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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Hormone Replacement Therapy

Soto-Rivera, Carmen L. MD; Agus, Michael S. D. MD; Sawyer, Jaclyn E. PharmD; Macrae, Duncan J. MB, ChB, sFRCA, FRCPCH

doi: 10.1097/PCC.0000000000000625
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Objective: To provide an overview of the current literature on the use of hormone replacement therapies in pediatric cardiac critical care.

Data Sources: PubMed, EMBASE, and the Cochrane Library were searched using keywords relevant to the hormonal therapy, with no limits on language but restricting the search to children 0–18 years old.

Study Selection: All clinical studies believed to have relevance were considered. Where studies in children were sparse, additional evidence was sought from adult studies.

Data Extraction: All relevant studies were reviewed, and the most relevant data were incorporated in this review.

Data Synthesis: All authors of this review contributed to the appraisal of the data extracted. Challenges and revisions by the authors were conducted by group e-mail debate.

Conclusions: Glycemic control: although it is likely that some children could benefit, the routine use of tight glycemic control cannot be recommended in children after cardiac surgery. Thyroid hormone replacement: routine use of thyroid hormone replacement to normalize levels after cardiac surgery cannot be recommended on current evidence. Until further evidence from adequately powered studies is available, therapeutic decisions should be based on individual patient circumstances. Corticosteroids: 1) cardiopulmonary bypass: although studies seem to favor steroid administration during surgery with cardiopulmonary bypass, a large randomized controlled trial is required before strong recommendations can be made; 2) refractory hypotension: the evidence for the use of steroid replacement in refractory hypotension is poor, and no firm recommendations can be made; and 3) abnormal adrenal function after cardiac surgery: there is inadequate evidence on which to make recommendations on the use of corticosteroid replacement in children with critical illness–related corticosteroid insufficiency in children following cardiac surgery.

1Divisions of Endocrinology and Medicine Critical Care, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA.

2Division of Pharmacy, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

3Paediatric Critical Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.

Dr. Soto-Rivera disclosed off-label product use: continuous glucose monitoring system off-label use in critically ill, nondiabetic, pediatric patients. Dr. Agus received support for this article research from the National Institutes of Health, and he disclosed off-label product use: the authors mention the use of continuous glucose monitoring in patients in the ICU. Continuous glucose monitoring is not currently approved for use in inpatients. He received research support in the form of in-kind donations and discounts off medical devices to support a trial of tight glucose control in the PICU. He also serves as a consultant to two different glucose meter companies (however, the topic of this review is not related to this ongoing research in tight glucose control, and the review and recommendations do not address any devices from any companies). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: d.macrae@rbht.nhs.uk

©2016The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies