not statistically significant

Efficacy of recombinant human erythropoietin in critically ill anaemic septic patients

To investigate the erythropoietic response to high dose of a weekly dosing schedule of recombinant human erythropoietin [rHuEPO] in critically ill anaemic septic patients, and to determine whether the administration of rHuEPO would reduce the number of red blood cell [RBC] transfusions required and whether would affect clinical course and final outcome or not. A prospective, randomized, controlled single center study. Critical Care Department [medical/surgical ICU], Cairo University Hospital. A total of 60 patients who were admitted to the intensive care unit [ICU] and met the eligibility criteria were enrolled into the study [30 into the rHuEPO group, 30 into the control group]. Patients were randomized to receive either rHuEPO or not. The study drug [40.000 units of rHuEPO] was administrated by subcutaneous injection beginning on ICU day 2 and continued once weekly for a minimum of 2 doses or until ICU discharge [for patients with ICU length of stay >2 weeks] up to a total of 4 doses. CBC, reticulocytic count, iron variables, APACHE II, SOFA scores were measured at baseline and subsequently thereafter every 3rd day until ICU discharge or death or up to a total of 28 days. The EPO treated group showed significant increases in reticulocytic count compared with baseline [P<0.001] as well as with the control group [P<0.006]. The EPO-treated group exhibited also significant increases in Hb concentration compared with baseline [P<0.001] as well as with the control group [P<0.03]. All patients in the control group received RBC transfusion [100%] while only [83.33%] of the patients who received rHuEPO were transfused. Concerning the in hospital clinical course, the EPO treated group showed significant decreases in their APACHE II score during the study period compared with baseline [P<0.001] as well as with the control group [P<0.05], the EPO treated group showed also no significant difference in their SOFA score during the study period compared with baseline [P=0.923], however, the control group exhibited continous and significant increase in their SOFA score throughout the study period compared with baseline [P<0.003]. There was no significant difference in the final outcome [i.e. recovery, mortality or morbidity] [P:0.337, P: 0.286 respectively]. The administration of rHuEPO to critically ill anaemic septic patients is effective in raising their reticulocytic counts, Hb concentrations and in reducing the total number of units of RBCs they require. In addition there was a trend toward better inhospital clinical course, increased recovery and decreased mortality in rHuEPO group