Role of Hydrocortisone in Multiple Trauma Patients

Introduction:

Multiple trauma is the most common cause of death and morbidity. Severe trauma can have a significant impact on the physical as well as the physiological health of a patient. Patients in the intensive care unit (ICU) are at risk from secondary infections such as nosocomial pneumonia (NP), which can sometimes be fatal. Hence, prompt diagnosis and immediate treatment are required to prevent fatalities. Hydrocortisone is administered in such situations to prevent diseases and further deterioration. Hydrocortisone, also known as cortisol, is a glucocorticoid secreted by the adrenal cortex.

What Is Hydrocortisone?

Hydrocortisone is a corticosteroid secreted by the adrenal cortex. It is a steroid medicine that works by soothing the body's immune response to inflammation and pain. They can be used in patients who do not have the natural stress hormone cortisol. It treats adrenocortical insufficiency, high blood calcium, and arthritis.

What Is the Mechanism of Action of Hydrocortisone?

Short-term effects of corticosteroids result in less leukocyte migration to sites of inflammation and decreased vasodilation.

Glucocorticoid receptor mediates gene expression changes leading to multiple downstream effects.

What Are the Uses of Hydrocortisone?

Hydrocortisone is a medical boon in treating various diseases and inhibiting the promotion of infections. Some of the uses of corticosteroids are as follows:

1. Skin Problems: There are a variety of cream lotions and ointments available that are used to treat psoriasis, diaper rashes, insect bites, heat rashes, eczema, etc.

2. Piles and Itchy Bottom: Suppositories are especially for inside and around the anus (bottom) and piles.

3. Mouth Ulcers: Mouth-dissolving tablets are available for ulcers that relieve the pain.

4. Painful Joints: Hydrocortisone injections are injected to reduce pain and swelling in patients with arthritis and injuries.

5. Adrenal Gland Problems: If the body does not make enough cortisol and Addison's disease and in the case where the adrenal gland is removed.

What Are the Dosages of Hydrocortisone?

• They are available in 5 mg, 10 mg, and 20 mg tablets.

• If taken for hormonal replacement, 20 mg to 30 mg is required daily.

• Dosages decided by the doctor depend upon the patient's condition and disease.

What Are the Side Effects of Hydrocortisone?

Like every other drug, Hydrocortisone also has side effects, some of which are as follows:

• Dizziness, weakness, or tiredness.

• Headaches.

• Muscle pain.

• Nausea.

• Diarrhea.

• Swelling in ankles.

There can be severe specific side effects of the same; contact a doctor immediately for the following :

1. If the patient is feeling depressed or anxious, has mood swings, or has frightening thoughts, these can be signs of mental health problems.

2. Chills, cough, pain while peeing, wounds not healing, or high fever.

3. Breathing fast, flushing, and being sleepy can be complications of diabetes.

4. Weight gain, rounded face, also known as moon face.

5. Muscle weakness, tiredness, loss of appetite, and vomiting can be signs of adrenal gland problems.

6. Deep vein thrombosis, blot clot.

7. Unusual bruising, brown-colored vomit.

These side effects can go away, but results like a round face may take weeks or even months.

What Are the Side Effects of Hydrocortisone on Children and Teenagers?

If a child or teenage group takes the medication for more than a year, it may slow their growth and development. The doctor should monitor their weight, height, and other signs regularly.

What Is Meant by Multiple Trauma?

Multiple trauma or polytrauma refers to individuals having two or more traumatic injuries with a severity score greater than 15. A traumatic brain injury can be categorized as severe when the Glasgow coma scale (GCS) is less than or equal to eight after initial supportive therapy. Patients with multiple trauma need immediate priority treatment and care to prevent fatal complications.

What Are the Associated Complications in Patients With Multiple Trauma?

Polytrauma patients are more at risk for developing complications. The most frequently associated complications are sepsis, bleeding, respiratory tract infections, urinary tract infections, and multi-organ failures. However, hospital-acquired pneumonia and trauma-related corticosteroid insufficiency are the most common complications.

Hospital-acquired pneumonia (HAP) is a type of lung infection (pneumonia) that occurs in patients during hospital admission (48 to 72 hours after admission). HAP is a grave condition and could prove fatal if not diagnosed and treated early. It is one of the leading causes of death, and the need for hospitalization and mechanical ventilation increases with the diagnosis of HAP.

Trauma-related corticosteroid insufficiency, also known as critical illness-related corticosteroid insufficiency (CIRCI), is another common complication associated with critically ill trauma patients. Proper functioning of the adrenocortical hormones is essential for optimal survival and better recovery in critically ill patients. However, it has been observed that some patients exhibit relative adrenal insufficiency or functional hypoadrenalism where the corticosteroid activity is inadequate in response to the patient's severity, thus resulting in CIRCI. Though hospital-acquired pneumonia is manageable, CIRCI is instead an underdiagnosed disorder.

What Is the Role of Hydrocortisone in Multiple Trauma Patients?

Hydrocortisone has proven to be valuable in decreasing the risk of HAP and efficiently managing CIRCI. Studies have revealed a significant reduction in HAP in trauma patients treated with Hydrocortisone. Critical illness-related corticosteroid insufficiency (CIRCI) can impair the body's natural mechanisms in response to critical illness and traumatic stress. In a few studies, researchers found that when patients with multiple trauma stress were given a stress dose bolus of corticosteroids of 200 to 350 mg daily, they showed improved patient outcomes. The stress dose steroid therapy has shown excellent results in increasing short-term survival chances in patients with critical illness and multiple trauma. It has also been shown to be efficacious in the case of sepsis, reducing mortality. Therapy also reduces the risk of infection and helps accelerate the healing process. Hydrocortisone therapy is also proven to save time under mechanical ventilation and hospital days and significantly benefit the patient in terms of medical expenses.

Conclusion :

The role of cortisol has been known in the medical field for years. Recent advancements and new clinical data, and research suggest that CIRCI is a prevalent condition that affects critically injured patients. For the best treatment of critically ill patients, the role of cortisol supplementation needs to be explored more to reduce secondary infections such as HAP or nosocomial pneumonia. The metabolism within an individual may vary from one patient to patient. The same dose at the same period for two different patients may result in two completely different outcomes.