tailieunhanh - Báo cáo khoa học: "Clinical review: Corticotherapy in sepsis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Corticotherapy in sepsis. | Critical Care April 2004 Vol 8 No 2 Prigent et al. Review Clinical review Corticotherapy in sepsis Helene Prigent1 Virginie Maxime2 and Djillali Annane3 Senior Resident Service de Réanimation Médicale Hôpital Raymond Poincaré Garches France 2Senior Resident Service de Réanimation Médicale Hôpital Raymond Poincaré Garches France 3Director of the ICU Service de Réanimation Médicale Hôpital Raymond Poincaré Garches France Correspondence Djillali Annane Published online 29 September 2003 Critical Care 2004 8 122-129 DOI cc2374 This article is online at http content 8 2 122 2004 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract The use of glucocorticoids corticotherapy in severe sepsis is one of the main controversial issues in critical care medicine. These agents were commonly used to treat sepsis until the end of the 1980s when several randomized trials casted serious doubt on any benefit from high-dose glucocorticoids. Later important progress in our understanding of the role played by the hypothalamic-pituitaryadrenal axis in the response to sepsis and of the mechanisms of action of glucocorticoids led us to reconsider their use in septic shock. The present review summarizes the basics of the physiological response of the hypothalamic-pituitary-adrenal axis to stress including regulation of glucocorticoid synthesis the cellular mechanisms of action of glucocorticoids and how they influence metabolism cardiovascular homeostasis and the immune system. The concepts of adrenal insufficiency and peripheral glucocorticoid resistance are developed and the main experimental and clinical data that support the use of low-dose glucocorticoids in septic shock are discussed. Finally we propose a decision tree for diagnosis of adrenal insufficiency and institution of cortisol replacement therapy. Keywords adrenal insufficiency glucorticoids hormone replacement therapy hypothalamic-pituitary-adrenal axis

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