tailieunhanh - Báo cáo y học: "The International Sepsis Forum’s controversies in sepsis: corticosteroids should not be routinely used to treat septic shock"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: The International Sepsis Forum’s controversies in sepsis: corticosteroids should not be routinely used to treat septic shock. | Critical Care October 2002 Vol 6 No 5 Bernard Commentary The International Sepsis Forum s controversies in sepsis corticosteroids should not be routinely used to treat septic shock Gordon Bernard Professor of Medicine Director Division of Allergy Pulmonary and Critical Care Medicine Vanderbilt University Nashville Tennessee USA Correspondence Gordon Bernard Published online 17 July 2002 Critical Care 2002 6 384-386 This article is online at http content 6 5 384 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X This article is based on a presentation at the 31st Annual Congress of the Society of Critical Care Medicine SCCM San Diego California USA 26-30 January 2002. The presentation was supported by the International Sepsis Forum ISF . Abstract Corticosteroid treatment of severe sepsis has been one of the most controversial clinical issues in critical care. In fact few agents can claim to have been evaluated in scores of studies spanning 3-4 decades. Yet convincing proof that corticosteroids are useful pharmacologic agents in the treatment of this major clinical problem remains elusive. Recently interest has resurfaced but this time the focus is on a steroid replacement approach for what has now been termed relative adrenal insufficiency rather than relying on the pharmacologic effects of steroids. This route holds promise but proof remains lacking. Keywords corticosteroids septic shock The issue of whether to use corticosteroids for treating septic shock has been ongoing for 20 or 30 years. Indeed there is much clinical and preclinical data that provide ample reasons for using corticosteroids in septic shock. For instance we know that steroids increase catecholamine-stimulated contractility vasomotor catecholamine response and adrenergic receptor density. They also prevent desensitization of p receptors and they may provide adrenal replacement. Cortisol status The normal cortisol range is 5-24 Lg dl and .