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J Thorac Cardiovasc Surg 2006;131:277-282
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: A randomized study

Florian Weis, MD a , Erich Kilger, MD, PhD a , Benno Roozendaal, PhD b , Dominique J.-F. de Quervain, MD, PhD c , Peter Lamm, MD, PhD d , Michael Schmidt, MD e , Martin Schmölz, MD a , Josef Briegel, MD, PhD a , Gustav Schelling, MD, PhD a , *

a Department of Anesthesiology, Ludwig-Maximilians-University, Munich, Germany
d Department of Cardiac Surgery, Ludwig-Maximilians-University, Munich, Germany
e Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
b Center for the Neurobiology of Learning and Memory, Department of Neurobiology and Behavior, University of California, Irvine, Calif
c Division of Psychiatry Research, University of Zurich, Zurich, Switzerland.

Received for publication April 7, 2005; revisions received June 28, 2005; accepted for publication July 12, 2005.

* Address for reprints: Gustav Schelling, MD, PhD, Ludwig-Maximilians University, Klinikum Grosshadern, Department of Anaesthesiology, 81377 Muenchen, Germany. (Email: gustav.schelling{at}med.uni-muenchen.de).

OBJECTIVES: Improvement in health-related quality of life is a major object of cardiac surgery. However, high stress exposure during the perioperative period of cardiac surgery can result in the formation of traumatic memories and symptoms of chronic stress or even posttraumatic stress disorder, which can have negative effects on health-related quality-of-life outcome. In this controlled study we examined whether exogenously administered stress doses of hydrocortisone during cardiac surgery reduce perioperative stress exposure and the long-term incidence of chronic stress symptoms and improve health-related quality of life after cardiac surgery.

METHODS: Thirty-six high-risk patients undergoing cardiac surgery were prospectively randomized to receive either stress doses of hydrocortisone or placebo. Of 28 available patients at 6 months after cardiac surgery, 14 had received hydrocortisone, and 14 had received placebo. Traumatic memories, chronic stress symptoms (posttraumatic stress disorder scores), and health-related quality of life were measured by using validated questionnaires.

RESULTS: Compared with patients from the placebo group, patients from the hydrocortisone group had a significantly shorter duration of intensive care unit treatment, required lower doses of the stress hormone norepinephrine during cardiac surgery, and had significantly fewer stress symptoms and a better health-related quality of life regarding physical function, chronic pain, general health, vitality, and mental health during follow-up. The groups did not differ with regard to the number or type of intensive care unit–related traumatic memories.

CONCLUSIONS: The use of stress doses of hydrocortisone in high-risk cardiac surgical patients reduces perioperative stress exposure, decreases chronic stress symptoms, and improves health-related quality of life at 6 months after cardiac surgery.

Abbreviations and Acronyms CPB = cardiopulmonary bypass; CS = cardiac surgery; HRQL = health-related quality of life; ICU = intensive care unit; IL-6 = interleukin 6; POD = postoperative day; PTSD = posttraumatic stress disorder; SF-36 = Short Form-36; TISS = Therapeutic Intervention Scoring System




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