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The Hormonal Milieu in Severe Sepsis and Septic Shock. What are the damages?

The Hormonal Milieu in Severe Sepsis and Septic Shock. What are the damages?. Djillali ANNANE, MICU, Raymond Poincaré Hospital, 92380 Garches, France Djillali.annane@rpc.ap-hop-paris.fr. THE ACTORS?. HYPOTHALAMIC PITUITARY ADRENAL AXIS NORADRENERGIC SYSTEM GLUCOSE / INSULINE DUO

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The Hormonal Milieu in Severe Sepsis and Septic Shock. What are the damages?

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  1. The Hormonal Milieu in Severe Sepsis and Septic Shock. What are the damages? Djillali ANNANE, MICU, Raymond Poincaré Hospital, 92380 Garches, France Djillali.annane@rpc.ap-hop-paris.fr

  2. THE ACTORS? • HYPOTHALAMIC PITUITARY ADRENAL AXIS • NORADRENERGIC SYSTEM • GLUCOSE / INSULINE DUO • VASOPRESIN

  3. THE ACTORS? • HYPOTHALAMIC PITUITARY ADRENAL AXIS • NORADRENERGIC SYSTEM • GLUCOSE / INSULINE DUO • VASOPRESIN

  4. ACTH (pg / ml) CORTISOL (ng / ml) HPA AXIS AND STRESS PLASMA IL-6 (ng / ml) Lenczowski, ANYAS 1998

  5. ADRENAL INSUFFICIENCY Mechanisms

  6. PLASMA CORTISOL LEVELS AND CLEARANCE Melby JC, JCI,1958.

  7. CORTISOL RESPONSE TO ACTH 250 Rothwell, Lancet 1991

  8. * * ADRENAL INSUFFICIENCY IN ANIMAL SEPSIS Koo et al, CCM 2001

  9. *

  10. ADRENAL INSUFFICIENCY Clinical significance

  11. AI AND PRESSURE RESPONSE TO CATECHOLAMINES Annane, BJCP 1998

  12. AI AND SYSTEMIC INFLAMMATION * * *

  13. 1.00 D max > 9 µg/dl 0.75 Probabilityof survival 0.50 0.25 D max  9 µg/dl 0.00 0 7 14 21 28 Time (days) AI AND SURVIVAL Annane, JAMA 2000

  14. THE ACTORS? • HYPOTHALAMIC PITUITARY ADRENAL AXIS • NORADRENERGIC SYSTEM • GLUCOSE / INSULINE DUO • VASOPRESIN

  15. EFFERENT Fibers AFFERENT Fibers . . . Centres vasopresseurs Noyau dorsal moteur du X Nucleus Solitarius Vasopressor centers Dorsal motor nucleus of X PARASYMPATHIQUE chemo. . IX baro. Sinus carotide chemo. baro. X HEART SYMPATHIQUE HEART THORACIC SPINE VESSELS

  16. RR 0.29 0.64 (sec) PSD [(imp/sec)2/Hz] 0.28 0 SND 200 16*103 (imp/sec) PSD [(imp/sec)2/Hz] 0 0 VND 300 8*102 (imp/sec) PSD [(imp/sec)2/Hz] 200 0 0 Hz 0.5

  17. NORADRENERGIC SYSTEM FAILURE Mechanisms

  18. Goldstein et al, CCM 1995

  19. Annane et al, Am J Respir Crit Care Med. 1999

  20. Annane et al, Am J Respir Crit Care Med. 1999

  21. Neuronal Apoptosis in Autonomic Nuclei • Locus Coeruleus

  22. Astrocytic and Microglial Reactions • Nucleus Supra-Opticus

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