CORTICOSTEROID EFFECT ON EARLY BETA-ADRENERGIC DOWN-REGULATION DURINGCIRCULATORY SHOCK - HEMODYNAMIC-STUDY AND BETA-ADRENERGIC-RECEPTOR ASSAY

Objectives: The steroid effect on critically ill patients remains cont roversial. The aim of this study is to characterize the effect of meth ylprednisolone on the heart in a beta-adrenergically down-regulated co ndition. Design: A prospective hemodynamic study and retrospective rec eptor assay. Setting: Multidisciplinary ICU in a university hospital. Subjects: 42 patients who required pulmonary arterial catheters and an additional 4 corpses who were available for study within 3 h of their deaths. Intervention: Intravenous methylprednisolone (10 mg/kg). Meas urements and results: We pursued a hemodynamic study following a gluco corticoid administration. In patients who had undergone a long term (> 72 h) catecholamine treatment, the cardiac index increased. In patien ts who had undergone a short term (1-72 h) catecholamine treatment and in patients with no record of catecholamine administration, the cardi ac index showed no remarkable change. Among the corpuses, who died soo n after their arrival, and the patients, who later died in the ward an d were available for further study, we measured beta-adrenergic recept or density in the left ventricular myocardium. It was found that recep tor density was decreased after long term catecholamine treatment. Met hylprednisolone, on the other hand increased the receptor density. Con clusion: Methylprednisolone improved the cardiac index, intriguingly, in patients with long term catecholamine treatment in circulatory shoc k. Myocardial beta-adrenergic receptor also increased in number after the administration of methylprednisolone. However, the hemodynamic imp rovement caused by methylprednisolone was not observed in patients wit hout beta-adrenergic down-regulation.