tailieunhanh - Báo cáo khoa học: "The low-dose ACTH test in the ICU: Not ready for prime time"

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: The low-dose ACTH test in the ICU: Not ready for prime time. | Available online at http content 10 4 313 University of Pittsburgh Department of Critical Care Medicine Evidence-Based Medicine Journal Club EBM Journal Club Section Editor Eric B. Milbrandt MD MPH Journal club critique The low-dose ACTH test in the ICU Not ready for prime time Makito Yaegashi1 and Arthur J. Boujoukos2 1 Clinical Fellow Department of Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA 2 Associate Professor Department of Critical Care Medicine University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA Published online 7 August 2006 This article is online at http content 10 4 313 2006 BioMed Central Ltd Critical Care 2006 10 313 DOI 101186 cc5000 Expanded Abstract Citation Siraux V De Backer D Yalavatti G Melot C Gervy C Mockel J Vincent JL Relative adrenal insufficiency in patients with septic shock comparison of low-dose and conventional corticotropin tests. Crit Care Med 2005 33 2479-2486 1 . Objective To compare a low-dose 1 pg adrenocorticotropic hormone ACTH stimulation test with the more standard 250 pg test for the diagnosis of relative adrenal insufficiency. Methods Design and setting Diagnostic study in a thirty-one bed mixed medico-surgical department of intensive care Patients Forty-six consecutive patients with septic shock. Intervention Corticotropin stimulation tests low-dose test 1 pg and standard 250-pg test performed consecutively at an interval 4 hrs. Measurements and main results In each test serum cortisol levels were measured before T0 and 30 T30 60 T60 and 90 T90 mins after corticotropin injection. The maximal increase in cortisol Amax was calculated as the difference between T0 and the highest cortisol value at T30 T60 or T90 and considered as adequate if 9 pg dL 250 nmol L . Nonresponders to the low dose test had a lower survival rate than responders to both tests 27 vs. 47 p .06 Kaplan Meier curves . Interestingly nonresponders to high-dose test